Journal articles on the topic 'Peri-operative data'
To see the other types of publications on this topic, follow the link: Peri-operative data.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Peri-operative data.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Bozzetti, Federico. "Peri-operative nutritional management." Proceedings of the Nutrition Society 70, no. 3 (May 31, 2011): 305–10. http://dx.doi.org/10.1017/s0029665111000486.
Full textAbstract:
The metabolic response to surgical trauma is mainly characterised by an increase in BMR, a negative N balance, increased gluconeogenesis and increased synthesis of acute-phase proteins. These reactions aim at ensuring the availability of endogenous substrates for healing wounds while the synthesis of acute-phase proteins enhances the scavenging process and helps repair. However, if this process is excessive or continues for too long, it leads to a progressive depletion of body compartment with a consequent adverse outcome. Obviously, the severity of such depletion is magnified if the patient is starving or is already malnourished and the consumption of lean body mass is not compensated by an exogenous supply of nutrients. The nutritional control of this metabolic reaction represents the traditional rationale for nutritional support of surgical patients. Subsequent data have shown that the negative effects of starvation are not simply due to the starvation per se but due to the starving gut, and peri-operative enteral nutrition has proven successful in blunting the metabolic response after injury and improving protein kinetics, net balance and amino acid flux across peripheral tissue and consequently in decreasing the complications. Finally, further clinical research has shown that many post-operative infections may result from immune suppression and that such state might be reversed to some degree by modulation of the immune response through specialised nutritional support in surgical patients, regardless of their nutritional status. This paper will focus on the updated evidence-based research on peri-operative nutrition (parenteral, enteral and immune-enhancing) in patients undergoing major surgery.
2
Sessler, D. I. "Big Data - and its contributions to peri-operative medicine." Anaesthesia 69, no. 2 (December 19, 2013): 100–105. http://dx.doi.org/10.1111/anae.12537.
Full text
3
Morgan, Ryan B., Allie Yan, Ankit Dhiman, Divya Sood, Cecilia T. Ong, Xiaoyang Wu, Ardaman Shergill, Blase N. Polite, Kiran Turaga, and Oliver Eng. "Survival in total preoperative verus perioperative chemotherapy for patients with metastatic high-grade appendiceal adenocarcinoma undergoing CRS/HIPEC." Journal of Clinical Oncology 40, no. 4_suppl (February 1, 2022): 90. http://dx.doi.org/10.1200/jco.2022.40.4_suppl.090.
Full textAbstract:
90 Background: Due to the relative infrequency of high grade appendiceal adenocarcinoma with peritoneal metastases, there is limited data to guide treatment strategies. Current practices for this disease are largely extrapolated from colon cancer patients with peritoneal metastases, who typically undergo six months of systemic chemotherapy in conjunction with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). The optimal timing of chemotherapy in relation to CRS/HIPEC remains unknown. In this study, we compare the efficacy of peri-operative chemotherapy to pre-operative chemotherapy alone. Methods: This is a retrospective review of patients who underwent CRS/HIPEC for high grade appendiceal cancers from a tertiary referral center from 2014-2020. Outcomes were compared between patients who underwent planned 6 months of chemotherapy followed by CRS/HIPEC (pre-operative group) versus planned 3 months of chemotherapy both pre- and post-operatively (peri-operative group). Results: 85 patients were treated for metastatic high-grade appendiceal cancers during the study period, of whom24 were eligible for inclusion. Of those included, 16 were in the peri-operative group and 8 in the pre-operative group. Most patients were white (75%), non-Hispanic (96%) and female (54%). Patients in the pre-operative group tended to be older (65 vs. 56 years, p = 0.02). For patients with specified histologic grading, poorly differentiated tumors were common (50%). Signet ring cell histology (42%) and mucinous features (67%) were frequent as well. Median overall survival was similar between the pre-operative and peri-operative groups (32.3 vs. 31.6 months, p = 0.97), although patients undergoing peri-operative treatment received fewer total cycles of chemotherapy on average (14.1 vs. 9.5 cycles, p < 0.01). Half of the patients in the peri-operative group (8/16) did not complete their chemotherapy regimen, with 75% discontinuing therapy due to chemotherapy-related toxicities. Within the peri-operative group, a non-significant decrease in median survival was observed for those who did not complete chemotherapy (27.8 vs > 53.6 months, p = 0.22). Conclusions: Peri-operative and total pre-operative chemotherapy strategies are associated with similar survival in patients with high grade appendiceal cancers undergoing CRS/HIPEC. Peri-operative administration may be limited by chemotherapy-related toxicities.
