scholarly journals Prediction of perioperative outcome after hepatic resection for pediatric patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jianxia Liu ◽  
Yunfei Zhang ◽  
Hai Zhu ◽  
Lin Qiu ◽  
Chunbao Guo
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Pringle Maneuver ◽  
Postoperative Outcomes ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Estimated Blood Loss

Abstract Background Hepatic resection is associated with significant risk of morbidity and mortality. Optimising the surgical techniques and perioperative management may improve in operative morbidity and mortality. However, perioperative variables involved in the improvement for postoperative outcomes in pediatric hepatectomy have not been defined. Methods We retrospectively reviewed 156 consecutive pediatric patients who underwent hepatectomy at our center (an academic tertiary care hospital) between 2006 and 2016. Baseline demographic variables, intraoperative variables, complications, and hospital stay were explored. The patients were further investigated using univariate and multivariate analysis for the factors involved in the postoperative outcomes. Results Of the conditions requiring resections, malignant and benign liver diseases accounted for 47.4% (74/156) and 52.6% (82/156), respectively. The overall hospital mortality was 1.9% (3/156) and the overall postoperative complication rate was 44.2% (69/156). Anatomical resections were performed in 128 patients (82.1%), including 14(9.0%) extended hepatectomies. Eighty percent of patients had three or more segments resected. The median operative time was 167.7 (65–600) minutes and median estimated blood loss was 320.1(10–1600) mL. On multivariate analysis, the estimated blood loss (EBL) (mL) (OR, 2.19; 95CI, 1.18–3.13; p = 0.016), extent of hepatectomy (OR, 1.81; 95CI, 1.06–2.69; p = 0.001) and pringle maneuver (OR, 1.38; 95CI, 1.02–1.88; p = 0.038) were the independent predictors of postoperative complications. Conclusions Extent of hepatectomy and estimated blood loss are largely responsible for the perioperative complications. With the surgical devices and management amelioration, like pringle maneuver, the treatment planning may be optimize in pediatric liver resection.

scholarly journals Prediction of perioperative outcome after hepatic resection for pediatric patients

2019 ◽  
Author(s):  
Yunfei Zhang ◽  
Jianxia Liu ◽  
Hai Zhu ◽  
Lin Qiu ◽  
chunbao guo
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Significant Risk ◽  
Pringle Maneuver ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Estimated Blood Loss

Abstract Background Hepatic resection is associated with significant risk of morbidity and mortality. Optimising the surgical techniques and perioperative management may improve in operative morbidity and mortality. However, perioperative variables involved in the improvement for postoperative outcomes in pediatric hepatectomy have not been defined.Methods We retrospectively reviewed 156 consecutive pediatric patients who underwent hepatectomy at our center (an academic tertiary care hospital) between 2006 and 2016. Baseline demographic variables, intraoperative variables, complications, and hospital stay were explored. The patients were further investigated using univariate and multivariate analysis for the factors involved in the postoperative outcomes.Results Of the conditions requiring resections, malignant and benign liver diseases accounted for 47.4% (74/156) and 52.6% (82/156), respectively. The overall hospital mortality was 1.9% (3/156) and the overall postoperative complication rate was 44.2% (69/156). Anatomical resections were performed in 128 patients (82.1%), including 14(9.0%) extended hepatectomies. Eighty percent of patients had three or more segments resected. The median operative time was 167.7 (65-600) minutes and median estimated blood loss was 320.1(10-1600) mL. On multivariate analysis, the estimated blood loss (EBL) (mL) (OR, 2.19; 95CI, 1.18-3.13; p=0.016), extent of hepatectomy (OR, 1.81; 95CI, 1.06-2.69; p=0.001) and pringle maneuver (OR, 1.38; 95CI, 1.02-1.88; p=0.038) were the independent predictors of postoperative complications.Conclusions Extent of hepatectomy and estimated blood loss are largely responsible for the perioperative complications. with the surgical devices and management amelioration, like pringle maneuver, the treatment planning may be optimize in pediatric liver resection.

scholarly journals Prediction of perioperative outcome after hepatic resection for pediatric patients

2019 ◽  
Author(s):  
Jianxia Liu ◽  
Yunfei Zhang ◽  
Hai Zhu ◽  
Lin Qiu ◽  
chunbao guo
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Significant Risk ◽  
Pringle Maneuver ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Estimated Blood Loss

Abstract Background Hepatic resection is associated with significant risk of morbidity and mortality. Optimising the surgical techniques and perioperative management may improve in operative morbidity and mortality. However, perioperative variables involved in the improvement for postoperative outcomes in pediatric hepatectomy have not been defined.Methods We retrospectively reviewed 156 consecutive pediatric patients who underwent hepatectomy at our center (an academic tertiary care hospital) between 2006 and 2016. Baseline demographic variables, intraoperative variables, complications, and hospital stay were explored. The patients were further investigated using univariate and multivariate analysis for the factors involved in the postoperative outcomes.Results Of the conditions requiring resections, malignant and benign liver diseases accounted for 47.4% (74/156) and 52.6% (82/156), respectively. The overall hospital mortality was 1.9% (3/156) and the overall postoperative complication rate was 44.2% (69/156). Anatomical resections were performed in 128 patients (82.1%), including 14(9.0%) extended hepatectomies. Eighty percent of patients had three or more segments resected. The median operative time was 167.7 (65-600) minutes and median estimated blood loss was 320.1(10-1600) mL. On multivariate analysis, the estimated blood loss (EBL) (mL) (OR, 2.19; 95CI, 1.18-3.13; p=0.016), extent of hepatectomy (OR, 1.81; 95CI, 1.06-2.69; p=0.001) and pringle maneuver (OR, 1.38; 95CI, 1.02-1.88; p=0.038) were the independent predictors of postoperative complications.Conclusions Extent of hepatectomy and estimated blood loss are largely responsible for the perioperative complications. with the surgical devices and management amelioration, like pringle maneuver, the treatment planning may be optimize in pediatric liver resection.

