Principles of surgery

2021 ◽  
pp. 51-174
Keyword(s):  
Subcutaneous Tissue ◽  
Operative Management ◽  
Breast Disease ◽  
Preoperative Care ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Respiratory Effort ◽  
Surgical Team ◽  
Care Services ◽  
The Common

This chapter examines the principles of surgery. It begins by explaining the process of history taking and case presentation, and outlining the common surgical symptoms. The chapter then looks at the process of examination and investigation of the patient. It details the evaluation of breast disease, the neck, the abdomen, pelvic disease, peripheral vascular disease, and the skin and subcutaneous tissue disease. The chapter also considers preoperative care, pre-optimisation of the patient, perioperative care, and post-operative management. Finally, it discusses the management of the critically ill surgical patient. The first step is recognising compensated critical illness (e.g. shock compensated by tachycardia and peripheral shutdown or respiratory failure compensated by unsustainable respiratory effort). The surgical team should consider using critical care services for both elective and emergency surgical patients.

scholarly journals Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient

2018 ◽  
Vol 7 (2) ◽  
pp. e000235
Author(s):  
Stacie Hodge ◽  
Sebastian Helliar ◽  
Hamish Ian Macdonald ◽  
Paul Mackey
Keyword(s):  
Rapid Identification ◽  
Surgical Patients ◽  
Management Tool ◽  
Surgical Patient ◽  
Surgical Team ◽  
Traffic Light ◽  
Early Assessment ◽  
Early Warning Scores ◽  
Assessment Unit ◽  
Multiple Cycles

Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple ‘plan-do-study-act’ cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of ‘red’ and ‘amber’ patients’ observations were communicated to the surgical team. The average time for a registrar to review a ‘red’ patient was 37 min and 79% of ‘green’ patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.

scholarly journals Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

2021 ◽  
Author(s):  
Carol J. Peden ◽  
Geeta Aggarwal ◽  
Robert J. Aitken ◽  
Iain D. Anderson ◽  
Nicolai Bang Foss ◽  
...  
Keyword(s):  
High Risk ◽  
English Language ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care ◽  
Surgical Patient ◽  
Emergency Laparotomy ◽  
Emergency General Surgery ◽  
Optimal Care ◽  
Level Of Evidence

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. Methods Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1. Results Twelve components of preoperative care were considered. Consensus was reached after three rounds. Conclusions These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

scholarly journals The role of the internal medicine specialist in the management of infective complications in general surgical wards

2013 ◽  
pp. 12-19
Author(s):  
Patrizia Zoboli ◽  
Giuseppe Chesi ◽  
Fabrizio Boni ◽  
Federica Maselli ◽  
Lisa Zambianchi
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Risk Evaluation ◽  
Medical Condition ◽  
The Elderly ◽  
Operative Management ◽  
Surgical Team ◽  
Medical Consultant ◽  
Post Surgery

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

scholarly journals EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shenbaga Rajamanikam ◽  
Suzzana Argyropoulos ◽  
Reza Arsalani Zadeh
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Surgical Procedures ◽  
Length Of Hospital Stay ◽  
Period Length ◽  
Surgical Patients ◽  
Surgical Team ◽  
Surgical Operations

Abstract Background COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period. Material and Method We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019. Results During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days. Conclusion During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.

scholarly journals Hubungan Kepatuhan Tim Bedah dalam Penerapan Surgery Safety Checklist dengan Infeksi Luka Operasi dan Lama Rawat Inap pada Pasien Seksio Sesarea di Rumah Sakit Umum Daerah Kabupaten Barru

2018 ◽  
Vol 5 (3) ◽  
pp. 145
Author(s):  
Amiruddin Amiruddin ◽  
Ova Emilia ◽  
Shinta Prawitasari ◽  
Leo Prawirodihardjo
Keyword(s):  
Patient Safety ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Medical Care ◽  
Hospital Stay ◽  
General Hospital ◽  
Surgical Patient ◽  
Site Infection ◽  
Surgical Team ◽  
Duration Of Hospital Stay