4
Diaz-Gil, Alicia, Joanne Brooke, Olga Kozlowska, Sarah Pendlebury, and Debra Jackson. "Care needs of people with dementia in the peri-operative environment: A systematic review." Dementia 19, no. 6 (November 12, 2018): 1889–906. http://dx.doi.org/10.1177/1471301218809225.
Full textAbstract:
The care of people with dementia within the hospital setting is challenging for healthcare professionals. Hospital design and services are not optimized for people with dementia, owing to the lack of preparation of healthcare professionals and the busy environment of the acute hospital. The peri-operative environment may present particular difficulties but little is known about the experience and care of people with dementia in this setting. The aim of this review was to examine the care of surgical patients who have dementia and their family members in peri-operative environments and describe strategies adopted by healthcare professionals. A systematic search of the following databases was completed: BNI, CINAHL, PubMED and PsychINFO in accordance with PRISMA guidelines. Data were extracted and analysed within a thematic analysis framework as described by Braun and Clarke . Ten papers based on eight studies were included, five (n = 355,010 participants) containing quantitative data and five reporting qualitative data (n = 395 participants). People with dementia who go undergo surgery experienced higher adverse post-operative outcomes such as respiratory problems or urinary tract infections. The key elements in surgical care for people with dementia included: health assessment throughout the surgical trajectory (pre-, intra- and post-operative) and the resources used by healthcare professionals in the peri-operative care. Healthcare professionals reported difficulties in the completion of health assessments due to the cognitive status of people with dementia and a lack of skills in dementia management. The use of restraints was still a common practice and a source of conflict. Dementia-specific training and guidelines focused on the care of surgical patients who have dementia in peri-operative environments are required to improve care and post-operative outcomes. More research is required to develop effective interventions to improve care and decrease the risk of complications for people with dementia in the peri-operative care environment.
5
Sylvester, D. C., and A. P. Coatesworth. "Antiplatelet therapy in ENT surgery: a review." Journal of Laryngology & Otology 126, no. 4 (December 19, 2011): 331–36. http://dx.doi.org/10.1017/s0022215111003239.
Full textAbstract:
AbstractIntroduction:Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.Methods:Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.Conclusion:Significant morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.
6
Jevons, G., H. Edginton, G. Mccall, A. Pillai, and S. Haque. "AB1345-HPR THE MULTIDISCIPLINARY FOOT CLINIC: A SERVICE EVALUATION PROJECT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1960.1–1961. http://dx.doi.org/10.1136/annrheumdis-2020-eular.343.
Full textAbstract:
Background:Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.Objectives:To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.Methods:Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.Results:Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.Conclusion:The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.Disclosure of Interests:None declared
7
Koea, Jonathan B., Yatin Young, and Kerry Gunn. "Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia." HPB Surgery 2009 (December 15, 2009): 1–8. http://dx.doi.org/10.1155/2009/271986.
Full textAbstract:
Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, ), less postoperative IV fluids (median 1200 mL versus 4300 mL, ) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, ) and had shorter hospital stays than those managed with epidural infusions (4.7 0.9 days versus 6.8 1.2 days, ). Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.
8
Thaly, R., K. Shah, and V. Patel. "408 ROBOTIC RADICAL PROSTATECTOMY: PERI-OPERATIVE AND OUTCOME DATA OF 500 CASES." European Urology Supplements 6, no. 2 (March 2007): 124. http://dx.doi.org/10.1016/s1569-9056(07)60406-0.
Full text
9
Owens, Gemma Louise, Vanitha Sivalingam, Mohamed Abdelrahman, James P. Beirne, Dominic Blake, Anna Collins, Rhianna Davies, et al. "Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?" International Journal of Gynecologic Cancer 30, no. 12 (October 12, 2020): 1959–65. http://dx.doi.org/10.1136/ijgc-2020-001834.
