scholarly journals Residents' Performance of Single-Incision Pediatric Endo-Surgery Appendectomy (SIPESA) Versus Conventional Laparoscopic Appendectomy (CLA) in Two Centers

2020 ◽  
Author(s):  
Enaam Raboei ◽  
Yazeed Owiwi ◽  
Alaa Ghallab ◽  
Ameen Alsaggaf ◽  
Turki Alofi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Armed Forces ◽  
Surgical Residents ◽  
Significant Difference ◽  
Medical City ◽  
Retrospective Comparative Study ◽  
Adequate Supervision ◽  
Operating Surgeon

Abstract Background: The outcome of SIPESA performed by surgical residents is explored once in the literature. To the best of our knowledge, there are no published studies comparing the outcome of SIPESA versus CLA performed by the surgical residents.Aim: To assess the outcome of SIPESA at King Fahd Armed Forces Hospital (KFAFH), Jeddah versus CLA at Prince Sultan Military Medical City (PSMMC), Riyadh performed by surgical residents. Material & Methods: A retrospective comparative study of the outcome of SIPESA versus CLA conducted in two centers from January 2011 to July 2018. The two groups were compared for age, seniority of operating surgeon, mean operative time (MOT), perioperative complications and length of hospital stay (LOS).Results: 136 appendectomies (83(61%) SIPESA & 53(39%) CLA) were performed by residents between January 2011 and July 2018 in both centers. Postoperative complications were reported in 3.8% of CLA and 3.6% of SIPESA. There was no significant difference in postoperative complications between the two groups. The MOT of SIPESA and CLA was 92.25 minutes & 87.85 minutes respectively. Conclusion: SIPESA and CLA performed by residents are equally safe and feasible with no added morbidity. We believe that this good outcome is related to the adequate supervision of residents by experienced surgeons in conjunction with a properly structured training program. There was no significant difference in the outcome of both groups.

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

2021 ◽  
pp. 1
Keyword(s):  
Postoperative Complications ◽  
Ileal Conduit ◽  
Perioperative Complications ◽  
Movement Time ◽  
Oral Intake ◽  
Total Cost ◽  
Handsewn Anastomosis ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

scholarly journals Enhanced recovery care versus traditional non- ERAS  care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Postoperative Fever ◽  
Vas Score ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

Profile of Patients with Completion Thyroidectomy and Assessment of Their Suitability for Outpatient Surgery

2011 ◽  
Vol 145 (5) ◽  
pp. 727-731 ◽  
Author(s):  
Gaosong Wu ◽  
Sara I. Pai ◽  
Nishant Agrawal ◽  
Jeremy Richmon ◽  
Alan Dackiw ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Vocal Fold ◽  
Outpatient Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Completion Thyroidectomy ◽  
Thyroid Lobectomy ◽  
Significant Difference ◽  
Symptomatic Hypocalcemia

Objective. Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure. Study Design. Case series with chart review. Setting. Tertiary care teaching hospital. Subjects and Methods. Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up. Results. Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation ( P = .50). Conclusion. Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions.

scholarly journals Enhanced recovery care versus traditional care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Care Group ◽  
Vas Score ◽  
Significant Difference ◽  
Traditional Care ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children of developmental dysplasia of the hip (DDH) between ERAS and traditional care group.Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). Pain response was better in the ERAS group than traditional care group in terms of mean 3-day VAS score (2.9±0.8 vs. 4.0±0.8, P<0.001) and maximum VAS score (4.1±0.8 vs. 4.9±0.8, P<0.001). However, there was no significant difference in the frequency of break-out pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276 ). The frequency of fever is lower in the ERAS group, possibly due to better temperature monitoring and management in the operating room. The frequency of urinary infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

scholarly journals Clavien Classification of Complication of Surgery in Emergency Laparotomy: A Study of 40 Cases in Combined Military Hospital.

