scholarly journals Day surgery for achalasia cardia: Time for consensus?

2016 ◽  
Vol 98 (2) ◽  
pp. 150-154 ◽  
Author(s):  
DN Naumann ◽  
S Zaman ◽  
M Daskalakis ◽  
R Nijjar ◽  
M Richardson ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Day Surgery ◽  
Complication Rates ◽  
Day Case ◽  
Achalasia Cardia ◽  
Before And After ◽  
Consensus Decision ◽  
Symptom Recurrence

Introduction Laparoscopic Heller’s myotomy (LHM) is the most effective therapy for achalasia of the oesophagus. Most case series of LHM report a length of hospital stay (LOS) >1 day. We present 14 years of experience of LHM to examine the safety and feasibility of LHM as a day case procedure. Methods We retrospectively examined patients undergoing elective LHM for achalasia at our institution between 2000 and 2014. Demographics, episode statistics, prior investigations and interventions were collated. Outcomes, including LOS, complications and re-interventions, were compared for the periods before and after a consensus decision at our institution in 2008 to perform LHM as a day case procedure. Results Sixty patients with a mean age of 41±13 years were included, of whom 58% were male. The median LOS for all patients was 1 day (interquartile range [IQR] 0–2.25). Overall, LHM was performed as a day case in 27 (45%) cases, at 2/26 (7.7%) in the first period versus 25/34 (73.5%) in the second (p<0.01). There were no significant differences in age, gender or previous interventions between day surgery and non-day surgery groups. One patient required subsequent unplanned surgery, while six (10%) needed endoscopic treatment of recurrent symptoms within 12 months. Conclusions LHM can be performed safely as a day case procedure. Complication rates are low, with only a small proportion of patients requiring endoscopic treatment for symptom recurrence within 1 year.

scholarly journals Instantaneous Wave-Free Ratio Measurement During Intracranial Submaximal Angioplasty: Case Series and 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. 422-428
Author(s):  
Kunal Vakharia ◽  
Muhammad Waqas ◽  
Najya Fayyaz ◽  
Amanda Young ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Case Series ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Ratio Measurement ◽  
Pressure Wire ◽  
Before And After ◽  
Stenosis Severity

Abstract BACKGROUND Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively. OBJECTIVE To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty. METHODS We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty. RESULTS A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients. CONCLUSION iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.

scholarly journals Cataract Surgery Outcomes in New South Wales, Australia

1970 ◽  
Vol 12 (3) ◽  
pp. 124-129
Author(s):  
Rahul Dubey ◽  
Kenny Chan ◽  
Somsak Lertsumitkul ◽  
John Grigg ◽  
Peter Joseph McCluskey
Keyword(s):  
Visual Acuity ◽  
Quality Care ◽  
Case Series ◽  
Complication Rates ◽  
Retrospective Case ◽  
Good Visual Acuity ◽  
South Wales ◽  
Vitreous Loss ◽  
Before And After ◽  
Referral Hospitals

Aim: To prospectively assess the visual acuity outcomes of phacoemulsification surgery in 2 tertiary referral hospitals over an 8-year period, and to compare the outcomes achieved by ophthalmology consultants and registrars in routine clinical practice to assess the appropriateness of patient allocation.Methods: This prospective/retrospective case series of phacoemulsification surgery recruited patients from 1 July 2000 to 30 Dec 2008. Patients underwent detailed ophthalmic examination before and after surgery.Phacoemulsification and insertion of intraocular lens was performed by consultants and senior and junior registrars, who were allocated by the treating consultant. Postoperative review was conducted 1 day, 1 week, 1 month, and 3 months after surgery.Results: Of the 1812 cases, 1596 (88.1%) were complication free. The mean postoperative visual acuity was 0.17 LogMAR (6/9 Snellen equivalent), with 1630 cases (90.0%) achieving 0.30 LogMAR (6/12) or better. Consultants, and senior and junior registrars all achieved similar postoperative visual acuities of 0.15 to 0.17 LogMAR (p = 0.5). There was a significantly different rate of vitreous loss between the 3 groups (p = 0.002), with consultants at 2.9% (9/309), senior registrars at 1.9% (15/804) and junior registrars at 5.3% (37/699).Conclusions: The visual acuity outcomes and complication rates confirm that quality care is being delivered to patients. The different complication rates between consultants and registrars reflect consultants allocating themselves more complicated cases and the training of junior registrars. The similar postoperative visual acuities achieved showed that allocation of patients among consultants and registrars was appropriate and good visual acuity outcomes were delivered to all patients.

TM3-5 Venous sinus stenting for IIH: what are the long-term outcomes?