scholarly journals Prediction of perioperative outcome after hepatic resection for pediatric patients

2019 ◽  
Author(s):  
Jianxia Liu ◽  
Yunfei Zhang ◽  
Hai Zhu ◽  
Lin Qiu ◽  
chunbao guo
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Significant Risk ◽  
Pringle Maneuver ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Estimated Blood Loss

Abstract Background Hepatic resection is associated with significant risk of morbidity and mortality. Optimising the surgical techniques and perioperative management may improve in operative morbidity and mortality. However, perioperative variables involved in the improvement for postoperative outcomes in pediatric hepatectomy have not been defined.Methods We retrospectively reviewed 156 consecutive pediatric patients who underwent hepatectomy at our center (an academic tertiary care hospital) between 2006 and 2016. Baseline demographic variables, intraoperative variables, complications, and hospital stay were explored. The patients were further investigated using univariate and multivariate analysis for the factors involved in the postoperative outcomes.Results Of the conditions requiring resections, malignant and benign liver diseases accounted for 47.4% (74/156) and 52.6% (82/156), respectively. The overall hospital mortality was 1.9% (3/156) and the overall postoperative complication rate was 44.2% (69/156). Anatomical resections were performed in 128 patients (82.1%), including 14(9.0%) extended hepatectomies. Eighty percent of patients had three or more segments resected. The median operative time was 167.7 (65-600) minutes and median estimated blood loss was 320.1(10-1600) mL. On multivariate analysis, the estimated blood loss (EBL) (mL) (OR, 2.19; 95CI, 1.18-3.13; p=0.016), extent of hepatectomy (OR, 1.81; 95CI, 1.06-2.69; p=0.001) and pringle maneuver (OR, 1.38; 95CI, 1.02-1.88; p=0.038) were the independent predictors of postoperative complications.Conclusions Extent of hepatectomy and estimated blood loss are largely responsible for the perioperative complications. with the surgical devices and management amelioration, like pringle maneuver, the treatment planning may be optimize in pediatric liver resection.

scholarly journals Patient characteristics and cardiac surgical outcomes at a tertiary care hospital in Kenya, 2008–2017: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11191
Author(s):  
Tamara Chavez-Lindell ◽  
Bob Kikwe ◽  
Anthony Gikonyo ◽  
Agricola Odoi
Keyword(s):  
Surgical Complications ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Adult Patients ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Care Hospital ◽  
Risk Of Death

Background Cardiac surgeries are high risk procedures that require specialized care and access to these procedures is often limited in resource-poor countries. Although fatalities for surgical patients across Africa are twice that of the global rate, cardiac surgical mortality continent-wide is only slightly higher than all-surgical mortality. Understanding demographic and health characteristics of patients and the associations of these characteristics with morbidity and mortality events is important in guiding care decisions. Therefore, the objectives of this study were to: (a) describe the characteristics of cardiac surgical patients; (b) identify the associations between these characteristics and morbidity and mortality events following cardiac surgery. Methods Patient characteristics and post-surgical complications were abstracted for all cardiac surgical patients treated at a tertiary care hospital in Kenya from 2008 to 2017. Descriptive analyses of demographic factors, co-morbidities, peri-operative conditions, and post-surgical complications were conducted for adult and pediatric patients. Cochran-Armitage trend test was used to assess temporal trends in risk of death. Multivariable ordinary logistic and Firth logistic models were used to investigate predictors of surgical outcomes. Results The study included a total of 181 patients (150 adult and 31 pediatric patients). Most (91.3%) adult patients had acquired conditions while 45.2% of the pediatric patients had congenital defects. Adult patients tended to have co-morbid conditions including hypertension (16.7%), diabetes mellitus (7.3%), and nephropathy (6.7%). Most patients (76.0% adults and 96.8% pediatric patients) underwent ≤ 2 surgical procedures during their hospital stay. Seventy percent of adult and 54.8% of the pediatric patients experienced at least one post-surgical complication including mediastinal hemorrhage, acute kidney injury and death. Patient characteristics played the greatest roles in predicting post-surgical complications. For adult patients, significant predictors of acute kidney injury included atrial fibrillation (OR = 18.25; p = .001), mitral valve replacement (OR = 0.14; p = .019), and use of cardiopulmonary bypass (OR = 0.06; p = .002). Significant predictors of 30-day mortality were age (OR = 1.05; p = .015) and atrial fibrillation (OR = 4.12, p = .018). Although the number of surgeries increased over the decade-long study period, there were no significant (p = .467) temporal trends in the risk of death. Conclusions Awareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.

scholarly journals Emergency peripartum hysterectomy: a 3 year review at a tertiary care hospital in Vindhya region of India

2020 ◽  
Vol 9 (11) ◽  
pp. 4455
Author(s):  
Neha Khatik ◽  
Avani Pandey ◽  
Shabd Singh Yadav ◽  
Kalpana Yadav
Keyword(s):  
Blood Loss ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Total Abdominal Hysterectomy ◽  
Team Approach ◽  
Care Hospital ◽  
Peripartum Hysterectomy ◽  
Estimated Blood Loss ◽  
Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

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