Intra-operative safety checklist - no effects on postoperative morbidity and mortality in high-risk surgical patients

2011 ◽  
Vol 28 ◽  
pp. 17 ◽  
Author(s):  
F. Hovaguimian ◽  
A. Lübbeke ◽  
C Barea ◽  
P. Hoffmeyer ◽  
F. Clergue ◽  
...  
Keyword(s):  
High Risk ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality ◽  
Surgical Patients

scholarly journals Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Emmanuel Futier ◽  
Camille Vaisse ◽  
Olivier Collange ◽  
Olivier Huet ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Therapy ◽  
Postoperative Morbidity ◽  
Large Body ◽  
Surgical Patients ◽  
Cardiac Output Monitoring ◽  
Routine Practice ◽  
Daily Routine ◽  
Hemodynamic Optimization ◽  
Number Of Patients

AbstractDespite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.

scholarly journals SURGICAL TREATMENT OF HIGH-RISK PATIENTS IN PATIENTS

2019 ◽  
pp. 6-11
Author(s):  
V. V. Boyko ◽  
Yu. V. Ivanova ◽  
M. E. Tymchtnko
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality ◽  
High Risk Patients ◽  
Risk Patients ◽  
Surgical Tactics ◽  
Level Of Risk

Summary. Due to analysis of the factors that lead to incompetence of bowels` anastomosis and sutures the levels of risk of the development of this complication were created. The surgical tactics depending on the level of risk of the development of bowels` sutures and anastomosis incompetence was created. The method of forming of late bowels` anstomosis in patients with high and moderate levels of risk of  the development of bowels` sutures and anastomosis incompetence were created. This method excludes performing of multistaged  intraabdominal operations. The using of developed algorithm allows to decrease postoperative morbidity and mortality.

scholarly journals Arterial pulse pressure and postoperative morbidity in high-risk surgical patients

2018 ◽  
Vol 120 (1) ◽  
pp. 94-100 ◽  
Author(s):  
G.L. Ackland ◽  
T.E.F. Abbott ◽  
R.M. Pearse ◽  
S.N. Karmali ◽  
J. Whittle ◽  
...  
Keyword(s):  
High Risk ◽  
Pulse Pressure ◽  
Postoperative Morbidity ◽  
Surgical Patients ◽  
Arterial Pulse ◽  
Arterial Pulse Pressure

Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients

2000 ◽  
Vol 28 (10) ◽  
pp. 3396-3404 ◽  
Author(s):  
Suzana M. A. Lobo ◽  
Paula F. Salgado ◽  
Vânia G. T. Castillo ◽  
Aldenis A. Borim ◽  
Carlos A. Polachini ◽  
...  
Keyword(s):  
High Risk ◽  
Oxygen Delivery ◽  
Morbidity And Mortality ◽  
Surgical Patients

scholarly journals Prospective, randomized trial of the effect of supranormal oxygen delivery on morbidity and mortality in high risk surgical patients

Critical Care ◽  
10.1186/cc514 ◽  
1999 ◽  
Vol 3 (Suppl 1) ◽  
pp. P140
Author(s):  
SMA Lobo ◽  
PS Fialho ◽  
AA Borim ◽  
SLA Brienzc ◽  
VG Castilho ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Oxygen Delivery ◽  
Morbidity And Mortality ◽  
Prospective Randomized Trial ◽  
Surgical Patients

scholarly journals Multimodal Monitoring With Haemodynamic Optimisations May Offer Some Benefit for Patients Undergoing Major Abdominal Surgery. A Randomised, Controlled Trial.

2020 ◽  
Author(s):  
Matej Jenko ◽  
Katarina Mencin ◽  
Vesna Novak-Jankovic ◽  
Alenka Spindler-Vesel
Keyword(s):  
High Risk ◽  
Abdominal Surgery ◽  
Hospital Stay ◽  
Postoperative Morbidity ◽  
Fluid Management ◽  
Major Abdominal Surgery ◽  
Surgical Patients ◽  
Haemodynamic Monitoring ◽  
Control Group ◽  
Multimodal Monitoring

Abstract Background: Combined monitoring of blood flow with assessment of fluid status and cerebral tissue oxygenation improve perioperative management and outcome of high-risk surgical patients. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery managed by same anaesthetic protocols with epidural analgesia.Methods: Prospective study was conducted in 2 parallel groups. High risk surgical patients undergoing major abdominal surgery were randomised in control group (CG), where standard monitoring was applied and protocol group (PG), where cerebral oxygenation and haemodynamic monitoring were used with protocol for intraoperative interventions.Results: There was no difference in median length of hospital stay, CG 9 days (IQR 8 days), PG 9 (5.5), p= 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in first 3 days) in CG, 0.75 mcg/L (IQR 3.19mcg/L), than in PG 0.3 mcg/L (0.88 mcg/L), p= 0.001. Patents in PG received larger intraoperative amount of fluids; median intraoperative fluid balance +1300 ml (IQR 1063ml) than CG; +375 ml (IQR 438ml), p<0.00.Conclusions: There was no difference in postoperative morbidity or hospital stay. Median postoperative value of procalcitonin was significantly higher in CG and was above laboratory reference range. There were significant differences in intraoperative fluid management.Trial registration: ClinicalTrials.gov, NCT02293473, Registered June 10, 2014, https://clinicaltrials.gov/

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
M Müller ◽  
C Heilmann ◽  
S Sorg ◽  
S Kueri ◽  
M Thoma ◽  
...  
Keyword(s):  
High Risk ◽  
Median Sternotomy ◽  
Surgical Patients
Sign in / Sign up

Export Citation Format

Share Document