Multiple Complications in Emergency Surgery

2020 ◽  
Vol 86 (7) ◽  
pp. 787-795 ◽  
Author(s):  
Justin S. Hatchimonji ◽  
Robert A. Swendiman ◽  
Elinore J. Kaufman ◽  
Dane Scantling ◽  
Jesse E. Passman ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Elective Surgery ◽  
Regression Analyses ◽  
Failure To Rescue ◽  
Emergency General Surgery ◽  
Improvement Project ◽  
Organ Systems ◽  
Accrual Rate ◽  
Multivariable Regression ◽  
Complications And Mortality

Background While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death. Methods We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac, renal, neurologic, or technical. We tabulated common combinations of complications. We then use logistic regression analyses to test the hypotheses that (1) increase in the number and frequency of complications would yield higher FTR rates and (2) secondary complications that span a greater number of organ systems or mechanisms carry a greater associated FTR risk. Results Of 329 183 EGS patients, 69 832 (21.2%) experienced at least 1 complication. Of the 11 195 patients who died following complication (16.0%), 8205 (63.4%) suffered more than 1 complication. Multivariable regression analyses revealed an association between the number of complications and mortality risk (odds ratio [OR] 2.37 for 2 complications vs 1, P < .001). There was a similar increase in mortality with increased complication accrual rate (OR 3.29 for 0.2-0.4 complications/day vs <0.2, P < .001). Increasing the number of types of complication were similarly associated with mortality risk. Discussion While past FTR analyses have focused primarily on index complication, a broader consideration of ensuing trajectory may enable identification of high-risk cohorts. Efforts to reduce mortality in EGS should focus on attention to those who suffer a complication to prevent a cascade of downstream complications culminating in death.

scholarly journals 892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Hashmi ◽  
S Khalid ◽  
K Raja ◽  
A Zaka ◽  
J Easterbrook
Keyword(s):  
Informed Consent ◽  
Royal College ◽  
Mortality Risk ◽  
General Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Surgical Practice ◽  
Full Compliance ◽  
Type Of Surgery

Abstract Introduction COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic. Method Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined. Results Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02). Conclusions RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

scholarly journals P64 Improving surgical consent – a quality improvement project to enhance the consenting process

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Manu Shrivastava ◽  
J Brown ◽  
L Sun ◽  
Rajini Rajagopal ◽  
Manu Shrivastava
Keyword(s):  
Quality Improvement ◽  
Endoscopic Sinus Surgery ◽  
Elective Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Quality Improvement Project ◽  
Sinus Surgery ◽  
Improvement Project ◽  
Consent Forms ◽  
Educational Meeting ◽  
Patient Interviews

Abstract Introduction RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission. Method Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020. Results All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations. Conclusions Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.

scholarly journals Analysis of Changes in Cancer-Related Fatigue of Breast Cancer Patients Receiving an Integrative Medicine Program

2020 ◽  
Vol 19 ◽  
pp. 153473542096378
Author(s):  
Friedemann Schad ◽  
Anja Thronicke ◽  
Phillipp von Trott ◽  
Shiao Li Oei
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Integrative Medicine ◽  
Regression Analyses ◽  
Breast Cancer Patients ◽  
Point Change ◽  
Cancer Related Fatigue ◽  
Tumor Stages ◽  
Multivariable Regression ◽  
Integrative Medicine Program

Introduction: Cancer-related fatigue (CRF) occurs frequently in breast cancer patients. The aim of this real-world study was to analyze the longitudinal changes of CRF in breast cancer patients receiving an integrative medicine program, which includes the application of non-pharmacological interventions (NPIs) and Viscum album L. (VA) extracts. Methods: All data were collected from the clinical register of the Network Oncology of a German certified breast cancer center of the Gemeinschaftskrankenhaus Havelhöhe (GKH). Primary breast cancer patients, treated upon initial diagnosis with integrated NPIs, comprising art and exercise therapy, nursing interventions, and educational components, during their hospital stay, and who had answered the German Cancer-Fatigue Scale (CFS-D) questionnaire at first diagnosis and 12 months later, were included. The associations between NPIs and CFS-D changes were analyzed with adjusted multivariable regression analyses, considering received treatment regimens and demographic variables, using the software R. Results: 231 female breast cancer patients of all tumor stages were evaluated. While chemotherapy exhibited significant severe deterioration, add-on VA applications seem to partially mitigate this impairment on CRF. 36 separate multivariable regression analyses for all NPIs showed that in particular significant associations between CFS-D improvements and the interventions nursing compresses (6 point change; P = .0002; R² = 28%) or elaborate consultations and life review (ECLR) (4 point change; P = .0002; R² = 25%) were observed. Conclusions: Breast cancer patients benefit from a hospital-based integrative medicine program. To alleviate fatigue symptoms during oncological therapy, an expansion of this concept should be developed in the future.

