Incidence and Association of Patient Safety Indicator 9 (Perioperative hemorrhage or hematoma) and clinical outcomes in Cardio-thoracic surgery hospital, Ain Shams University, Egypt

Background Patient Safety Indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. Aim the study aimed to measure the association between the AHRQ patient safety indicator PSI9 (Perioperative hemorrhage or hematoma) and the clinical outcome including death, readmission within 30 days and length of stay at the cardiothoracic surgery hospital Ain Shams University. Methods exploratory prospective cohort study was conducted to follow up patients from admission till 1 month after discharge at the cardiothoracic surgery hospital who fulfills the inclusion criteria. Data were collected for 330 patients through basic information sheet and follow-up sheet. Results the incidence rate of PSI9 was 49.54 per 1000 discharges. Demographic data was not significantly associated with increased incidence of PSI9. The risk of development of PSI9 was significantly higher in patients admitted directly to ICU [relative risk (RR) =5.6]. The risk of death and readmission was higher in cases developed PSI9 than the cases without PSI9 [RR = 2.40 (0.60-9.55) and 2.43 (0.636 - 9.48) respectively]. Conclusion high incidence rate of PSI9 and the incidence is higher in male gender and 60 years old and more patients. Those patients developed PSI9 were at high risk for readmission and death. Recommendations the hospital administration should consider strategies and policies to decrease the rate of PSI9 and subsequent unfavorable clinical outcomes.

When it is oportune to avoid cesarean myomectomy? An analysis of possible factors influencing duration of treatment in the intensive care unit

Background: Cesarean myomectomy (CM) is a controversial issue, even relatively contraindicated in obstetric practice. Recent reports showed that CM is not associated with increased morbidity, but those are lacking the data about risks of intensive care unit (ICU) treatment. Aim: The authors evaluated the factors affecting the duration of ICU treatment in patients after CM. Material and Methods: The study included 57 women who underwent CM and were postoperatively admitted and treated in ICU. Correlation analysis was used to estimate the effect of various parameters on the duration of ICU treatment. Results: There was a highly significant correlation between duration of ICU treatment and number of postoperative transfusions (p=0.001), duration of surgery (p=0.007), intraoprative hemorrhage (p=0.008) and myoma diameter (p=0.009). Duration of ICU treatment was also correlated with gestational age, hypertensive syndrome in pregnancy, preoperative hematocrit and hemoglobin values, number of intraoperative transfusions, postoperative hemorrhage and repeated myomectomy. Conclusions: In our report, longer ICU tretment was required in cases of perioperative hemorrhage, prolonged surgeries and those requiring perioperative transfusion. Patients who have had previous myomectomy, with lower preoperative hemoglobine and hematocrit vaues and bigger myomas are at risk of prolonged ICU treatment.

Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication.