scholarly journals Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

2020 ◽  
Vol 30 (5) ◽  
Author(s):  
Kirubel Abebe ◽  
Biniyam Geremew ◽  
Befekadu Lemmu ◽  
Engida Abebe
Keyword(s):  
Mortality Rate ◽  
Anastomotic Leak ◽  
Elective Surgery ◽  
Perforated Appendicitis ◽  
Wound Dehiscence ◽  
Mortality Data ◽  
Abdominal Abscess ◽  
On Demand ◽  
Primary Surgery ◽  
Significant Difference

BACKGROUND: Complications from abdominal surgery may necessitate a second or more surgeries, re-laparotomy. It is associated with significant morbidity and mortality. Data on relaparotomy from the developing nations is limited. This study aims to assess the indications and outcome of patients who had relaparotomyMETHODS: A retrospective review of medical records of all patients who underwent Re-laparotomy at St. Paul’s Hospital Millennium Medical College from January 2016 to December 2017 was done.RESULT: Of 2146 laparotomies, 6.9% (149) needed re-laparotomy and 129 patients were analyzed. Most (123,95.3%) had on-demand re-laparotomy. Patients operated on emergency made 70.5% (91) of the cases making the ratio of emergency to elective surgery 2.4:1. The three most common surgeries that needed re-laparotomy were, Perforated appendicitis (35,27.1%), bowel obstructions (28,21.7%) , and trauma (20,13.4%). The most common indications for relaparotomy were intra-abdominal abscess (57,44.23%), wound dehiscence (17,13.2%) and anastomotic leak (15 ,11.6%). Surgical site infection (128,100%) and malnutrition (58,45%) were the leading complications. The overall mortality rate was 12.8 % (19). There was no statically significant difference in mortality rate between on-demand and planned re-laparotomy (P=0.388), urgency of the primary surgery (P=0.891) and the number of relaparotomy (p=0.629). Re-laparotomy for anastomotic leak(p=0.001) and patients above fifty years of age (P=0.015) had significant associations with mortality.CONCLUSION: Intra-abdominal abscess collection, wound dehiscence and anastomotic leak were the most common indications of re-laparotomies. Age above fifty years and anastomotic leaks were significantly associated with mortality 

scholarly journals Severity and prognosis in intensive care: prospective application of the Apache II Index

1999 ◽  
Vol 117 (5) ◽  
pp. 205-214 ◽  
Author(s):  
Joel Isidoro Costa ◽  
José Luiz Gomes do Amaral ◽  
Masashi Munechika ◽  
Yara Juliano ◽  
José Gomes Bezerra Filho
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Prognostic Index ◽  
Clinical Severity ◽  
Apache Ii ◽  
Sample Population ◽  
Significant Difference ◽  
Critical Patients

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

scholarly journals Differentiated approach to surgical treatment of atherosclerotic lesions of supra-aortic arteries

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
I. Kopolovets ◽  
P. Berek ◽  
V. Sihotsky ◽  
M. Kubikova ◽  
N. Torma ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Carotid Artery ◽  
Cerebrovascular Disease ◽  
Elective Surgery ◽  
Surgical Reconstruction ◽  
Atherosclerotic Lesions ◽  
Group I ◽  
Brachiocephalic Trunk ◽  
Significant Difference

Atherosclerotic lesions of the supra-aortic arteries are mainly localized in the carotid artery bifurcations – 57%, the subclavian artery – 18%, the vertebral arteries – 14%, the brachiocephalic trunk and the common carotid artery – 11%.Objective. Theobjective of the research was to systematize the principles of surgical treatment of patients with atherosclerotic lesions of the supra-aortic arteries taking into consideration their polymorbidity and the multicentricity of atherosclerosis.Materials and methods. The results of surgical reconstruction of the supra-aortic arteries in 468 patients were analyzed.All the patients were divided into two groups.Group I included 276 (59%) patients with previous surgical or endovascular intervention on any vascular territory for treatment of atherosclerotic lesions being admitted to the hospital for elective surgery on the extracranial arteries.Group II included 192 (41%) patients without previous surgical and invasive treatments of arterial pathology being hospitalized for surgery on the supra-aortic arteries.Results. In Group I, according to the objective and clinical methods of examination, the patients’ condition was more critical due to somatic and intraoperative risk. When analyzing the results of postoperative complications there was no statistically significant difference between both groups (p<0.05).The overall rate for serious complications (acute cerebrovascular disease and myocardial infarction) in both groups was 3.4%; the mortality rate was 1.1%.Conclusions. 1. Approximately 87% of surgical reconstructions of the aortic arch branches are aimed at the prevention of acute cerebrovascular disease. 2. Surgical treatment of atherosclerotic lesions of the supra-aortic arteries allows us to achieve good postoperative results (the overall rate for serious complications – 3.4%, the mortality rate –1.1%).

