Comparison of transverse versus longitudinal skin incisions for femoral endarterectomy and patchplasty

Vascular ◽  
2021 ◽  
pp. 170853812110514
Author(s):  
Smilen Kuyumdzhiev ◽  
Galena Kuyumdzhieva ◽  
Alok Tiwari
Keyword(s):  
Length Of Stay ◽  
Femoral Artery ◽  
Wound Complication ◽  
Outpatient Setting ◽  
Wound Complications ◽  
Protective Effects ◽  
Readmission Rates ◽  
Backward Elimination ◽  
Intravenous Antibiotics ◽  
Angioplasty And Stenting

Introduction Access to the femoral artery for a femoral endarterectomy and patchplasty (CFE) can be undertaken either through transverse (TI) or longitudinal incision (LI). LIs have been shown in previous studies to have higher groin complications though these were undertaken in multiple types of vascular procedures. We looked at wound complications for patients undergoing elective CFE procedures only with or without angioplasty via TI or LI. Methods All patients who had undergone CFE were retrospectively analysed from a prospective database. Length of stay, wound complications and readmission rates were recorded. Factors for wound complication were looked at using logistic regression with backward elimination. Results 122 CFE procedures were performed (30 TI) over the study period. 92 (76.7%) of patients had a prosthetic patch used, whilst 57 (46.7%) patients underwent an adjunctive endovascular procedure, namely, iliac angioplasty and stenting. Median length of stay was 3 days for both groups. The wound complication rate was 6.7% in the TI group and 22.6% in the LI group. 85.6% of the wound complications were identified after discharge. 6/122 (4.9%) were readmitted for intravenous antibiotics, whilst others were managed in the outpatient setting. TI (aOR = 0.15; 95% 0.03–0.75) and combined open FE with endovascular revascularisation (aOR = 0.33; 95% 0.11–0.95) had protective effects on wound complications. Type of the patch used was not associated with any wound complications ( p = 0.07). Conclusion Compared to traditional LI, TI for CFE and OTA have lower risk of wound complications and reduced readmission rates in our series. We advocate adopting TI as the standard for femoral artery procedures rather than LI.

Postoperative continuous catheter-infused local anesthetic reduces pain scores and narcotic use after lower extremity revascularization

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 262-270 ◽  
Author(s):  
William Shutze ◽  
William P Shutze Jr ◽  
Purvi Prajapati ◽  
Gerald Ogola ◽  
Jordan Schauer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Local Anesthetic ◽  
Wound Complications ◽  
X Rays ◽  
Readmission Rates ◽  
Pain Scores ◽  
Average Pain ◽  
Revascularization Procedures ◽  
Lower Extremity Revascularization

Objective Postoperative pain following lower extremity revascularization procedures is traditionally controlled with narcotic administration. However, this may not adequately control the pain and puts the patient at risk for complications from opiate use. Here we report an alternative strategy for pain management using a continuous catheter-infused local anesthetic into the operative limb. Design Retrospective case–control study. Methods Patients undergoing lower extremity revascularization procedures using continuous catheter-infused local anesthetic were compared to similar patients undergoing similar procedures during the same time period who did not receive continuous catheter-infused local anesthetic. Records were reviewed for pain scores, narcotics consumption, length of stay, need for postoperative chest X-ray, supplemental oxygen use, wound complications, and 30-day readmission. Results There were 153 patients (mean age 69.5 years) from September 2011 to December 2014 who underwent common femoral artery procedures, femoral-popliteal bypass, femoral-tibial bypass, popliteal aneurysm repair, popliteal to pedal bypass, popliteal artery thrombo-embolectomy, sapheno-popliteal venous bypass, or ilio-femoral bypass. There were no significant differences between the continuous catheter-infused local anesthetic ( n=57) and control ( n=96) groups regarding age, body mass index, cardiac history, diabetes, hypertension, and procedures performed. The continuous catheter-infused local anesthetic group showed better cumulative average pain scores, better high pain scores on postoperative days 1–3, and better average pain scores on postoperative days 2–3 ( P<0.03). The continuous catheter-infused local anesthetic group had lower median narcotics consumption on postoperative days 1–2 ( P=0.02). No differences were found in postoperative length of stay, urinary catheter use, number of postoperative chest X-rays, oxygen use, mobilization, or fever. Wound complications occurred in 8.8% of the continuous catheter-infused local anesthetic group and in 11.5% of controls (P=0.79). Readmission rates were 23% (continuous catheter-infused local anesthetic) and 21% (controls; P=0.84). Conclusion Postoperative continuous catheter-infused local anesthetic reduces pain scores and pain medication use compared to standard opiate therapy in these patients, without increasing wound complication or readmission rates. Continuous catheter-infused local anesthetic appeared to have no effect on the incidence of pulmonary complications, mobilization, or fever.

scholarly journals Immediate versus Delayed Sarcoma Reconstruction: Impact on Outcomes

