scholarly journals Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

2020 ◽  
Author(s):  
Wibke Schulte ◽  
Ilhamiyya Aliyeva ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Emergency Surgery ◽  
Online Survey ◽  
Elective Surgery ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Complication Rates ◽  
Emergency Patients ◽  
Artificial Opening

Abstract Background: The surgical creation of an artificial opening of the bowel, called ostomy, can become necessary for very different causative diseases. A special subgroup are ostomies created during emergency surgery, which pose particular challenges to affected patients. This work is dedicated to their detailed characterization.Methods: A retrospective analysis of surgical ostomy creations at an acute care university hospital and an online survey for patients with an ostomy were performed and evaluated.Results: In our study, about one third of all ostomies were created during emergency surgery (37.4%). Compared to patients who received an ostomy during elective surgery, emergency patients had a higher ASA score and diagnoses requiring acute surgical care. Patients undergoing emergency surgery were more likely to have inadequate preoperative medical education (60% vs. 33.3%, p=0.029), and rarely received preoperative ostomy marking (4% vs. 79.2%, p<0.001). Emergency patients underwent minimally invasive surgery less frequently (26.8% vs. 51.3%, p=0.001), and showed a higher rate of peristomal wound dehiscence (9.9% vs. 2.5%, p=0.028). Accordingly, emergency ostomies often resulted in an overall reduction in postoperative quality of life.Conclusion: Ostomies are often created during emergency surgery under suboptimal perioperative conditions. This results in higher complication rates and negative physical and psychological effects. Therefore, intensive interdisciplinary care is essential to provide the best possible care for patients affected by these artificially created intestinal outlets.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

Results of surgical treatment of pilonidal sinus in 50 patients operated by the Bascom 2 method – prospective study

2019 ◽  
Vol 91 (5) ◽  
pp. 1-5
Author(s):  
Paweł Dutkiewicz ◽  
Przemysław Ciesielski ◽  
Małgorzata Kołodziejczak
Keyword(s):  
Quality Of Life ◽  
Wound Healing ◽  
Pilonidal Sinus ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
Healing Time ◽  
Physical And Mental Health ◽  
The World ◽  
Wound Healing Time

Introduction: Treatment of the pilonidal sinus, due to the various surgery method, remains the current topic of discussion during surgeon meetings around the world. The newest methods of treatment consist in the excision and simultaneous closure of the wound with the cleft lift techniques. One of such methods is the Bascom 2 technique widely used in the world and less popular in Poland. Aim of the study: To evaluate the results of treatment of pilonidal cysts using the Bascom 2 method performed by one operator. Material and method: 50 patients (40 men, 10 women), Avg. 30.6 years of age, All patients treated with the Bascom 2 method in one surgical ward by one operator (resident during specialization training) with the use of a uniform surgical care for all operational protocols. The following were assessed: BMI, average hospitalization time, pain, post-operative complications, wound healing time, patient's quality of life, and the percentage of recurrences after surgery. The follow-up period ranged from 12 to 52 months. Results: Average BMI 27.13 kg / m2. Avg. time of hospitalization 2.95 days. Postoperative pain in the first 24 hours was on average 4.55 points. (+/- 2.24 points); on the 10th day of. 2.04 points (+/- 1.58 points); in the 30th day of the 0.76 points (+/- 1.1 points). Pain after healing 0.14 points (+/- 0.40 points). Postoperative complications occurred in 28.57% of patients (partial wound dehiscence (16.32%), serum leak (10.2%), hematoma (6.12%), total wound dehiscence (0%), wound infection (0%). The average time of full healing was 2.94 weeks. The recurrence occurred in one patient (2.04%). Conclusions: Bascom 2 method is characterized by low recurrence rate and short wound healing time. It is a safe, effective and patient-accepted treatment method. Statistically significantly improves the patient's quality of life one year after surgery in terms of both physical and mental health.

scholarly journals Evaluation of the McGrath® MAC videolaryngoscope in a tertiary teaching hospital

2016 ◽  
Vol 26 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Jolin Wong ◽  
Zihui Tan ◽  
Patrick Wong
Keyword(s):  
Confidence Interval ◽  
Success Rate ◽  
Online Survey ◽  
Elective Surgery ◽  
Good Choice ◽  
Tube Insertion ◽  
Tertiary Teaching ◽  
Airway Trauma ◽  
Difficult Airways

