scholarly journals The Use of the S-MART Tourniquet in Hand Surgery: A Safe and Effective Way to Provide a Bloodless Field

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
O. Templeton-Ward ◽  
J. Feher ◽  
P. Davey
Keyword(s):  
Postoperative Complications ◽  
Surgical Procedures ◽  
Hand Surgery ◽  
Bloodless Field

We have retrospectively reviewed our use of the S-MART sterile silicon ring self-exsanguinating tourniquet in 300 consecutive minor hand surgical procedures. A total of 3 postoperative complications were identified, only 1 of which was directly related to the tourniquet’s use. We outline the reasons of why we feel that this device provides a safe and effective bloodless field and the benefits of its use.

scholarly journals Prognostic Nutritional Index Considering Resection Range Is Useful for Predicting Postoperative Morbidity of Hepatectomy

2021 ◽  
Author(s):  
Shigeyuki Nagata ◽  
Shohei Maeda ◽  
Satoko Nagamatsu ◽  
Seiichiro Kai ◽  
Yasuro Fukuyama ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Procedures ◽  
Predictive Value ◽  
Surgical Procedure ◽  
Major Hepatectomy ◽  
Prognostic Nutritional Index ◽  
Complication Rates ◽  
Immunological Status ◽  
Grade Ii ◽  
Prognostic Nutrition Index

Abstract Background Poor preoperative nutritional and immunological status are major risk factors for postoperative complications in patients with various malignancies. Lower preoperative prognostic nutrition index (PNI) is associated with higher rates of postoperative complications and poorer prognosis in those patients. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure. Methods This retrospective study included 510 patients who underwent open hepatectomies for HCC. The predictive value of the preoperative nutritional and immunological status for postoperative complications was assessed using the PNI. Postoperative complications were defined as grade II or higher per the Clavien-Dindo classification. Postoperative complication rates were compared according to surgical procedure (major hepatectomy vs minor hepatectomy). Results Patients with postoperative complications had significantly lower PNIs than those without (43.1 ± 5.5 vs 47.0 ± 5.7, P < 0.001). In the multivariate analysis, low preoperative PNI (< 45) was an independent risk factor for postoperative complications after hepatectomy (hazard ratio, 3.85). When patients were classified per their PNI (high vs low) and extent of surgical procedures (major vs minor), there were more complications among patients with low PNI than those with high PNI, regardless of the extent of surgical procedures. Specifically, the group of patients with low PNI who underwent major hepatectomy had significantly higher rates of postoperative complications than the other groups. Conclusions Adding the resection range to the PNI is useful for predicting the postoperative morbidities of hepatectomy patients.

scholarly journals Impact of Uninterrupted Use of Clopidogrel on Postoperative Complications After Extracavitary Vascular Surgical Procedures

2013 ◽  
Vol 57 (1) ◽  
pp. 295
Author(s):  
Panos Kougias ◽  
Neal Barshes ◽  
George Pisimisis ◽  
Peter Lin ◽  
Briauna Lowery ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Procedures ◽  
Vascular Surgical Procedures

scholarly journals Re-formation of absent anterior chamber by iris incision using a 20-gauge knife in eyes with advanced paediatric vitreoretinopathies

2019 ◽  
Author(s):  
Chunli Chen ◽  
Tian Tian ◽  
Peiquan Zhao ◽  
Xiaorong Li
Keyword(s):  
Postoperative Complications ◽  
Prospective Study ◽  
Anterior Chamber ◽  
Surgical Procedures ◽  
The Novel ◽  
Paediatric Patients ◽  
Initial Episode

Abstract Background To present the novel usage of iris incision in paediatric patients lacking an anterior chamber due to various advanced vitreoretinopathies.Methods Forty-one patients (41 eyes) were enrolled in this consecutive, prospective study. Iris incision was performed in all patients. The number of iris incision times, surgical procedures, and intraoperative and postoperative complications were collected. Patients were followed up for at least 6 months.Results Anterior chamber formation was achieved with only 1 initial episode of iris incision in 28 (68.3%) eyes, with 2 episodes in 11 (26.8%) eyes, and with 3 episodes in the remaining 2 (4.9%) eyes, which also underwent 1 episode of external SRF drainage. Except for iris incarceration, which occurred in 7 (17%) of the eyes during surgery, no other related complications were noted at the last follow-up.Conclusions This novel use of iris incision is effective, simple and safe in the management of an lost anterior chamber.

scholarly journals Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Mariateresa Giglio ◽  
Giandomenico Biancofiore ◽  
Alberto Corriero ◽  
Stefano Romagnoli ◽  
Luigi Tritapepe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Neurosurgical Procedures ◽  
Goal Directed Therapy ◽  
Number Of Patients ◽  
Risk Patients

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

Minimally Invasive Pediatric Surgery: The Learning Curve

2020 ◽  
Vol 30 (02) ◽  
pp. 172-180
Author(s):  
Marie Uecker ◽  
Joachim F. Kuebler ◽  
Benno M. Ure ◽  
Nagoud Schukfeh
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Surgical Procedures ◽  
Operative Time ◽  
Learning Curves ◽  
Current Evidence ◽  
Stenosis Rate ◽  
Mucosal Perforation