A18 A simulation study of the number of events per variable recommended in multivariable regression analyses

1993 ◽  
Vol 14 (5) ◽  
pp. 406 ◽  
Author(s):  
Peter Peduzzi ◽  
John Concato ◽  
Alvan R. Feinstein ◽  
Theodore R. Halford
Keyword(s):  
Simulation Study ◽  
Regression Analyses ◽  
Multivariable Regression

Nonbeneficial Intensive Care: Misalignments Between Provider Assessments of Benefit and Use of Invasive Treatments

2019 ◽  
Vol 35 (12) ◽  
pp. 1411-1417 ◽  
Author(s):  
Christopher Hwe ◽  
Jennifer Parrish ◽  
Bryan Berry ◽  
Oleg Stens ◽  
Dong W. Chang
Keyword(s):  
Intensive Care ◽  
Public Hospital ◽  
Chart Review ◽  
Severity Of Illness ◽  
Venous Catheter ◽  
Regression Analyses ◽  
Clinical Factors ◽  
Central Venous ◽  
Factors Associated ◽  
Multivariable Regression

Background: The purpose of this study was to examine how frequently invasive intensive care unit (ICU) treatments are delivered to critically ill patients despite clinicians’ impressions that ICU care may be nonbeneficial. Methods: Patients admitted to the medical ICU of an academic public hospital were prospectively categorized according to guidelines from the Society of Critical Care Medicine which classifies patients based on severity of illness and likelihood of recovery (categories 1-4). Clinical data and use of ICU treatments in patients with high (category 1) and low (category 3) likelihoods of benefit were collected by chart review. Multivariable regression analyses examined associations between use of invasive treatments and patient categories, and clinical factors associated with receiving invasive ICU treatments despite low likelihood of benefit. Results: There were 533 patients (369 in category 1 and 164 in category 3) in the study. A total of 19.8%, 29.9%, and 28.9% of patient-days on mechanical ventilation, vasopressors, and renal replacement therapy, respectively, were delivered to patients who were considered unlikely to benefit from ICU treatments (category 3) and ultimately did not survive hospitalization. These patients also received 35.2% of cardiopulmonary resuscitation attempts and 22.6% of central venous catheter placements. Clinicians’ impressions of likelihood of benefit (category 1 vs 3) were not associated with odds of receiving invasive ICU treatments. Clinical characteristics associated with greater odds of receiving potentially nonbeneficial treatments included older age, presence of dementia or malignancy, and higher Acute Physiologic Assessment and Chronic Health Evaluation score. Conclusions: Invasive ICU treatments are frequently delivered to patients who are not expected to benefit from ICU care and die during hospitalization. These findings highlight the need to improve utilization of ICU services among patients with advanced medical illnesses.

The cognitive reserve theory in the setting of pediatric-onset multiple sclerosis

2016 ◽  
Vol 22 (13) ◽  
pp. 1741-1749 ◽  
Author(s):  
Luisa Pastò ◽  
Emilio Portaccio ◽  
Benedetta Goretti ◽  
Angelo Ghezzi ◽  
Silvia Lori ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Reserve ◽  
Reliable Change Index ◽  
Neuropsychological Performance ◽  
Regression Analyses ◽  
Neuropsychological Battery ◽  
Healthy Control ◽  
Multivariable Regression ◽  
Potential Impact ◽  
Pediatric Onset