Background: Videolaryngoscopes have become increasingly popular in recent years for use in both normal and difficult airways. Despite this trend, their benefit remains controversial. The McGrath® MAC videolaryngoscope (Aircraft Medical Ltd, Edinburgh, UK) is used for first line or rescue intubation, and for training in videolaryngoscopy intubation. We conducted a prospective observational study to assess the performance of the McGrath® MAC. Methods: We evaluated the use of the McGrath® MAC videolaryngoscope from January 2016 to April 2016. We recruited 500 adult patients undergoing elective surgery requiring endotracheal intubation. Data was collected via an online survey. The primary outcome was the success of intubation with the McGrath® MAC. Secondary outcomes included the ease of the McGrath® MAC insertion, best glottic view, ease of tracheal tube insertion, number of intubation attempts, evidence of airway trauma, quality of view, adjunct used, airway manoeuvres used, quality of image on monitor screen and overall impression of the device. Results: A total of 428 responses were analysed. The overall success rate was 97.9% (95% confidence interval 96.0–99.0%). The success rate for those with predictors of difficult airway was 95.5% (95% confidence interval 87.6–99.5%). Easy scope insertion was reported by 97.2% of anaesthetists and 89.7% reported easy tube insertion. Some of our cases (1.9%) were complicated by airway trauma involving superficial oropharyngeal or lip injury. Conclusion: The McGrath® MAC videolaryngoscope is a good choice for a videolaryngoscope, conferring advantages of a high intubation success rate, ease of laryngoscope insertion and ease of intubation. It is suitable for use in predicted difficult airways.

scholarly journals 689 A Service Evaluation of Colonic Stent Procedures Over A 10 Year Period at University Hospital Bristol

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Y Embury-Young ◽  
F Caslake Holding ◽  
E Wates ◽  
J Shabbir
Keyword(s):  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Large Bowel ◽  
Elective Surgery ◽  
Symptom Relief ◽  
Service Evaluation ◽  
Large Bowel Obstruction ◽  
University Hospital ◽  
Stent Insertion ◽  
Colonic Stent

Abstract Introduction The National Institute of Clinical Excellence (NICE) updated guidance in January 2020 and recommend colonic stent insertion for acute left-sided bowel obstruction as either palliative treatment or a bridge to elective surgery. Colonic stent insertion has shown improved outcomes in reducing hospital stay and stoma rate when compared to emergency surgery in patients presenting with large bowel obstruction. Objectives This service evaluation aimed to identify indications, complications, and outcomes of colonic stent insertion at University Hospital Bristol(UHB). Method Retrospective analysis of all colonic stent procedures performed at UHB between 1st January 2010 to 31st May 2020. Results 87 patients had a colonic stent procedure. 60(69%) were performed as an emergency and 27(33%) electives. Obstruction was secondary to a tumour in 84(97%) patients and diverticular strictures in 3(3%). 19(22%) had stent insertion as a bridge to elective surgery. 64(74%) stents were successfully deployed. 15(75%) required emergency surgery where the stent was unsuccessful. Complications occurred in 9(14%) successfully deployed stents, including: perforation(1;1%); per-rectal bleed(1;1%); dislodgement(1:1%); bacterial translocation(1;1%); tenesmus(2;2%); more than one stent required(3;3%). 30-day mortality was 11%. Conclusions The majority of colonic stent procedures at UHB were for patients presenting with acute large bowel obstruction secondary to malignancy. Few of these patients were suitable for surgery and stent insertion primarily for symptom relief. Where stent insertion is unsuccessful there is a high conversion (75%) to emergency surgery. Complications were observed in 14% of stent procedures and 30-day mortality was 11%.

scholarly journals VA Video Telehealth and Training Programs During the COVID-19 Response

2021 ◽  
Author(s):  
Rhonda Johnston ◽  
Rita F. Kobb ◽  
Claire Marty ◽  
Padraic McVeigh
Keyword(s):  
Online Survey ◽  
Surgical Care ◽  
Office Visits ◽  
Face To Face ◽  
Patient Interaction ◽  
Telemedicine Consultation ◽  
Physician Patient ◽  
And Training

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were administered to gauge patient experience with electronic medical record-based telemedicine visits. Results: Participants noted several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. Thirty-six percent of the patients agreed that the quality of care was hindered by the lack of a physical exam, and 61.7% of the patients agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7), and 95.8% of the patients would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort to the in-office control, the telemedicine patients noted an improved ability to communicate with their physician in 5 out of 8 domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth provides satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

scholarly journals Complications of Spine Surgery in “Super Obese” Patients

2020 ◽  
pp. 219256822095339
Author(s):  
Gennadiy A. Katsevman ◽  
Scott D. Daffner ◽  
Nicholas J. Brandmeir ◽  
Sanford E. Emery ◽  
John C. France ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Complication Rate ◽  
Elective Surgery ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Control Group ◽  
Complication Rates ◽  
Obese Patients ◽  
Super Obese ◽  
Indications And Complications

