scholarly journals Forward Surgical Team Procedural Burden and Non-operative Interventions by the U.S. Military Trauma System in Afghanistan, 2008–2014

2019 ◽  
Vol 185 (5-6) ◽  
pp. e759-e767
Author(s):  
Amanda M Staudt ◽  
Mithun R Suresh ◽  
Jennifer M Gurney ◽  
Jennifer D Trevino ◽  
Krystal K Valdez-Delgado ◽  
...  
Keyword(s):  
Wound Care ◽  
Trauma System ◽  
Operative Procedures ◽  
Morbidity And Mortality ◽  
Surgical Team ◽  
Mortality And Morbidity ◽  
Surgical Interventions ◽  
Mortality Burden ◽  
Operative Care ◽  
Surgical Teams

Abstract Introduction No published study has reported non-surgical interventions performed by forward surgical teams, and there are no current surgical benchmarks for forward surgical teams. The objective of the study was to describe operative procedures and non-operative interventions received by battlefield casualties and determine the operative procedural burden on the trauma system. Methods This was a retrospective analysis of data from the Joint Trauma System Forward Surgical Team Database using battle and non-battle injured casualties treated in Afghanistan from 2008–2014. Overall procedure frequency, mortality outcome, and survivor morbidity outcome were calculated using operating room procedure codes grouped by the Healthcare Cost and Utilization Project classification. Cumulative attributable burden of procedures was calculated by frequency, mortality, and morbidity. Morbidity and mortality burden were used to rank procedures. Results The study population was comprised of 10,992 casualties, primarily male (97.8%), with a median age interquartile range of 25.0 (22.0–30.0). Affiliations were non-U.S. military (40.0%), U.S. military (35.1%), and others (25.0%). Injuries were penetrating (65.2%), blunt (32.8), and burns (2.0%). Casualties included 4.4% who died and 14.9% who lived but had notable morbidity findings. After ranking by contribution to trauma system morbidity and mortality burden, the top 10 of 32 procedure groups accounted for 74.4% of operative care, 77.9% of mortality, and 73.1% of unexpected morbidity findings. These procedure groups included laparotomy, vascular procedures, thoracotomy, debridement, lower and upper gastrointestinal procedures, amputation, and therapeutic procedures on muscles and upper and lower extremity bones. Most common non-operative interventions included X-ray, ultrasound, wound care, catheterization, and intubation. Conclusions Forward surgical team training and performance improvement metrics should focus on optimizing commonly performed operative procedures and non-operative interventions. Operative procedures that were commonly performed, and those associated with higher rates of morbidity and mortality, can set surgical benchmarks and outline training and skillsets needed by forward surgical teams.

Peri-operative elective path optimization through algorithms in the Local Health Authority of Bologna

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Leonessi ◽  
P Tubertini ◽  
A Longanesi ◽  
E Malaguti ◽  
S Guicciardi ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Health Authority ◽  
Surgical Planning ◽  
Waiting Times ◽  
Local Health Authority ◽  
Local Health ◽  
Surgical Interventions ◽  
Patient Preparation ◽  
Surgical Teams ◽  
Available Resources

Abstract Background High costs of healthcare and population ageing force the health system to constantly improve its efficiency in order to provide patients the best possible care with the available resources. In this perspective, the Local Health Authority and the University of Bologna started an experimentation to re-organize, manage and control the peri-operative elective path of general surgery, a discipline that works in a multiplatform environment according to a Hub & Spoke logic. Methods The experimentation is built on two mathematical programming models. The first one defines patient preparation appointments (i.e. diagnostic and anesthesiologic visits), harmonizing patient preparation with available resources, and planning migration from Hub to Spoke platforms, in order to optimize waiting time and facilities utilization. The second model defines weekly optimal admission plans. Both models consider the availability of resources in terms of surgical teams, operating room slots and number of beds for each operating unit. The proposed approach works on a four-week time horizon following a rolling horizon framework (weekly update) in order to effectively manage high priority patients. Results Both models have been tested on real-world instances over a six-month observation period. Overall, it was possible to increase the efficiency of surgical programming by reducing the waiting times for surgical interventions in over 20% of cases of high priority patiets in four local departments. Conclusions The proposed model represents one of the few cases in Italy of surgical programming developed through mathematical models. It will be necessary to evaluate the evolution of its effectiveness to optimize the system's ability to respond to the growing health needs of the population. Key messages Mathematical models are needed to optimize surgical planning. Efficiency of surgical planning may reduce waiting times for high priority procedures.