Full textAbstract:
IntroductionOlder patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.MethodsA web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1–7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.ResultsOf the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.ConclusionsObstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.
10
Haifler, Miki, Yossi Ventura, Kamil Malsha, Sagi Shpitzer, Amnon Zisman, Jack Baniel, Gilad Amiel, Azik Hoffman, and Shay Golan. "Neoadjuvant chemotherapy-induced sarcopenia to predict perioperative complications following radical cystectomy for bladder cancer." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 478. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.478.
Full textAbstract:
478 Background: Radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) is the standard of care for muscle invasive bladder cancer and has a high rate of complications. Malnutrition is common among RC patients and is an established risk factor for peri-operative complications. The association of NAC and nutritional status and its effect on post-operative complications is not fully understood. We hypothesize that NAC hinders nutritional status and thus increases complication rates after RC. Methods: We retrospectively examined the records of NAC/RC patients. We included demographic, clinical and pathologic data and type and cycle number of NAC. Nutritional status was assessed with the smooth muscle area (SMA) of the psoas muscle at the level of L4 vertebrae measured on cross-sectional imaging. Patients with missing imaging data were excluded. SMA was measured pre and post NAC. The difference between the measurements was used as a predictor variable (delta_SMA). The outcomes assessed were ileus, infection, rehospitalization and a composite outcome of any complication. Results: The study included 50 patients, from 3 high volume centers in Israel. Median delta_SMA was -197 (-366, -88) mm2. Demographic, clinical and pathologic parameters were similar in patients with and without complications. delta_SMA was an independent predictor of ileus (OR = 0.98, p=0.003), peri-operative infection (OR = 0.98, p=0.0015) and any complications (OR = 0.98, p = 0.011) on univariable analysis. Delta_SMA remained an independent predictor of ilieus (OR 0.97, p=0.014), peri-operative infections (OR 0.95, p=0.023) and any complications (OR 0.98, p=0.01) on multivariable regression analysis. Delta_SMA was not a significant predictor of rehospitalization. Conclusions: In patients undergoing RC, NAC causes a measurable nutritional insult. The change in SMA predicts significant peri-operative complications. Future studies should examine the role of nutritional intervention during NAC in the framework of a clinical trial.
11
Myles, P. S., J. B. Carlisle, and B. Scarr. "Evidence for compromised data integrity in studies of liberal peri‐operative inspired oxygen." Anaesthesia 74, no. 5 (February 17, 2019): 573–84. http://dx.doi.org/10.1111/anae.14584.
Full text
12
Radaelli, Stefano, Anant Desai, Chiara Colombo, Marco Fiore, and Alessandro Gronchi. "Peri-operative Therapies for Localized Retroperitoneal Soft Tissue Sarcoma." Oncology & Hematology Review (US) 08, no. 01 (2012): 65. http://dx.doi.org/10.17925/ohr.2012.08.1.65.
Full textAbstract:
Retroperitoneal soft tissue sarcomas are rare solid tumors that usually arise in the retroperitoneum or the pelvis. They are often large at presentation and push adjacent structures, displacing them, anatomically. The most common adult histotypes are liposarcoma and leiomyosarcoma. Five-year overall survival is less than 50 % and is mainly determined by the high incidence of local relapse and to a lesser extent by their capacity to metastasize. Radical surgery is still the most effective treatment. While an aggressive surgical policy consisting of multivisceral resections ‘en bloc’ with the mass has undoubtedly decreased, the rate of local recurrence, prognosis remains poor. Retrospective analyses and early prospective data suggest a benefit from using neoadjuvant radiotherapy in order to improve local control. Chemotherapy plays an important role in advanced disease, but very little evidence supports a real advantage in delivering it prior to surgery to make the resection more likely to achieve clear margins or postoperatively to decrease the risk of systemic recurrence. Further studies are required to explore the role of these neoadjuvant/adjuvant therapies, particularly in the context of new developments in molecular therapeutic agents.