Study Design: Retrospective chart review with matched control. Objective: To evaluate the indications and complications of spine surgery on super obese patients. Methods: A retrospective review assessed super obese patients undergoing spine surgery at a level-1 trauma and spine referral center from 2012 to 2016. Outcomes were compared to age-matched controls with body mass index (BMI) <50 kg/m2. The control group was further subdivided into patients with BMI <30 kg/m2 (normal) and BMI between 30 and 50 kg/m2 (obese). Results: Sixty-three super obese patients undergoing 86 surgeries were identified. Sixty patients (78 surgeries) were in the control group. Age and number of elective versus nonelective cases were not significantly different. Mean BMI of the super obese group was 55 kg/m2 (range 50-77 kg/m2) versus 29 kg/m2 in the controls (range 20-49 kg/m2). Fifty-two percent of surgeries were elective, and the most common indication was degenerative disease (39%). Compared with controls, super obese patients had a higher complication rate (30% [n = 19] vs 10% [N = 6], P = .0055) but similar 30-day mortality rate (5% vs 5%), a finding that was upheld when comparing super obese with each of the control group stratifications (BMI 30-50 and BMI <30 kg/m2). The most common complication among super obese patients was wound dehiscence/infection (n = 8, 13%); 2 patients’ surgeries were aborted. Complication rates for elective surgery were 21% (n = 7) for super obese patients and 4% (n = 1) for controls ( P = .121); complication rates for nonelective procedures were 40% (n = 12) and 14% (n = 5), respectively ( P = .023). Conclusion: The complication rate of spine surgery in super obese patients (BMI ≥ 50 kg/m2) is significantly higher than other patients, particularly for nonelective cases.

scholarly journals Gynaecomastia correction: A review of our experience

2014 ◽  
Vol 47 (01) ◽  
pp. 56-60 ◽  
Author(s):  
Arvind Mohan ◽  
Muhammad Adil Abbas Khan ◽  
Karthik Srinivasan ◽  
Jeremy Roberts
Keyword(s):  
Complication Rate ◽  
Case Series ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Male Population ◽  
Treatment Techniques ◽  
High Satisfaction ◽  
Superficial Wound

ABSTRACT Introduction: Gynaecomastia is a common problem in the male population with a reported prevalence of up to 36%. Various treatment techniques have been described but none have gained universal acceptance. We reviewed all gynaecomastia patients operated on by one consultant over a 7-year period to assess the morbidity and complication rates associated with the procedure. Materials and Methods: Clinical notes and outpatient records of all patients who underwent gynaecomastia correction at University Hospital North Staffordshire between 01/10/2001 to 01/10/2009 were retrospectively reviewed. A modified version of the Breast Evaluation Questionnaire was used to assess patients satisfaction with the procedure. Results: Twenty-nine patients and a total of 53 breasts were operated on during the study period. Patients underwent either liposuction alone (6 breasts - 11.3%), excision alone (37 breasts - 69.8%) or both excision and liposuction (10 breasts - 18.9%). Twelve operated breasts (22.6%) experienced some form of complication. Minor complications included seroma (2 patients), superficial wound dehiscence (2 patients) and minor bleeding not requiring theatre (3 patients). Two patients developed haematomas requiring evacuation in theatre. No cases of wound infection, major wound dehiscence or revision surgery were encountered. Twenty-six patients (89.7%) returned the patient satisfaction questionnaire. Patients scored an average 4.12 with regards comfort of their chest in different settings, 3.98 with regards chest appearance in different settings, and 4.22 with regards satisfaction levels for themselves and their partner/family. Overall complication rate was 22.6%. Grade III patients experienced the highest complication rate (35.7%), followed by grade II (22.7%) and grade I (17.6%). Overall complication rates among the excision only group was the highest (29.8%) followed by the liposuction only group (16.7%) and the liposuction and excision group (10.0%). There were high satisfaction rates amongst both patients and surgeon. Eleven patients (37.9%) had their outcome classified as ‘excellent’ by the operating surgeon, 16 patients (55.2%) as ‘good’, 1 (3.4%) as ‘satisfactory’ and 1(3.4%) as ‘poor’. Conclusion: Gynaecomastia is a complex condition which poses a significant challenge to the plastic surgeon. Despite the possible complications our case series demonstrates that outcomes of operative correction can be favourable and yield high levels of satisfaction from both patient and surgeon.

