scholarly journals Why complex surgeries in children are associated with poorer outcomes

2021 ◽  
Keyword(s):  
Quality Assurance ◽  
Surgical Procedures ◽  
Paediatric Anaesthesia ◽  
Morbidity And Mortality ◽  
Perioperative Outcome ◽  
Perioperative Morbidity ◽  
Complex Surgical Procedures

Despite obvious progress in perioperative morbidity and mortality we still face challenges in explaining why complex surgical procedures in children are associated with poorer outcomes. This review aims to address the importance of improving perioperative outcome through the implementation of strategies for quality assurance and the safe conduct of paediatric anaesthesia.

scholarly journals Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anne Knisely ◽  
Zhen Ni Zhou ◽  
Jenny Wu ◽  
Yongmei Huang ◽  
Kevin Holcomb ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Morbidity And Mortality ◽  
Perioperative Morbidity

scholarly journals Patient Selection for Day Case-eligible Surgery

2013 ◽  
Vol 119 (6) ◽  
pp. 1310-1321 ◽  
Author(s):  
Michael R. Mathis ◽  
Norah N. Naughton ◽  
Amy M. Shanks ◽  
Robert E. Freundlich ◽  
Christopher J. Pannucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Surgical Procedures ◽  
Patient Selection ◽  
Outpatient Surgery ◽  
Morbidity And Mortality ◽  
Day Case ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Selection For

Abstract Background: Due to economic pressures and improvements in perioperative care, outpatient surgical procedures have become commonplace. However, risk factors for outpatient surgical morbidity and mortality remain unclear. There are no multicenter clinical data guiding patient selection for outpatient surgery. The authors hypothesize that specific risk factors increase the likelihood of day case-eligible surgical morbidity or mortality. Methods: The authors analyzed adults undergoing common day case-eligible surgical procedures by using the American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2010. Common day case-eligible surgical procedures were identified as the most common outpatient surgical Current Procedural Terminology codes provided by Blue Cross Blue Shield of Michigan and Medicare publications. Study variables included anthropometric data and relevant medical comorbidities. The primary outcome was morbidity or mortality within 72 h. Intraoperative complications included adverse cardiovascular events; postoperative complications included surgical, anesthetic, and medical adverse events. Results: Of 244,397 surgeries studied, 232 (0.1%) experienced early perioperative morbidity or mortality. Seven independent risk factors were identified while controlling for surgical complexity: overweight body mass index, obese body mass index, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, previous cardiac surgical intervention, and prolonged operative time. Conclusions: The demonstrated low rate of perioperative morbidity and mortality confirms the safety of current day case-eligible surgeries. The authors obtained the first prospectively collected data identifying risk factors for morbidity and mortality with day case-eligible surgery. The results of the study provide new data to advance patient-selection processes for outpatient surgery.

scholarly journals Prognosis of gliomas in the 1970s and today

2005 ◽  
Vol 18 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Joachim Oertel ◽  
Ekaterina von Buttlar ◽  
Henry Werner Siegfried Schroeder ◽  
Michael Robert Gaab
Keyword(s):  
Mr Imaging ◽  
Surgical Procedures ◽  
Morbidity And Mortality ◽  
Low Grade ◽  
Perioperative Morbidity ◽  
Low Grade Gliomas ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Mean Time

The benefit of the current strategy for diagnosis (magnetic resonance [MR] imaging) and treatment (surgery, chemotherapy, radiotherapy) of gliomas, in contrast to the standard treatment in use before MR imaging and the micro-surgical era, has not yet been determined. A retrospective statistical analysis was performed for all patients with glioma who underwent surgery at a single institution between 1965 and 1974 (Group I, 88 patients) or 1986 and 1995 (Group II, 249 patients). There were no major differences in symptomatology, tumor localization, and number of surgical procedures. The mean time until tumor diagnosis was significantly shorter in Group II (Group I, 48 weeks; Group II, 19.5 weeks). Also, the mean time from initial symptoms to surgery was significantly shorter for high-grade gliomas in Group II (Group I, 16.3 weeks; Group II, 11.7 weeks). For high- as well as low-grade gliomas, there was a clear reduction of the perioperative morbidity and mortality rates in Group II. Nevertheless, for the postoperative duration of survival, no significant differences were demonstrated for high- or low-grade gliomas. Based on the results of this study, the perioperative morbidity and mortality rate as well as the time from diagnosis to treatment have been remarkably reduced within the last 30 years. Nevertheless, the overall prognosis for patients with gliomas has not changed from the 1970s until today. Thus, the introduction of modern diagnostic modalities and surgical procedures has not improved the outcome in patients with glioma. Further research to improve the treatment of this disease is urgently needed.

scholarly journals Venovenosus extrakorporális membránoxigenizációval (ECMO) végzett mellkassebészeti műtétek tapasztalatai Magyarországon. Retrospektív klinikai tanulmány

2019 ◽  
Vol 160 (42) ◽  
pp. 1655-1662
Author(s):  
Ildikó Madurka ◽  
Jenő Elek ◽  
Ákos Kocsis ◽  
László Agócs ◽  
Ferenc Rényi-Vámos
Keyword(s):  
Gas Exchange ◽  
Lung Resection ◽  
Lung Ventilation ◽  
Clinicopathological Characteristics ◽  
Morbidity And Mortality ◽  
Related Complication ◽  
Single Lung Ventilation ◽  
Perioperative Morbidity ◽  
Venovenous Ecmo ◽  
Vv Ecmo

Abstract: Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655–1662.

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