13
Fawcett, Jonathan, Katrin Marie Sjoquist, Rob Padbury, Christopher Christophi, Niall Christopher Tebbutt, Charles Henry Caldow Pilgrim, Val Gebski, Nicole Wong, Christine Aiken, and David Goldstein. "ATTACHE: A phase III, multicenter, randomized comparison of chemotherapy given prior to and post surgical resection versus chemotherapy given post surgical resection for hepatic metastases from colorectal cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): TPS3643. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.tps3643.
Full textAbstract:
TPS3643 Background: No randomized studies have directly compared the role of peri-operative to adjuvant chemotherapy for resectable liver metastases. Benefit from post operative compared to peri-operative treatment has been suggested in a recent retrospective study of 499 patients with resected colorectal liver metastases which showed improved survival with entirely post-operative chemotherapy. Given this data and that of the small randomised trials demonstrating improved surgical outcomes with adjuvant chemotherapy, the role of entirely post-operative chemotherapy as a means of improving outcomes while reducing the negative effects of pre-operative treatment needs to be examined. Methods: 200 patients randomized 1:1 to 6 months of treatment post-operatively or 3 months of treatment pre-operatively and 3 months post-operatively. Site investigators will nominate chemotherapy schedule (mFOLFOX6, XELOX or FOLFIRI when adjuvant oxaliplatin received previously) prior to randomisation. Primary endpoint: proportion of patients in each arm with surgical complications within 30 days. Secondary endpoints: proportion of patients completing planned chemotherapy, post operative mortality rate (in each group), tolerability and safety of treatment, response rate by RECIST V1.1 and CEA, time to progression, time to treatment failure, overall survival, QoL (EORTC QLQ-C30 and QLQ-LMC21). A planned prospective meta-analysis with MRC (UK) and NSABP C-11 trials will have sufficient power to examine the effect of schedule (peri- or post-operative) on progression free survival (PFS). Eligibility: Patients with histologically proven colorectal cancer with radiologically confirmed, resectable liver metastases without evidence of extra-hepatic disease are eligible. Patients with synchronous metastases who have undergone resection of the primary tumour are eligible but patients requiring combined resection of primary cancer and liver metastatic disease are excluded. Patients with involved hilar nodes or wound implant metastases will not be eligible. Trial Status: Study opened to accrual August 2011.
14
Iwadoh, K., Y. Ogawa, M. Soeno, K. Miki, K. Kai, A. Sannomiya, T. Murakami, et al. "Prediction of Renal Allograft Function at POD 7 With Pre/Peri-Operative Clinical Data." Transplantation 98 (July 2014): 565–66. http://dx.doi.org/10.1097/00007890-201407151-01900.
Full text
15
Naredla, P., A. Khan, and M. Ahmed. "Outcomes and peri operative morbidity of spine procedures- Our results compared to GIRFT data." International Journal of Surgery 55 (July 2018): S85—S86. http://dx.doi.org/10.1016/j.ijsu.2018.05.405.
Full text
16
Zhang, Oscar, Robert Alzul, Matheus Carelli, Franca Melfi, David Tian, and Christopher Cao. "Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer." Journal of Personalized Medicine 12, no. 8 (August 12, 2022): 1311. http://dx.doi.org/10.3390/jpm12081311.
Full textAbstract:
(1) Background: Conventional open thoracotomy has been the accepted surgical treatment for resectable non-small cell lung cancer. However, newer, minimally invasive approaches, such as robotic surgery, have demonstrated similar safety and efficacy with potentially superior peri-operative outcomes. The present study aimed to quantitatively assess these outcomes through a meta-analysis. (2) Methods: A systematic review was performed using electronic databases to identify all of the relevant studies that compared robotic surgery with open thoracotomy for non-small cell lung cancer. Pooled data on the peri-operative outcomes were then meta-analyzed. (3) Results: Twenty-two studies involving 12,061 patients who underwent robotic lung resection and 92,411 patients who underwent open thoracotomy were included for analysis. Mortality rates and length of hospital stay were significantly lower in patients who underwent robotic resection. Compared to open thoracotomy, robotic surgery was also associated with significantly lower rates of overall complications, including atrial arrhythmia, post-operative blood transfusions, pneumonia and atelectasis. However, the operative times were significantly longer with robotic lung resection. (4) Conclusions: The present meta-analysis demonstrated superior post-operative morbidity and mortality outcomes with robotic lung resection compared to open thoracotomy for non-small cell lung cancer.