Background: Surgical Patient Safety is essential to be carried out in operating theatre to prevent mortality and surgical complication. Patient safety is the basic principal in medical care and a major component of medical care management in hospital (WHO, 2009).Objective: To investigate association between SSC implementation among surgical team, surgical site infection and duration of hospital stay.Method: This is an analytical cross sectional study. Population of this study was women who underwent cesarean section with live birth in Barru general hospital during 1 December 2016-30 April 2017. This study was carried out in Barru general hospital, 137 samples met inclusion and exclusion criteria. Data was obtained from medical records. Maternal outcome were duration of hospital stay, surgical site infection, and maternal mortality. Besides, this study also assesed knowledge and compliance of surgical team in implementation of SSC. The result of this study was analysed with computer statisctics analysis program.Result adn Discussion: One-hundred thirty seven patients met study criteria. Compliance of surgery team in SSC was 64%,. SSC was not implemented precisely in 36% patients (49 patients). There is no significant association between surgical team compliance with surgical site infection in cesarean section patients (p=0.078). A significant association was found between surgical team compliance with duration of hospital stay (p=0.006).Conclusion: The surgical team compliance in implementation of SSC was not yet optimal. An intensive socialization is needed to improve compliance of team in order that SSC implementation run promptly. This was part of efforts to reduce post operative complication and shorten hospital stay.Keywords: SSC, cesarean section, compliance, infection, duration of hospital stay

scholarly journals Free Newborn Care Services: A New Initiative in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 340-344
Author(s):  
Gambhir Shrestha ◽  
Prajwal Paudel ◽  
Parashu Ram Shrestha ◽  
Shambhu Prasad Jnawali ◽  
Deepak Jha ◽  
...  
Keyword(s):  
Human Resources ◽  
Neonatal Mortality ◽  
Newborn Care ◽  
Public Hospitals ◽  
Significant Progress ◽  
The Public ◽  
Care Services ◽  
Common Causes ◽  
The Status ◽  
The Common

Background: Nepal has made a significant progress in reducing child mortality. However, the annual rate of reduction in neonatal mortality is not satisfactory. As safeguarded by constitution of Nepal and to address neonatal mortality due to poverty and inequity, government has introduced free newborn care (FNC) package. This study aims to assess the status of FNC services in all the public hospitals.Methods: Child Health Division organized 5 workshops region-wise with the theme of newborn care services in March/April 2018 to cover all the public hospitals in the country. A template was designed comprising of duration of FNC implementation, number of newborns admitted since implementation, morbidities pattern, and number of babies served. It was circulated and all hospitals were advised to fill it and present in the review. Later, the data were compiled and analyzed.Results: Only 58 presentations out of 93 participated hospitals were included in this study. The total admitted cases were 8564 newborns. The common causes of admission were neonatal sepsis (44.5%) followed by asphyxia (14.29%) and hyperbilirubinemia (11.4%). A total of 1573 neonates received services of FNC package C, 3722 package B, 3081 received package A. The main challenges faced in implementation reported were lack of infrastructure and human resources to provide services and the reimbursement is not enough.Conclusions: Free newborn care is a new initiative taken to reduce neonatal mortality. This package is very helpful to serve sick newborns. However, the package should be revised taking into consideration the appropriate reimbursement and extra staffs to provide this service.Keywords: Free newborn care; government efforts; health services.