scholarly journals The first experience of pneumovesicoscopic ureteral reimplantation in children under 2 years of age

2020 ◽  
Vol 24 (5) ◽  
pp. 303-306
Author(s):  
Sergey A. Karpachev ◽  
S. N. Zorkin ◽  
A. S. Gurskaya ◽  
A. O. Tarzyan ◽  
R. R. Bayazitov ◽  
...  
Keyword(s):  
Young Children ◽  
Small Volume ◽  
Limiting Factors ◽  
Age Group ◽  
Ureteral Reimplantation ◽  
Highly Qualified ◽  
Surgical Team ◽  
Surgical Interventions ◽  
Open Procedure ◽  
Procedure Duration

Actuality. To date, there are few publications focused on pneumovesicoscopic ureteral reimplantation in young children. The article is devoted to surgical interventions in this age group. Material and methods. Surgical interventions on small volume bladder have significant technical difficulties. The authors assessed potentials for performing pneumovesicoscopic ureteral reimplantation by the Cohen technique in 14 children under 2 with various obstructive uropathies. Results. In all children, surgical interventions were performed according to preoperative plans. There were no conversions to an open procedure. As it has been found out, patient’s age and bladder volume were not limiting factors for this type of intervention. Conclusion. The pneumovesicoscopic ureteral reimplantation in young children is a hi-tech procedure which requires a unique equipment and a highly qualified surgical team. To reduce the procedure duration, further experience and more information are needed.

scholarly journals Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

2020 ◽  
Vol 14 (1) ◽  
pp. 95-102
Author(s):  
Mohammad Vafaee-Shahi ◽  
Elaheh Soltanieh ◽  
Hossein Saidi ◽  
Aina Riahi
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Brain Imaging ◽  
Morbidity And Mortality ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Imaging Results ◽  
History Of ◽  
Abnormal Brain ◽  
Febrile Status Epilepticus

Background: Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus. Methods: This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study. Results: The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36% versus 14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology. Conclusion: Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.

scholarly journals Venous Thromboembolic Disease and Bone Marrow Transplant: A Remarkable Cause of Mortality and Morbidity — Potentially Preventable

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5070-5070
Author(s):  
Marta Rivas Luque ◽  
Estefanía Morente Constantin ◽  
Pablo Romero Garcia ◽  
Maria Almudena Garcia-Ruiz ◽  
Manuel Jurado
Keyword(s):  
Medical History ◽  
Conflicts Of Interest ◽  
Protein S ◽  
Marrow Transplant ◽  
Morbidity And Mortality ◽  
Hematopoietic Stem ◽  
Mortality And Morbidity ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Hemorrhagic Risk