2019 ◽  
Vol 11 (2) ◽  
pp. 7-13
Author(s):  
Md Mahboob Hasan ◽  
Md Abdul Matin ◽  
Sardar Shahnabi Jafran ◽  
Syeda Zeenat Laila ◽  
Md Monjur Hasan Mamun
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Armed Forces ◽  
Outcome Data ◽  
Military Hospital ◽  
Emergency Laparotomy ◽  
Female Ratio ◽  
Clavien Classification

Introduction: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers, therapies and over time. Objective: Objective of the study was to assess the Clavien classification of surgical complications of patients who underwent emergency laparotomy. Materials and Methods: The classification was tested on 40 patients who underwent emergency laparotomy in various Combined Military Hospitals (CMH) over a period of 09 years. Data recorded including demographics, clinical presentations, operating techniques, incision, post-operative complications and the duration of hospital stay. Results: Out of the total 40 patients, 28(70%) were male and 12(30%) female. Male: Female ratio was 2.33:1. A total of 29(72.50%) patients experienced postoperative complications. More than one complications occurred in 14(35%) patients. There were 13(32.50%) patients in the Clavien grade-I category, 09(22.50%) patients were classified as grade-II and grade-IIIa, 05(12.50%) patients had IIIb complications, grade-IVb and V complications occurred in 03(07.50%) patients each. The mean length of hospital stay was 15.28 days. Conclusion: This classification seems to be applicable in most parts of the world and may even be used by surgeons who are less experienced. In addition, standardization of postoperative care is essential to minimize postoperative complications. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 7-13

scholarly journals Bariatric fellowship positively influences early outcomes for laparoscopic Roux-en-Y gastric bypass surgery over seven years of independent practice

2018 ◽  
Vol 100 (8) ◽  
pp. 657-661 ◽  
Author(s):  
A Ilczyszyn ◽  
W Lynn ◽  
S Rasheed ◽  
J Davids ◽  
R Aguilo ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Learning Curve ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Risk Scores ◽  
Perioperative Outcomes ◽  
First Year ◽  
Independent Practice ◽  
Conversion To Open Surgery ◽  
Significant Difference

Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically demanding and has an associated learning curve. We published previously that bariatric fellowship reduces the learning curve of primary LRYGB and improves patient outcomes after one year of independent practice. However, the long-term effect of fellowship is unknown. We therefore aimed to compare the 30-day outcomes of LRYGB between the first year of a surgeon’s independent practice with the subsequent six years. Materials and methods A prospective database of patients undergoing primary LRYGB under a single surgeon from March 2010 until February 2017 was analysed. Two groups were studied: first year (< 1 year) and the subsequent six years (≥ 1 year) of independent practice. Patient demographics, length of hospital stay, conversion to open surgery, perioperative complications and mortality were compared. Results Among 279 eligible patients, 74 (26.5%) were in the < 1 year group and 205 (73.5%) in ≥ 1 year group. The preoperative risk scores, American Society of Anesthesiologists (ASA) grade, P = 0.00; obesity surgery mortality risk score (OS-MRS), P = 0.04) were significantly higher in ≥ 1 year group. There was no significant difference in perioperative outcomes (length of stay, P = 0.38; total complications, P = 0.20; readmissions, P = 1.00; reoperations, P = 0.60) between the two groups. Conclusions Bariatric fellowship reduces the learning curve for LRYGB and helps to achieve excellent outcomes in the first and subsequent years of independent practice. The higher risk profile of ≥ 1 year group did not equate to an increase in complications, suggesting that experience and standardisation may help in handling complex cases. To our knowledge, this represents the only such study in the literature.

scholarly journals With Adequate Supervision, the Grade of the Operating Surgeon is not a Determinant of Outcome for Patients Undergoing Urgent Colorectal Surgery

2007 ◽  
Vol 89 (8) ◽  
pp. 760-765 ◽  
Author(s):  
WJ Hawkins ◽  
KM Moorthy ◽  
D Tighe ◽  
K Yoong ◽  
RT Patel
Keyword(s):  
Colorectal Surgery ◽  
Primary Outcome ◽  
Systemic Complications ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Delayed Complications ◽  
Secondary Outcomes ◽  
Emergency Colorectal Surgery ◽  
Adequate Supervision ◽  
Operating Surgeon

INTRODUCTION It is essential that higher surgical trainees (HSTs) obtain adequate emergency operative experience without compromising patient outcome. The aim of this study was to compare the outcomes of patients operated by HSTs with those operated by consultants and to look at the effect of consultant supervision. PATIENTS AND METHODS A retrospective analysis of 362 patients who underwent urgent colorectal surgery was performed. The primary outcome was 30-day mortality. Secondary outcomes were intra-operative and postoperative surgery, specific and systemic complications, and delayed complications. RESULTS Comparison of the patients operated by a consultant (n = 190) and a HST (n = 172) as the primary surgeon revealed no significant difference between the two groups for age, gender, ASA status or indication for surgery. There was a difference in the type of procedure performed (left-sided resections: consultants 122/190, HST 91/172; P = 0.050). There was no difference between the two groups for the primary and secondary outcomes. However, HSTs operating unsupervised performed significantly fewer primary anastomoses for left-sided resections (P =0.019) and had more surgery specific complications (P = 0.028) than those supervised by a consultant. CONCLUSIONS HSTs can perform emergency colorectal surgery with similar outcomes to their consultants, but adequate consultant supervision is vital to achieving these results.