AbstractThe use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

2019 ◽  
Vol 85 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Oscar Cano-Valderrama ◽  
JosÉ L. Porrero ◽  
Esther Quirós ◽  
Oscar Bonachia ◽  
MarÍA J. Castillo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Surgical Procedures ◽  
Polypropylene Mesh ◽  
Mesh Repair ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Onlay Mesh

Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

scholarly journals Surgery and anesthesia in sickle cell disease. Cooperative Study of Sickle Cell Diseases

Blood ◽  
1995 ◽  
Vol 86 (10) ◽  
pp. 3676-3684 ◽  
Author(s):  
M Koshy ◽  
SJ Weiner ◽  
ST Miller ◽  
LA Sleeper ◽  
E Vichinsky ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Sickle Cell Disease ◽  
General Anesthesia ◽  
Sickle Cell ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Complication Rates ◽  
Cooperative Study ◽  
Cell Disease

From 1978 to 1988, The Cooperative Study of Sickle Cell Disease observed 3,765 patients with a mean follow-up of 5.3 +/- 2.0 years. One thousand seventy-nine surgical procedures were conducted on 717 patients (77% sickle cell anemia [SS], 14% sickle hemoglobin C disease [SC], 5.7% S beta zero thalassemia, 3% S beta zero + thalassemia). Sixty-nine percent had a single procedure, 21% had two procedures, and the remaining 11% had more than two procedures during the study follow- up. The most frequent procedure was abdominal surgery for cholecystectomy or splenectomy (24% of all surgical procedures, N = 258). Of these, 93% received blood transfusion, and there was no association between preoperative hemoglobin A level and complication rates (except reduction in pain crisis). Overall mortality within 30 days of a surgical procedure was 1.1% (12 deaths after 1,079 surgical procedures). Three deaths were considered to be related to the surgical procedure and/or anesthesia (0.3%). No deaths were reported in patients younger than 14 years of age. Sickle cell diseases (SCD)-related complications after surgery were more frequent in SS patients who received regional compared with general anesthesia (adjusted for risk level of the surgical procedure, patient age, and preoperative transfusion status, P = .058). Non-SCD-related postoperative complications were higher in both SS and SC patients who received regional compared with those who received general anesthesia (P =.095). Perioperative transfusion was associated with a lower rate of SCD- related postoperative complications for SS patients undergoing low-risk procedures (P = .006, adjusted for age and type of anesthesia), with crude rated of 12.9% without transfusion compared with 4.8% with transfusion. In SC patients, preoperative transfusion was beneficial for all surgical risk levels (P = .009). Thus, surgical procedures can be performed safely in patients with SCD.

Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

2018 ◽  
Vol 46 (02) ◽  
pp. 81-86 ◽  
Author(s):  
Klaus Failing ◽  
Marc Koene ◽  
Kerstin Fey ◽  
Sabita Stöckle
Keyword(s):  
Postoperative Complications ◽  
Septic Arthritis ◽  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Complication Rate ◽  
Clinical Relevance ◽  
Orthopaedic Surgery ◽  
Complication Rates ◽  
Perioperative Antibiotics ◽  
Type Of Surgery

Summary Objective: Retrospective analysis of postoperative complications in equines after clean, orthopaedic surgical procedures in order to detect differences between animals treated with antibiotics and horses without receiving these drugs. Material and methods: Details on 652 patients, surgical procedures and surgery-associated complications were compiled from horses being operated between June 2011 and January 2015. Antibiotic-receiving patients (n = 259) were tested for differences in complication rates and characteristics to controls (n = 393). Results: The total complication rate was 39.1 %. Increased swelling was observed most often (25.6 %), followed by exudation (7.5 %), fever without incisional alterations (2.3 %), suture dehiscence (1.8 %), and seroma (0.8 %). Seven patients (five treated, two controls) developed septic arthritis within a total of 463 arthroscopies (1.5 %). There were no significant differences in the development of postoperative complications, which were seen in 97/259 (37.5 %) antibiotic receiving patients and in 158/393 (40.2 %) controls. The application of perioperative antibiotics was significantly influenced by surgeon (p < 0.0001) and type of surgery (p = 0.0007) and increased with the number of surgical lesions (p = 0.03). In patients undergoing tendovaginoscopy/ bursoscopy, fasciotomy and neurectomy (n = 98), antibiotic prophylaxis was initiated less frequently than in other surgeries, e. g. combinations of surgeries, splint bone extraction, tenotomy, and arthroscopy (n = 554). Conclusion: Severe complications in equine clean orthopaedic surgery are rare and complication rates in patients either receiving perioperative antibiotics or not were not significantly different. Clinical relevance: Based on the results the use of antibiotics appears to be non-essential in uncomplicated elective orthopaedic interventions in the horse.

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