2019 ◽  
Vol 90 (3) ◽  
pp. e16.2-e16
Author(s):  
H Asif ◽  
C Craven ◽  
L Thorne ◽  
L Watkins ◽  
A Toma
Keyword(s):  
Stent Placement ◽  
Case Series ◽  
Venous Sinus ◽  
Stent Insertion ◽  
Complication Rates ◽  
Icp Monitoring ◽  
Clinical Notes ◽  
Before And After ◽  
Csf Diversion

ObjectivesIdiopathic intracranial hypertension (IIH) is associated with dural venous sinus stenosis (DVSS). This is increasingly treated with endovascular insertion of stents. Clinical and manometric improvements after stent placement have been described. However, there is little data reporting further need for CSF diversion, complication rates and sustained improvements in ICP.DesignSingle centre case series.SubjectsTwenty-four IIH patients underwent stent insertion on discovery of DVSS with medical management ongoing.MethodsClinical notes, radiographic reports and 24 hour ICP monitoring data before and after stent placement was collected.ResultsAfter 1089.2±107.1 days, 6 patients remained symptomatic and went onto require CSF diversion, 75.0% did not require CSF diversion. One patient developed stent thrombosis requiring VKA anticoagulation for 3 months, this patient also developed new stenosis proximal to the stent at 2 years. A second patient developed in-stent stenosis requiring balloon angioplasty at 2 years and subsequent repeat stenting at 3 years. Eleven patients had 24 hour ICP monitoring at baseline and a mean of 231.9±129.5 days after DVSS stent placement. The mean reduction in ICP was 7.92±1.80 mmHg (p<0.01) and PA was 2.84±0.84 mmHg (p<0.01).ConclusionsDVSS stenting is a viable endovascular therapy for IIH with modest long-term patency and ICP reduction. However, a quarter of stented patients required subsequent CSF diversion to manage their symptoms.

Is Same-Day Inguinal Hernia Surgery Possible?

2016 ◽  
Vol 101 (3-4) ◽  
pp. 137-143 ◽  
Author(s):  
Recai Capoglu ◽  
Cagri Tiryaki ◽  
Ertugrul Kargi ◽  
Emre Gonullu ◽  
Neset Nuri Gonullu ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Local Anesthesia ◽  
Length Of Hospital Stay ◽  
Day Surgery ◽  
Complication Rates ◽  
Hernia Surgery ◽  
Repair Method ◽  
Lichtenstein Hernia Repair

The Lichtenstein hernia repair is associated with low recurrence rates and short operation times, and can be performed under local anesthesia. Thus, this is among the most-preferred methods used in recent years. Our objective was to explore the same-day discharge rates, and the causes of delayed discharge and re-admission to hospital, of patients treated using the Lichtenstein repair method, to evaluate the feasibility of performing same-day hernia surgery in clinical practice. One hundred of a total of 236 patients diagnosed with unilateral inguinal or femoral hernias, who required surgical treatment, and who agreed with the conditions of the study, were prospectively included. All patients were treated using the Lichtenstein mesh repair method, under local anesthesia between June 2006 and January 2008. We investigated the types and locations of hernias, duration of surgery, seniority of the surgeon, the feasibility of same-day surgery in subgroups stratified by ASA risk scores, and postoperative complication rates, in patients who underwent inguinal surgery under local anesthesia. The rates of pain and postoperative complications were very low in hernia patients who underwent same-day surgery under local anesthesia. The operation reduces the length of hospital stay and helps patients mobilize earlier. Both the literature, and our data, indicate that inguinal hernia repair under local anesthesia is safe and effective, reducing anesthesia-related complications and the length of hospital stay; is cost-effective; and is applicable in all patients.

scholarly journals ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL

2020 ◽  
Vol 33 (3) ◽  
Author(s):  
Mauricio Adam Feitosa SAMPAIO ◽  
Simone Losekann Pereira SAMPAIO ◽  
Plinio da Cunha LEAL ◽  
Ed Carlos Rey MOURA ◽  
Lívia Goreth Galvão Serejo ALVARES ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Emergency Surgery ◽  
Caloric Intake ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Complication Rates ◽  
Postoperative Vomiting ◽  
Project Impact ◽  
Before And After ◽  
The Impact

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

EVALUATION OF DYSPHAGIA USING THE EATING ASSESSMENT TOOL QUESTIONNAIRE (EAT-10) BEFORE AND AFTER ENDOSCOPIC TREATMENT OF THE ZENKER DIVERTICULUM

2018 ◽  
Author(s):  
M Guerra Veloz ◽  
M Jose González-Mariscal ◽  
M Belvis Jimenez ◽  
J Loscertales ◽  
H Galera-Ruiz ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Assessment Tool ◽  
Zenker Diverticulum ◽  
Before And After

Evaluating Vitality and Periodontal Sensitivity of Teeth Adjacent to the Site of Open Sinus Lift Surgery before and after Treatment: A Case Series Study

2020 ◽  
Vol 30 (2) ◽  
pp. 77-81
Author(s):  
Amir Moeintaghavi ◽  
Negar Azami ◽  
Mohammad Sadegh Zohrevand ◽  
Farid Shiezadeh ◽  
Hamid Jafarzadeh ◽  
...  
Keyword(s):  
Case Series ◽  
Sinus Lift ◽  
Case Series Study ◽  
Before And After ◽  
Series Study

scholarly journals Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Amr Nady Abdelrazik ◽  
Ahmad Sameer Sanad
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Control Groups ◽  
Analog Scale ◽  
Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

2021 ◽  
pp. 000313482098881
Author(s):  
Yehonatan Nevo ◽  
Tali Shaltiel ◽  
Naama Constantini ◽  
Danny Rosin ◽  
Mordechai Gutman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Complication Rates ◽  
Activity Tracking ◽  
Primary Endpoints ◽  
Specific Complication ◽  
Secondary Endpoints ◽  
Enhanced Recovery Programs

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

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