Does an enhanced recovery after surgery protocol affect perioperative surgical outcomes in stage III tubercular empyema? A comparative analysis of 243 patients

2020 ◽  
pp. 021849232096643
Author(s):  
Mohan Venkatesh Pulle ◽  
Neha Tiwari ◽  
Belal Bin Asaf ◽  
Harsh Vardhan Puri ◽  
Sukhram Bishnoi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Perioperative Outcomes ◽  
Control Group ◽  
Study Group ◽  
Intraoperative Blood Loss ◽  
Improved Outcomes ◽  
Prolonged Air Leak ◽  
Surgery Center

Background Enhanced recovery after surgery protocols in tuberculous empyema surgery have the potential for improved outcomes, but have not been studied widely. This study aimed to analyze the outcomes after implementation of an enhanced recovery after surgery protocol in patients undergoing surgery for tubercular empyema. Methods A retrospective analysis of patients who underwent surgery for tuberculous empyema in a dedicated thoracic surgery center from March 2012 to March 2019 was performed. The control group included patients operated on between March 2012 and March 2016. The enhanced recovery after surgery protocol was strictly introduced into our practice from April 2016. The study group included patients operated on between April 2016 and March 2019. All perioperative outcomes were measured, documented, analyzed, and compared between the two groups. There were 166 patients in the control group and 77 in the study group. Results Intraoperative blood loss ( p = 0.0001), prolonged air leak ( p = 0.04), chest tube duration ( p = 0.005), and length of stay ( p = 0.003) were significantly reduced in the study group. Overall rates of postoperative complications ( p = 0.04) including wound infection ( p = 0.01) were also significantly lower in the study group. Conclusions Implementation of an enhanced recovery after surgery protocol in patients undergoing surgery for tuberculous empyema is feasible and effective. Application of such a protocol leads to less intraoperative blood loss, shorter hospital stay and duration of chest drainage, and fewer complications. Application of enhanced recovery after surgery protocols are strongly recommended in tubercular empyema surgery.

scholarly journals Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?

2020 ◽  
Vol 6 (7) ◽  
pp. 1253
Author(s):  
Heempali Das Dutta ◽  
Pabina Rayamajhi ◽  
Nazeef Ibrahim
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postoperative Bleeding ◽  
University Teaching ◽  
Control Group ◽  
Study Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding ◽  
The Difference ◽  
And Control

<p class="abstract"><strong>Background:</strong> The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated.  </p><p class="abstract"><strong>Results:</strong> A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.</p><p><strong>Conclusions:</strong> There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy. </p>

scholarly journals EXPERIENCE OF ERAS PROTOCOL IMPLEMENTATION IN THE SURGICAL PRACTICE FOR THE TREATMENT OF POSTOPERATIVE VENTRAL HERNIA

2019 ◽  
pp. 98-100
Author(s):  
T. V. Tarasiuk ◽  
R. P. Yuzkiv
Keyword(s):  
Surgical Treatment ◽  
Enhanced Recovery ◽  
Anterior Abdominal Wall ◽  
Enhanced Recovery After Surgery ◽  
Average Duration ◽  
Control Group ◽  
Study Group ◽  
Laparoscopic Hernioplasty ◽  
Eras Protocol ◽  
Ventral Hernias

Aim: to study the experience of introducing elements of the protocol for enhanced recovery after surgery (ERAS) in the surgical treatment of postoperative ventral hernias. Materials and methods: This article presents the results of surgical treatment of 122 patients with postoperative ventral hernias, in whom in 24 (20%) cases operations on the anterior abdominal wall were performed laparoscopically (study group), in 98 (80%) - by “open” method (control group). Results: The average duration of the “open” operations was 135 ± 45 min., laparoscopic one - 120 ± 30 min. After laparoscopic hernioplasty patients became active within 1.5-2 hours after extubation. After the operation according to the sublay method, in 61.2% of cases the patient was verticalized and became active within the chamber after 5-6 hours, and in 38.7% of cases- during the first days after operation. Postoperative stay in hospital among patients in the control group after “open” hernioplasty was 7.3 ± 1.5, after laparoscopic surgery - 2.6 ± 1.2. Conclusions: Based on the analysis of the obtained results, it is possible to argue about the feasibility of introducing elements of the ERAS protocol for the surgical treatment of postoperative ventral hernias, especially when performing laparoscopic hernioplasty.