Perbandingan Linieritas Dalam Pendeteksian Faktor-Faktor Yang Mempengaruhi Angka Kematian Bayi Di Provinsi Aceh

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Desfira Ahya ◽  
Inas Salsabila ◽  
Miftahuddin
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Linear Model ◽  
Health Workers ◽  
Additive Model ◽  
Infant Mortality Rate ◽  
Mortality Data ◽  
Important Indicator ◽  
Penalized Spline ◽  
Aceh Province

Angka Kematian Bayi/ Infant Mortality Rate (IMR) merupakan indikator penting dalam mengukur keberhasilan pengembangan kesehatan. Nilai IMR juga dapat digunakan untuk mengetahui tingkat kesehatan ibu, kondisi kesehatan lingkungan dan secara umum, tingkat pengembangan sosio-ekonomi masyarakat. Penelitian ini bertujuan untuk memperoleh model IMR terbaik menggunakan tiga pendekatan: Model Linear, Model Linear Tergeneralisir dan Model Aditif Tergeneralisir dengan basis P-spline. Sebagai tambahan, berdasarkan model tersebut akan terlihat variabel yang mempengaruhi tingkat kematian bayi di provinsi Aceh. Penelitian ini menggunakan data jumlah kematian bayi di tahun 2013-2015. Data dalam penelitian ini diperoleh dari Profil Kesehatan Aceh. Hasil menunjukkan bahwa model terbaik dalam menjelaskan angka kematian bayi di provinsi Aceh tahun 2013-2015 ialah Model Linear Tergeneralisir dengan basis P-spline menggunakan parameter penghalusan 100 dan titik knots 8. Faktor yang sangat mempengaruhi angka kematian ialah jumlah pekerja yang sehat.   Infant mortality rate (IMR) is an important indicator in measuring the success of health development. IMR also can be used to knowing the level of maternal health, environmental health conditions and generally the level of socio-economic development in community. This research aims to get the best model of infant mortality data using three approaches: Linear Model, Generalized Linear Model and Generalized Additive Model with Penalized Spline (P-spline) base. In addition, based on the model can be seen the variables that affect to infant mortality in Aceh Province. This research uses data number of infant mortality in Aceh Province period 2013-2015. The data in this research were obtained from Aceh’s Health Profile. The results show that the best model can be explain infant mortality rate in Aceh Province period 2013-2015 is GAM model with P-spline base using smoothing parameter 100 and knots 8. Factor that high effect to infant mortality is number of health workers.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

scholarly journals NCOG-65. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN TUMORS IN GERIATRIC PATIENTS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii144-ii144
Author(s):  
Elizabeth Ginalis ◽  
Shabbar Danish
Keyword(s):  
Mortality Rate ◽  
Neurological Symptom ◽  
Geriatric Patients ◽  
Age Groups ◽  
Postoperative Mortality ◽  
Thermal Therapy ◽  
Partial Recovery ◽  
Intracranial Tumors ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference

Abstract INTRODUCTION There is a paucity of studies assessing the use of magnetic resonance-guided laser interstitial thermal therapy (LITT) in the elderly population. METHODS Geriatric patients (≥65 years) treated with LITT for intracranial tumors at a single institution from January 2011 to November 2019 were retrospectively identified. We grouped patients into two cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded. RESULTS There were 55 patients who underwent 64 distinct LITT procedures. The majority of tumors (62.5%) treated were recurrent brain metastasis/radiation necrosis. The median hospital length of stay was 1 day, with no significant difference between age groups. Hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (68.3%) were discharged to their preoperative accommodation. Rate of discharge to home was not significantly different between age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1%) were found to have acute neurological complications, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (n = 1). The complication and 30-day postoperative mortality rate were not significantly different between age groups. CONCLUSIONS LITT can be considered as a minimally invasive and safe neurosurgical procedure for treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential as neurosurgeons treat an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT.