scholarly journals Evaluation of possum scoring system in patients undergoing laparotomy

2019 ◽  
Vol 6 (2) ◽  
pp. 512
Author(s):  
Manoharan G. V. ◽  
Vijayalakshmi G.
Keyword(s):  
Scoring System ◽  
Elective Surgery ◽  
High Risk Patient ◽  
Surgical Care ◽  
Scoring Systems ◽  
Patient Counseling ◽  
Emergency Group ◽  
Set Up ◽  
Prediction Of Complications

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient is at risk of developing complications contributes to the quality of surgical care and cost reduction in surgery. Among the variety of scoring systems used to identify the “high risk” patient POSSUM scoring is the most widely used.Methods: Patients undergoing laparotomy were selected serially and their physiological severity score on admission and operative severity scored at the end of 30days and compared with the POSSUM predicted score.Results: In the elective surgery group, patients with morbidity correlated with high POSSUM scores but due to low overall morbidity conclusions could not be drawn while in the emergency group predicted morbidity correlated well with observed results. The low overall mortality in the study group precluded meaningful analysis.Conclusions: POSSUM scoring system has an undeniable advantage in this set up for better patient counseling, improving the surgical outcomes in both emergency and elective wards and for better management of limited resources and manpower.

Palatal Fistula Risk after Primary Palatoplasty

2018 ◽  
Vol 55 (6) ◽  
pp. 807-813 ◽  
Author(s):  
Kimberly M. Daniels ◽  
Emily Yang Yu ◽  
Rebecca G. Maine ◽  
Yin Heng ◽  
Li Yang ◽  
...  
Keyword(s):  
United States ◽  
San Francisco ◽  
Rural China ◽  
Surgical Care ◽  
The United States ◽  
University Hospital ◽  
Chinese Patients ◽  
Fistula Formation ◽  
Complication Rates ◽  
Palatal Fistula

Background: Humanitarian surgical organizations provide palatoplasties for patients without access to surgical care. Few organizations have evaluated the outcomes of these trips. This study evaluates the palatal fistula rate in patients from two cohorts in rural China and one in the United States. Methods: This study compared the odds of fistula formation among three cohorts whose palates were repaired between 2005 and 2009. One cohort included 97 Chinese patients operated on by teams from the United States and Canada under the auspices of Resurge International. They were compared to cohorts at Huaxi Stomatology Hospital and the University of California San Francisco (UCSF). Age, fistula presence, and Veau class were compared among cohorts using Chi-square tests. Logistic regression was used to analyze predictors of fistula formation. Results: The fistula risk was 35.4% in patients treated by humanitarian teams, 12.8% at Huaxi University Hospital and 2.5% at UCSF ( P < 0.001). Age and Veau class were associated with fistula formation (Age P = 0.0015; Veau P < 0.001). ReSurge and Huaxi patients had 20.2 and 5.6 times the odds of developing a fistula, respectively, compared to UCSF patients ( P < 0.01, both). A multivariable model controlling for surgical group, age, and gender showed an association between Veau class and the odds of fistula formation. Conclusions: Chinese children undergoing palatoplasty by international teams had higher odds of palatal fistula than children treated by Chinese surgeons in established institutions and children treated in the United States. More research is required to identify factors affecting complication rates in low-resource environments.

scholarly journals Perioperative communication from the perspective of patients undergoing bariatric surgery

2014 ◽  
Vol 23 (2) ◽  
pp. 347-355 ◽  
Author(s):  
Caroline Lemes Pozza Morales ◽  
Jenefer Garcez Alexandre ◽  
Suzana Prim ◽  
Lúcia Nazareth Amante
Keyword(s):  
Bariatric Surgery ◽  
Multidisciplinary Team ◽  
Surgical Care ◽  
Perioperative Period ◽  
Communication Process ◽  
University Hospital ◽  
Southern Brazil ◽  
Individual Interviews ◽  
Surgical Unit

This was a qualitative and descriptive study that aimed to determine how patients understand instructions provided by a multidisciplinary team during perioperative periods of bariatric surgery. Data were collected through three individual interviews. Six patients admitted to a surgical unit of a university hospital in southern Brazil, in April and May 2012, participated in the study. Thematic analysis revealed three categories: communication in the perioperative period of bariatric surgery; quality of life and post- surgical care following bariatric surgery; and communication in the work process of the multidisciplinary team. The results showed satisfaction with the information received, but problems in the communication process and apprehension about life after surgery were highlighted. Furthermore, the absence of outpatient nursing care was demonstrated.

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