Background: The study of cognitive reserve (CR) in relationship with cognitive impairment (CI) in pediatric-onset multiple sclerosis (POMS) may provide cues to identifying subjects at higher risk of impairment and scope for therapeutic strategies. Objectives: To assess the potential impact of CR on cognition in a cohort of POMS patients. Methods: In all, 48 POMS patients were followed up for 4.7 ± 0.4 years. CI was defined as the failure of ⩾3 tests on an extensive neuropsychological battery. Change of neuropsychological performance was assessed through the Reliable Change Index (RCI) method. At baseline, CR was estimated by measuring the intelligence quotient (IQ). The relationships were assessed through multivariable regression analyses. Results: At baseline, CI was detected in 14/48 (29.2%) patients. Two out of 57 healthy control (HC; 3.5%) met the same criteria of CI ( p < 0.001). A deteriorating cognitive performance using the RCI method was observed in 18/48 patients (37.6%). Among the 34 cases who were cognitively preserved at baseline, a higher reserve predicted stable/improving performance (odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.03–1.20; p = 0.006). Conclusion: Our results suggest that higher CR in POMS patients may protect from CI, particularly in subjects with initial cognitive preservation, providing relevant implications for counseling and rehabilitation strategies.

scholarly journals Complications Versus Lawsuits !

2020 ◽  
Vol 2 (11) ◽  
Keyword(s):  
Gastric Bypass ◽  
Laparoscopic Cholecystectomy ◽  
Plastic Surgery ◽  
Mortality Risk ◽  
Surgical Complications ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Bariatric Procedure ◽  
Medical Claim ◽  
Complications And Mortality

Not every medical claim or lawsuit is necessarily result of a complication or a malpractice. This is especially true in Plastic surgery practice. It was interesting to compare serious surgical complications and mortality risk in various specialties. Gastric bypass surgery, a very popular bariatric procedure designed to treat obesity carries a mortality risk of 0.3% within a month (1:333 cases). Laparoscopic cholecystectomy carries a mortality risk of 0.15% or (1:666) within a month of the surgery as well. Whereas Liposuction as a sole procedure (probably the most common aesthetic operation globally) carries a mortality risk of 1:5000 based on one of the most critical reviews on this issue (Grazer et al. PRS 2000; 105:436-66).

scholarly journals 1222 Improving Consenting for Emergency General Surgery During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Oyewole ◽  
A Sandhya ◽  
A Tawfik ◽  
A Elzaafarany ◽  
J Ma ◽  
...  
Keyword(s):  
Perioperative Period ◽  
Pulmonary Complications ◽  
Surgical Patients ◽  
Inclusion Criteria ◽  
Emergency General Surgery ◽  
Exclusion Criteria ◽  
Incision And Drainage ◽  
Consent Forms ◽  
Risk Of Death ◽  
Complications And Mortality

Abstract Aim Patients undergoing surgery during the Covid pandemic are exposed to increased risks of pulmonary complications and mortality. These novel risks need to be documented on the consent form. We carried out various interventions to ensure appropriate consenting and documentation following an initial audit that revealed poor compliance with published guidelines. Method The initial audit reviewed consent forms of patients undergoing emergency surgery over two-weeks in May 2020 while the re-audit was over a two-week period in June 2020 following implementation of interventions. Inclusion Criteria: Age &gt;18-years, urgent or emergency laparoscopic surgery Exclusion criteria: Age &lt;18-years, Open surgery, ‘Covid-light’ areas, NELA. Results 57 consent forms were assessed during the audit loop: 22 laparoscopic appendicectomies and diagnostic laparoscopies, 14 incision and drainage, 8 laparoscopic cholecystectomies, 4 hernia repairs, and 9 other procedures. Consenting for covid pneumonia increased from 70% to 89%, potential ITU admission 56% from 25% and the risk of death 63% from 21% Conclusions The covid pandemic changed our surgical practice. There are many unknowns regarding the risks to surgical patients, however, evidence shows increased risks of covid pneumonia, ITU admission and death in the perioperative period. Our consenting and the documentation of such conversations with patients must reflect our new reality.

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