scholarly journals A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Li ◽  
Xi Liang ◽  
Shan Xu ◽  
Ye Xiong ◽  
Jianrong Huang
Keyword(s):  
Survival Rate ◽  
Blood Loss ◽  
Liver Failure ◽  
Control Group ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Liver Support ◽  
Liver Support System

AbstractWe aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

scholarly journals Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng’s multifunction operative dissector in laparoscopic hemihepatectomy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract Objectives This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). Methods We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. Results The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. Conclusions We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

scholarly journals Prophylactic Hypogastric Artery Ligation during Placenta Percreta Surgery: A Retrospective Cohort Study

2018 ◽  
Vol 08 (02) ◽  
pp. e142-e145
Author(s):  
Theresa Kuhn ◽  
Kristina Martimucci ◽  
Abdulla Al-Khan ◽  
Robyn Bilinski ◽  
Stacy Zamudio ◽  
...  
Keyword(s):  
Blood Loss ◽  
Retrospective Cohort ◽  
Placenta Percreta ◽  
Control Group ◽  
Study Group ◽  
Distributed Data ◽  
Hypogastric Artery ◽  
Blood Products ◽  
Artery Ligation ◽  
Cesarean Hysterectomy

Objective To evaluate if prophylactic hypogastric artery ligation (HAL) decreases surgical blood loss and blood products transfused. Study Design This is a retrospective cohort study comparing patients with placenta percreta undergoing prophylactic HAL at the time of cesarean hysterectomy versus those who did not. Data were presented as means ± standard deviations, proportions, or medians with interquartile ranges. Demographic and clinical data were compared in the groups using Student's t-test for normally distributed data or the Mann–Whitney U test for nonnormally distributed data. Fisher's exact test was used for proportions and categorical variables. Data are reported as significant where p was <0.05. Results There were 26 patients included in the control group with no HAL and 11 patients included in the study group. Estimated blood loss for the study group was 1,000 mL versus 800 mL in the control. Units of PRCBs transfused were 4.5 units in the study group versus 2 units for the control group. None of these measures were found to be statistically significant. Conclusion Our data suggest there was no benefit in the use of prophylactic HAL in decreasing surgical blood loss or amount of blood products transfused in patients who had a cesarean hysterectomy performed for placenta percreta. Précis Prophylactic HAL does not decrease blood loss during surgery for placenta percreta.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

Restrictive Pulmonary Dysfunction May Increase Blood Loss During Liver Resection

2021 ◽  
pp. 000313482110604
Author(s):  
Takahiro Yoshikawa ◽  
Daisuke Hokuto ◽  
Satoshi Yasuda ◽  
Naoki Kamitani ◽  
Yasuko Matsuo ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Resection ◽  
Blood Loss ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Pulmonary Dysfunction ◽  
Intraoperative Blood Loss ◽  
Control Groups ◽  
Anatomical Liver Resection ◽  
And Control

Background Restrictive pulmonary dysfunction (RPD) is a risk factor for perioperative complications during gastrointestinal surgery. We hypothesized that high airway pressure due to RPD results in increased intraoperative blood loss during liver surgery. Thus, we investigated the effects of RPD on perioperative outcomes for liver resection. Methods This study included 496 patients who underwent curative liver resection at our hospital between April 2009 and April 2020. Perioperative outcomes for the RPD and control groups were compared. Restrictive pulmonary dysfunction was defined as % vital capacity <80%. Results Forty-one patients (8.3%) had RPD. No significant differences were observed in intraoperative blood losses (440 mL vs 320 mL, P = .340), overall complication rates (29.3% vs 31.2%, P = .797), or pulmonary complication rates (4.9% vs 9.0%, P = .286) between the RPD and control groups. In the 256 patients who underwent anatomical liver resection, 18 patients (7.0%) had RPD. The intraoperative blood loss was significantly higher in the RPD group (925 mL vs 456 mL, P = .013), but no differences in the overall complication rates (44.4% vs 37.3%, P = .528) or pulmonary complication rates (11.1% vs 10.5%, P = .589) between the two groups were detected. A multivariate analysis showed that RPD was an independent risk factor for intraoperative blood loss ≥500 mL during anatomical liver resection (odds ratio 4.132; 95% confidence interval 1.135-15.045; P = .031). Discussion Restrictive pulmonary dysfunction may be a risk factor for intraoperative blood loss during anatomical liver resection, which requires exposure of the main hepatic vein.

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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