Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial

2020 ◽  
Vol 272 (5) ◽  
pp. 684-689
Author(s):  
Klara Nilsson ◽  
Fredrik Klevebro ◽  
Ioannis Rouvelas ◽  
Mats Lindblad ◽  
Eva Szabo ◽  
...  
Keyword(s):  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Randomized Controlled

An Eight-Year Analysis of Surgical Morbidity and Mortality: Data and Solutions

2006 ◽  
Vol 72 (11) ◽  
pp. 1070-1081
Author(s):  
Michael A. Goldfarb ◽  
Thomas Baker
Keyword(s):  
Surgical Outcome ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Time Process ◽  
Operative Techniques ◽  
Barriers To Adoption ◽  
Surgical Morbidity ◽  
Technical Complications ◽  
Common Problems

In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The “Hostile Abdomen Index” has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.

scholarly journals An unusual presentation of Gossypiboma associated with secondary infertility: a case report

2021 ◽  
Vol 10 (8) ◽  
pp. 3236
Author(s):  
Eshwarya J. Kaur ◽  
Ganesh Saravagi
Keyword(s):  
Case Report ◽  
Unusual Case ◽  
Adnexal Mass ◽  
Perioperative Period ◽  
Definitive Diagnosis ◽  
Unusual Presentation ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Secondary Infertility ◽  
Abdominal Complications

Gossypibomas are a rare cause of surgical morbidity and mortality. When unrecognised in the perioperative period, they can present later with a myriad of abdominal complications. We present an unusual case of gossypiboma that was discovered as a cause of secondary infertility, misdiagnosed as a complex adnexal mass. After a definitive diagnosis was made, the removal of gossypiboma restored fertility in the patient successfully.

Lessons Learned From the Surgical Morbidity and Mortality Conference

2019 ◽  
Vol 76 (1) ◽  
pp. 174-181 ◽  
Author(s):  
Kaio S. Ferreira ◽  
Kenneth Lynch ◽  
Beth A. Ryder ◽  
Michael Connolly ◽  
Thomas Miner ◽  
...  
Keyword(s):  
Lessons Learned ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Morbidity And Mortality Conference ◽  
Mortality Conference

scholarly journals Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

2010 ◽  
Vol 92 (1) ◽  
pp. 56-60 ◽  
Author(s):  
K Gash ◽  
E Brown ◽  
A Pullyblank
Keyword(s):  
Clostridium Difficile ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Fulminant Colitis ◽  
Surgical Morbidity ◽  
Predisposing Factor ◽  
Number Of Patients ◽  
Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

Internal Hernia: Postoperative Complication of Roux-en-Y Gastric Bypass Surgery

2006 ◽  
Vol 72 (7) ◽  
pp. 581-585 ◽  
Author(s):  
Aaron Eckhauser ◽  
Alfonso Torquati ◽  
Yassar Youssef ◽  
Joan L. Kaiser ◽  
William O. Richards
Keyword(s):  
Gastric Bypass ◽  
Length Of Stay ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
The United States ◽  
Morbidity And Mortality ◽  
Transverse Mesocolon ◽  
Surgical Morbidity ◽  
Internal Hernias ◽  
Clinical Awareness

Obesity surgery is becoming one of the most common general surgery procedures done in the United States. Internal hernias are a known and increasingly more common occurrence after laparoscopic roux-en-Y gastric bypass (LRYGB). Increased clinical awareness of this complication will lead to decreased surgical morbidity and mortality. We retrospectively reviewed our database of 529 patients who had undergone LRYGB from 2000 to 2005 and identified those presenting with intestinal obstruction from an internal hernia. The type of internal hernia (jejunojejunostomy, transverse mesocolon, roux limb mesentery [Peterson's hernia]), length of time from presentation to operative intervention, and length of stay were obtained for all patients. Of 529 laparoscopic retrocolic retrogastric LRYGBs, 13 internal hernias (2.5%) were identified in 13 different patients. Eight of the hernias were at the mesenteric defect created by the jejunojejunostomy (62%), 3 originated from the transverse mesocolon defect (23%), and 2 were a Peterson's hernia (15%). The median time from initial operation to repair was 150 days. The average time from presentation to operative repair was 29.2 hours (range, 5–67.5 hours). The median length of stay was 3 days (range, 1.5–45 days). Eleven hernias were repaired laparoscopically (85%). There were no mortalities associated with obstruction from the internal hernia. Intestinal obstruction from an internal hernia after LRYGB is becoming increasingly more common. General awareness of this condition and high clinical suspicion allow for prompt surgical intervention with decreased morbidity and mortality.

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