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kyle J. Sanniec ◽  
Cristine S. Velazco ◽  
Lyndsey A. Bryant ◽  
Nan Zhang ◽  
William J. Casey III ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Multidisciplinary Treatment ◽  
Wound Dehiscence ◽  
Wound Complication ◽  
Wound Complications ◽  
Immediate Reconstruction ◽  
Intravenous Antibiotics ◽  
Rare Malignancy ◽  
Management Algorithms ◽  
Sarcoma Patient

Background.Sarcoma is a rare malignancy, and more recent management algorithms emphasize a multidisciplinary approach and limb salvage, which has resulted in an increase in overall survival and limb preservation. However, limb salvage has resulted in a higher rate of wound complications.Objective.To compare the complications between immediate and delayed (>three weeks) reconstruction in the multidisciplinary limb salvage sarcoma patient population.Methods.A ten-year retrospective review of patients who underwent sarcoma resection was performed. The outcome of interest was wound complication in the postoperative period based on timing of reconstruction. We defined infection as any infection requiring intravenous antibiotics, partial flap failure as any flap requiring a debridement or revision, hematoma/seroma as any hematoma/seroma requiring drainage, and wound dehiscence as a wound that was not completely intact by three weeks postoperatively.Results.70 (17 delayed, 53 immediate) patients who underwent sarcoma resection and reconstruction met the inclusion criteria. Delayed reconstruction significantly increased the incidence of postoperative wound infection and wound dehiscence. There was no difference in partial or total flap loss, hematoma, or seroma between the two groups.Discussion and Conclusion.Immediate reconstruction results in decreased wound complications may reduce the morbidity associated with multidisciplinary treatment in the limb salvage sarcoma patient.

Banning the use of intracorporeal morcellation.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 132-132
Author(s):  
Julian C. Schink ◽  
Stephen F. Rechner ◽  
Douglas M VanDrie ◽  
Ralph N Rogers
Keyword(s):  
Length Of Stay ◽  
Vaginal Hysterectomy ◽  
Wound Complication ◽  
Abdominal Hysterectomy ◽  
Wound Complications ◽  
Safety Communication ◽  
Quality Reporting ◽  
Power Morcellation ◽  
Fda Safety Communication ◽  
One Year

132 Background: In response to the FDA safety communication we banned the use of intracorporeal morcellation effective April 22nd 2014. Clinicians expressed frustration and a concern that an increase in the abdominal hysterectomy rate or percentage, wound complications, and length of stay would occur. Our PDCA (plan, do, check, and act) safety process reviewed these quality and safety metrics one year later. Methods: This is a retrospective evaluation of a prospective institutional decision. Data evaluated in a patient anonymous fashion using Crimson and Optum quality reporting software. Results: In 2013 the power morcellator was used in 157 cases. In the twelve months following the ban, the wound complication rate, SSI's, and LOS all decreased, and vaginal hysterectomy rate increased. Conclusions: An institutional ban of intracorporeal and power morcellation resulted in a decrease in the overall number of hysterectomies, including abdominal hysterectomy. Laparoscopic supracervical hysterectomy was replaced by vaginal hysterectomy and an associated decrease in complications and length of stay. [Table: see text]

Length of Stay and Readmission Rates in Pediatric Acute Heart Failure

2021 ◽  
Vol 40 (4) ◽  
pp. S122-S123
Author(s):  
D.S. Burstein ◽  
C. Connelly ◽  
C.S. Almond ◽  
R.A. Niebler ◽  
J.A. Godown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Readmission Rates

Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

Impact of length of stay in psychiatric intensive care on the episode trajectory

2021 ◽  
Author(s):  
H. Thomas de Burgh ◽  
Jeremy McCabe ◽  
Kamal Gupta
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Extended Period ◽  
Post Discharge ◽  
Readmission Rates ◽  
Rapid Turnover ◽  
Complex Patients ◽  
Step Down ◽  
The Uk ◽  
Relationship Of

Background: Length of stay (LOS) on admission to psychiatric intensive care in the UK varies widely, with few studies examining the relationship of LOS to clinical outcomes. Data from two South London male PICUs delivering care with the contrasting philosophies of rapid turnover versus slower stepdown were investigated to determine if additional LOS correlated with clinical benefit.Method: Data on admissions to the PICUs were collected over six months and assessed for outliers and then for variance using Levene’s test. The variables were compared using independent samples t-tests. Pearson correlations were alsocalculated for the major variables.Results: Mean LOS was 8.4 days higher on PICU 1 (p = 0.026) and readmission rates to hospital 6 months post discharge were 27% higher on PICU 1 (p = 0.025). There were no strong correlations between LOS on either PICU and the other five variables examined.Conclusion: It was intuitive to expect better outcomes in the PICU with a slower turnover where complex patients could receive an extended period of re-evaluation of pharmacological treatments and engagement with services and could achieve a fuller recovery from the episode. However, this group had no reduction in LOS following step-down to the wards, readmission rates to PICU during in the index episode or re-hospitalisation six months following discharge. The PICU with a policy of rapid-turnover, concentrating on reducing acuity and risk and rapid step down, was equally effective on the measures evaluated.

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