Body contouring in the post-bariatric surgical patient

2017 ◽  
Vol 10 (3) ◽  
pp. 148-155
Author(s):  
Sameena Hassan ◽  
Sharmila Jivan ◽  
LeRoux Fourie
Keyword(s):  
Body Contouring ◽  
Surgical Patients ◽  
Surgical Patient ◽  
National Guidelines ◽  
Referral Criteria ◽  
Key Points ◽  
Bariatric Patients ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Plastic ◽  
General Wellbeing

Current statistics put obesity rates in England at 25%, with a further 36% being classed as overweight; the associated prescription cost for medical management is £15 300 000. The sequelae of obesity include heart disease, diabetes, hypertension, stroke and mental health illness. Post-bariatric surgical patients face significant on-going morbidity related to excess tissue, mobility and general wellbeing. The national guidelines for reconstructive plastic surgery on post-bariatric patients attempt to ration funding for surgery while eliminating the postcode lottery effect. This article summarises key points in the management of the post-bariatric surgical patient and emphasises referral criteria for body contouring.

Abstract 4092: Initial Experience with Subxiphoid Percutaneous Epicardial Ventricular Tachycardia Ablation in Patients with Prior Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Srijoy Mahapatra ◽  
George M McDaniel ◽  
Pamela K Mason ◽  
Gorav Ailawadi
Keyword(s):  
Cardiac Surgery ◽  
Success Rate ◽  
Nyha Class ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Success Rates ◽  
Ventricular Tachycardia Ablation ◽  
Prior Surgery ◽  
Vt Ablation ◽  
Surgical Group

Introduction: Epicardial ablation via subxiphoid percutaenous access improves VT ablation success rate and is growing in popularity. However, it is unclear if this technique is feasible in patients with prior cardiac surgery because of pericardial adhesions. We describe results in our initial 12 patients with previous cardiac surgery. Methods: A total of 27 patients (11 women) underwent an epicardial VT ablation after failed antiarrhythmic drug therapy and at least one endocardial ablation. Twelve patients had undergone previous cardiac surgery (7 CABG, 3 valve only, 2 combined). The pericardium was accessed using a Tuohy needle. Then a guidewire and an irrigated tip catheter were used to free up adhesions. VT was mapped and ablated. We compared the results in patients with and without prior surgery. Results: There was no difference in the age (62±11 vs 58±13 years, p=ns), percent women (41 vs 40%, p=ns), EF (30±9 vs 27±11, p=ns), NYHA class (2.4±1.0 vs 2.1±0.9, p=ns) or use of beta-blockers (100 vs 93%, p=ns) or ACE inhibtors (100 vs 93%, p=ns) among patients with and without prior cardiac surgery. However, patients with prior surgery were more likely to have CAD (100 vs 66% p=0.02) and be on ASA (100 vs 73%, p=0.04.) The mean procedure (298±90 vs 178±45 min, p=0.01) and fluoroscopy time (106±24 vs 45±11 min, p=0.01) was longer in patients with prior surgery versus without surgery. The entire epicardium was mapped in 15/15 (100%) of the nonsurgical patients but only in 7/11 (64%) of the surgical patients due to adhesions (p=0.02.) The acute success rate, defined as elimination of all clinical VTs, was lower in the surgical group (75 vs 100%, p=0.02). Elimination of all VTs was achieved less often in post-surgical patient than non-surgical patients (58 vs 80%, p=0.04.) There were two occurrences of RV perforation in each group both treated with conservative therapy. There were no other complications. After 7±2 months, 66% of surgical patients and 80% of non-surgical patients were VT free (p=0.04) as monitored by ICD or 1, 3, and 6 month monitor. One patient in non-surgical group died of heart failure. Conclusion: Prior cardiac surgery does not preclude epicardial VT ablation but is associated with longer procedure times and lower success rates.

Post thoracic surgery

2007 ◽  
pp. 103-106
Keyword(s):  
Clinical Practice ◽  
Thoracic Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Morbidity And Mortality ◽  
Surgical Patient ◽  
Current Clinical Practice ◽  
Operative Morbidity ◽  
Careful Assessment

Post thoracic surgery 104 Successful post-operative management of the thoracic surgical patient requires careful assessment. Potential complications should be recognized and managed early, as this will reduce post-operative morbidity and mortality. • In current clinical practice 30 day postoperative mortality following elective lobectomy is approximately 2–3% and minor morbidity is 40–50%....

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