Cricohyoepiglottopexy: long-term results in 55 patients

1999 ◽  
Vol 113 (6) ◽  
pp. 532-537 ◽  
Author(s):  
J. G. Lallemant ◽  
P. Bonnin ◽  
I. El-Sioufi ◽  
J. Bousquet
Keyword(s):  
Total Laryngectomy ◽  
Functional Result ◽  
Anterior Commissure ◽  
Long Term Results ◽  
Tumour Control ◽  
Primary Surgery ◽  
Significant Difference ◽  
Voice Preservation ◽  
Discharge From Hospital

AbstractNear total laryngectomy with cricohyoepiglottopexy (CHEP) allows cure of glottic carcinomas with voice preservation. The subject of this study was to evaluate CHEP in terms of tumour control and functional result in T1 and T2 glottic carcinomas.This study reviewed retrospectively 55 consecutive cases of CHEP performed between January 1, 1981 and September 1, 1992 with the exclusion of post-radiotherapy salvage surgery. CHEP was indicated for a T1a limit to the anterior commissure and/or with dysplasia of the other vocal fold (10 cases), T1b (11 cases) and T2 (34 cases) glottic carcinomas. All our patients have a follow-up of more than five years.The post-operative course after this surgery was generally uneventful. The median time to decannulation was 18 days, to removal of the nasogastric tube was 15 days and to discharge from hospital was 23 days. No significant difference was observed according to the preservation of one or both arytenoid cartilages. The long-term functional result can be considered to be good in three-quarters of cases, with normal oral swallowing and an easily understood voice. The remaining one quarter had a whispery voice and sometimes episodes of aspiration when swallowing liquids. In terms of oncological results, the five-year recurrence-free survival rate was 94 per cent for T1 and 84 per cent for T2. The ultimate tumour control (taking into account four cases of total laryngectomy) was 94 per cent for T1 and 93 per cent for T2.Primary surgery by CHEP therefore appears to be a good option for early glottic carcinomas. The main problem remains that voice recovery is mediocre in one quarter of patients.

scholarly journals Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Sivesh K. Kamarajah ◽  
Behrad Barmayehvar ◽  
Mustafa Sowida ◽  
Amirul Adlan ◽  
Christina Reihill ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Glomerular Filtration ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Major Complication ◽  
Postoperative Outcomes ◽  
Queen Elizabeth Hospital ◽  
Complication Rates ◽  
Significant Difference ◽  
The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

Abstract 257: Urban Teaching and Non-Teaching Hospitals Outcomes: Myocardial Infarction

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Priscilla O Okunji ◽  
Johnnie Daniel
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Income Group ◽  
The United States ◽  
Teaching Hospitals ◽  
Age Difference ◽  
Age Group ◽  
Urban Teaching ◽  
Significant Difference ◽  
The Impact

Background: Patients with myocardial infarction reportedly have different outcomes on discharge according to hospital characteristics. In the present study, we evaluated the differences between urban teaching hospitals (UTH) and non-teaching hospitals (NTH), discharged in 2012. We also investigated on the outcomes. Methods: Sample of 117,808 subjects diagnosed with myocardial infarction were extracted from a nationwide inpatient stay dataset using the International Classification Data, ICD 9 code 41000 in the United States, according to hospital location, size, and teaching status. Results: The analysis of the data showed that more whites were admitted to both teaching and non teaching hospitals with more males (~24%) admitted than their female counterparts. However, blacks were admitted more (~15%) in urban teaching hospitals than medium urban non teaching hospitals. Age difference was noted as well, while age group (60-79 years) were admitted more in UTH, inversely urban non-teaching hospitals admitted more older (80 years or older) age group. A significant difference (~28%) was observed in both hospital categories with UTH admitting more patients of $1.00 - $38,999.00 income group than other income categories. In addition, it was observed that patients with MI stayed more (~5%) for 14 or more days, and charged more especially for income group of $80,000 or above in UTH than NTH. No significant difference was found in the mortality rate for both hospital categories. Conclusion: The overall outcomes showed that the mortality rate between urban teaching and non-teaching hospitals were non significant, though the inpatients MI stayed longer and were charged more in UTH than NTH. The authors call for the study to be replicated with a higher level of statistical measures to ascertain the impact of the variables on the outcomes for a more validated result.

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