scholarly journals IS RIGHT DONOR NEPHRECTOMY SAFE? OUR EXPERIENCE IN ARMED FORCES INSTITUTE OF UROLOGY

2021 ◽  
Vol 71 (2) ◽  
pp. 409-13
Author(s):  
Haroon Sabir Khan ◽  
Arshad Mahmood ◽  
Ahsin Manzoor Bhatti ◽  
Sohail Sabir ◽  
Sarwar Alvi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Armed Forces ◽  
Warm Ischemia ◽  
Donor Nephrectomy ◽  
Warm Ischemia Time ◽  
Ischemia Time ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Related Donor ◽  
The Mean

Objective: To identify any adversities in the intraoperative and early postoperative outcome of right live-related donor nephrectomy. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2013 to Jul 2015. Methodology: A total of 143 successive patients underwent open live donor nephrectomies (right=41). Perioperative outcome for both sided procedures were analyzed to identify any difference as regard the intraoperative (warm ischemia time, total duration of surgery, peroperative complications) and early postoperative parameters (days of hospitalization, complications). Results: No statistically significant difference was found in studied parameters like total operative time, the warm ischemia time, duration of hospital stay and the intra- and early postoperative complications amongst both the groups. The mean warm ischemia time was 86 ± 12 seconds (Rt) versus 90 ± 12 seconds (Lt). The mean time for surgery was 110 ± 18.1 minutes (Rt) versus 121 ± 18.2 minutes (Lt). There were only five minor complications and one major complication. Conclusion: Right live-related donor nephrectomy is equally safe and feasible option with similar intra-and postoperative complications as for left side. Therefore, whenever required, it is safe to leave the donor with a better functioning kidney.

scholarly journals Quality of Life among Surgical Residents at King Abdulaziz Medical City in Jeddah, Saudi Arabia

2019 ◽  
Vol 7 (23) ◽  
pp. 4163-4167
Author(s):  
Malik Almailabi ◽  
Rakan Alajmi ◽  
Atheel Balkhy ◽  
Mohammed Khalifa ◽  
Zaher Mikwar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Saudi Arabia ◽  
Male And Female ◽  
Work Related ◽  
Surgical Residents ◽  
Significant Difference ◽  
Related Quality ◽  
Medical City ◽  
The Mean

BACKGROUND: Surgical residency program is considered one of the toughest residency programs, which affects quality of life of the residents during training years. To date, no study has evaluated quality of life among residents, especially surgical residents here in Saudi Arabia. AIM: The objective of this study is to evaluate quality of life among surgical residents. METHODS: The study is a cross-sectional study conducted during September 2018 in King Khalid Hospital at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. The study utilized the Work-Related Quality of Life, WRQoL, scale which measures perceived quality of life covering six domains: General Well-Being (GWB), Home-Work Interface (HWI), Job and Career Satisfaction (JCS), Control at Work (CAW), Working Conditions (WCS) and Stress at Work (SAW), in addition to demographic questions, asking about (age, gender, marital status, resident level, specialty, BMI, smoking, number of days of exercise per week, hours of sleep per day, on-calls per month, clinics per week, operations per week). RESULTS: Of the 99 surgical residents training at KAMC, 73 residents returned the survey with a response rate of 72.8%. The mean age of the residents was 28 ± 2.1 years with the mean BMI of 25 kg/m2. 54.8% were married, and 42.5% were smokers. Half of the residents (50.7%) working in King Abdulaziz Medical City have low work-related quality of life. In comparison between male and female residents’ overall Quality of life, there was no significant difference between them (p = 0.363). CONCLUSIONS: Our main study finding is that half of the residents (50.7%) working at KAMC has low work-related quality of life, and there is no significant difference between male and female residents. Further studies are needed to determine the causes and improve the work-related quality of life among surgical residents.

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