Abstract Thrombotic events are frequent in patients undergoing HSCT, being an important cause of morbidity and mortality. The highest incidence occurs three months after the transplant. There are several risk factors, which add to those already known for VTE: neoplasia, central venous catheters, immobilization, chemotherapy, infections, GVHD. In the series described, the frequencies are variable, between 0.5 and 23.5%, with an overall incidence of 5%. In patients with GVHD, this incidence increases, with up to 35% of events. METHODS A retrospective observational study that includes patients transplanted in our Unit between 2014 and 2017 has been conducted, with the objective of analyzing the incidence of VTE peri-TPH. Likewise, we have analyzed if it is associated to catheter, presence of CVRF, if there was a known medical history of thrombophilia, number of platelets at time of thrombosis, the heparin used and whether anticoagulation was maintained indefinitely or not. RESULTS Out of the 235 patients included in our series, 130 underwent an autologous transplant and 105 an allogeneic transplant. 18 thrombotic events occurred (9 men and 9 women, aged between 18 and 65 years), which means 7.5% (14 occurred between days 0-100, 12 in patients undergoing autologous hematopoietic stem cell transplantation). Three of them had thromboembolism and the rest deep vein thrombosis, 4 of which with catheter. The platelet count at the time of the event ranges from 21 to 409,000 / mm3. Regarding the heparin used, 2 were treated with Tinzaparin and the rest with Bemiparin. Only 1 of the patients presented prior VTE. Among the patients, there were some with CVRF and others without relevant medical history. Just in one patient, a family thrombophilia study had been performed prior to his hematological diagnosis, resulting in a deficit of protein S. In 8 of the patients, anticoagulation was maintained indefinitely with LMWH in the post-transplant period. CONCLUSIONS Our incidence approaches the literature, albeit the series of published cases are heterogeneous and with variable differences. Although the incidence of thrombosis in these patients is a cause of marked morbidity and mortality, the risk of bleeding also increases, therefore routine prophylaxis is not recommended in all patients. We must undergo an exhaustive analysis of the data to identify individually which patients may be candidates for prophylaxis, with the aim of reducing the incidence without raising the hemorrhagic risk of our patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia

2020 ◽  
Vol 30 (3) ◽  
Author(s):  
Berhanetsehay Teklewold ◽  
Tilahun Deresse ◽  
Goytom Kinfe ◽  
Henok Teshome
Keyword(s):  
Patient Safety ◽  
Multidisciplinary Team ◽  
Addis Ababa ◽  
Univariate Analysis ◽  
Tertiary Hospital ◽  
Morbidity And Mortality ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Morbidity And Mortality Conferences

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking.METHODS: A facility based cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants’ opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants’ opinion about the morbidity and mortality conferences.RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations.CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.

scholarly journals Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

2020 ◽  
Author(s):  
Bhavin B. Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Operative Time ◽  
Univariate Analysis ◽  
Operating Time ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
The Mean ◽  
Eras Protocol

ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

2018 ◽  
Vol 164 (6) ◽  
pp. 423-427 ◽  
Author(s):  
Yvain Goudard ◽  
C Butin ◽  
C Carfantan ◽  
G Pauleau ◽  
E Soucanye de Landevoisin ◽  
...  
Keyword(s):  
Low Income ◽  
Elective Surgery ◽  
Surgical Care ◽  
Host Population ◽  
Surgical Team ◽  
Low Income Country ◽  
Operative Outcomes ◽  
Surgical Teams ◽  
A Prospective Study

BackgroundThe 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject.MethodsAll surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated.ResultsDuring this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2–4), and the median follow-up was 30 days (22–34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01).ConclusionsHumanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.

Guidelines of the Association of Polish Surgeons and the Polish Society of Surgical Oncology on the accreditation of healthcare centers providing cytoreductive surgery and HIPEC for primary and secondary peritoneal cancers

2020 ◽  
Vol 92 (4) ◽  
pp. 47-53
Author(s):  
Tomasz Jastrzębski ◽  
Piotr Richter ◽  
Wojciech Zegarski ◽  
Adam Dziki ◽  
Grzegorz Wallner ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Systemic Treatment ◽  
Survival Rates ◽  
Surgical Oncology ◽  
Surgical Team ◽  
Surgical Interventions ◽  
Peritoneal Cancer ◽  
Polish Society ◽  
Patient Groups

Surgical interventions in patients with peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and systemic treatment are becoming more common and, when applied to selected patient groups, they reach 5-year survival rates of 32–52%. Good clinical outcomes require experienced and well-equipped healthcare centers, experienced surgical team and adequate patient qualification process. As a result of the discussion on the need for evaluation of quality of care and treatment outcomes and at the request of the Peritoneal Cancer Section of the Polish Society of Surgical Oncology, accreditation standards have been developed and the Accreditation Committee has been established for healthcare centers providing cytoreductive surgery and HIPEC for the management of primary and secondary peritoneal cancers.

Abstract P010: D 1 R And D 5 R And Their Role In The Etiology Of Inverse Salt Sensitivity Of Blood Pressure

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
John J Gildea ◽  
Michael G Daley ◽  
Peng Xu ◽  
Katherine A Schiermeyer ◽  
Wei Yue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Salt Sensitivity ◽  
T Test ◽  
Morbidity And Mortality ◽  
The Novel ◽  
Proximal Tubule Cells ◽  
Mortality And Morbidity ◽  
R And D ◽  
Low Sodium ◽  
Renal Proximal Tubule Cells

Cardiovascular studies show increased morbidity and mortality in individuals consuming low sodium diets as well as high salt diets. The incidence of salt sensitivity of blood pressure (SS) in normotensives is approximately 18%, causing similar mortality and morbidity as hypertensives. Paradoxically, approximately 15% of normotensives demonstrate an increase in blood pressure on low sodium diets, known as inverse salt sensitivity (ISS). However, little is known about the morbidity and mortality associated with ISS, let alone the mechanisms behind this condition. Since dopamine regulates up to 75% of renal sodium handling, we hypothesized that the dopamine 1 and 5 receptors (D1R, D5R) were involved with the etiology of ISS. Using renal proximal tubule cells (RPTC) isolated from salt diet participant’s urine exposed to 90 mM salt (NaCl) (2 hr), we demonstrated reduced binding of the non-cell permeable D1-like antagonist (D1R and D5R) bodipy-530 SKF83566 (Fl-SKF) in the ISS RPTC when compared to salt resistant (SR) RPTC (ISS -13.9 ± 3.8% vs SR -1.1 ± 3.2%, n=12, p<0.05, t-test). Incubation in 190 mM NaCl for 2 hours and overnight (ON) increased Fl-SKF binding only in the ISS RPTCs but not the SR RPTC when compared to 140 mM NaCl (NS) (ISS 2 Hours +16.6 ± 6.2% and ISS ON +12.0 ± 2.8%, n=12, p<0.05 vs NS, t-test). ON incubation in 90 mM NaCl reduced Fl-SKF binding in both ISS and SR RPTC (ISS -15.2 ± 2.9% and SR -16.3 ± 2.3%, n=12, p<0.01, vs NS, t-test), and this effect was completely blocked by co-incubation with the angiotensin type 1 receptor (AT1R) antagonist losartan (LOS, 1 uM). The decrease in Fl-SKF binding in 90 mM NaCl was attributed to the D5R, and an increase in FL-SKF binding in 190 mM NaCl was verified to be due to an increase in plasma membrane D1R expression using antibodies directed to extracellular epitopes. A D5R specific monoclonal antibody developed in-house binds to the third extracellular loop of this receptor in order to measure these receptors selectively. Continued studies will be conducted with these cell lines with D1R and D5R knocked down to determine specific roles these receptors have in the novel ISS phenotype.

scholarly journals POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities

2020 ◽  
Vol 11 ◽  
pp. 215145932093167
Author(s):  
William L. Johns ◽  
Benjamin Strong ◽  
Stephen Kates ◽  
Nirav K. Patel
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Mortality Rate ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Significant Risk ◽  
Screening Tools ◽  
Morbidity And Mortality ◽  
Mortality And Morbidity ◽  
Operative Severity Score

Introduction: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients. Materials and Methods: Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury. Results: Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring. Discussion/Conclusion: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.

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