17
Lim, Howard John, Hae Rin Kim, Devin Schellenberg, Christian K. Kollmannsberger, and Winson Y. Cheung. "Comparison of adjuvant chemoradiation to perioperative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 139. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.139.
Full textAbstract:
139 Background: There are several accepted peri-operative treatment modalities for resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In 2008, peri-operative chemotherapy (CT) using the MAGIC protocol was adopted as the preferred approach over adjuvant chemoradiation with the MacDonald protocol (cXRT) in British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from pharmacy records of patients (pts) referred to 1 of 5 cancer treatment centres in BC were analyzed from Jan 2001-July 2010. Pts that underwent curative resection for GC or GEJ were included. The cXRT cohort was defined as those treated from Jan 2001-Dec 2007, prior to the introduction of CT. The CT cohort included those treated from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: Table 1 summarizes the patient characteristics. In the CT arm, there were more males, fewer pts with a LN ratio >0.2, and shorter median follow-up. 92.1% completed pre-operative chemotherapy and 44.7% completed post-operative chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). Median survival was 37.5 and 36.9 months in the CT and cXRT arms, respectively. Conclusions: Delivery of CT was consistent with the MAGIC trial whereas more patients completed cXRT than in the MacDonald trial (73.3% vs. 64%). Outcomes of CT compared to cXRT appear to be similar in this comparative analysis with similar relapse and survival rates. Pre-operative CT results in fewer pts with a LN ratio > 0.2. Either modality can be considered in the peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]
18
Siddiqui, Muhammad Mujtaba Ali, Muhammad Zubair Ahmad Ansari, and Abdul Ghaffer. "Outcome of open heart surgery in patients with age above 75 years." Professional Medical Journal 27, no. 07 (July 10, 2020): 1521–26. http://dx.doi.org/10.29309/tpmj/2020.27.07.4776.
Full textAbstract:
Objectives: Open heart surgery is considered as high risk procedure in elderly patients. We study the operative outcomes of open heart surgery in patients of age above 75 years in geography of world where life expectancy is around 67 years. Study Design: Retrospective Study. Setting: Research of Rawalpindi Institute of Cardiology (RIC). Periods: From January 2014 to December 2018. Material & Methods: Demographic and baseline characteristics of patients were retrieved from cardiac surgery database (cascade, Lahore) of RIC. For all patients who underwent open heart surgery and had age above 75 years. Operative mortality, neurological outcome, low cardiac output state(LCOS), peri-operative myocardial infarction, postop.erative atrial fibrillation (POAF), acute kidney injury (AKI), chest reopening, ICU stay, hospital stay and 1-year survival etc. Are analyzed from retrieved data. Results: Operative mortality is 5.71%, type II neurological deficit is 16.42% and POAF is 25%. Incidence of peri-operative mi, lcos, aki and chest reopening etc is low along with acceptable ICU stay and hospital stay durations. 1-years survival is 95.46%. Conclusion: open heart surgery can be offered to patients with age above 75 years with low operative mortality and morbidity except with relatively higher incidence of type ii neurological deficit and POAF. 1- years survival is impressive with figures of 95.46%.
19
Cifarelli, Christopher. "SURG-02. INTRAOPERATIVE RADIOTHERAPY FOR BRAIN METASTASES: EVALUATION OF ELECTROCORTICOGRAPHY AND PERI-OPERATIVE SEIZURE RISK." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii251. http://dx.doi.org/10.1093/neuonc/noac209.968.
Full textAbstract:
Abstract BACKGROUND Intraoperative radiotherapy (IORT) has emerged as a viable tool for consolidation of surgery and radiation for brain metastases into a single episode of care, but its relative novelty compared to SRS or fractionated radiotherapy warrants evaluation of its safety. While post-operative seizure risk is typically minimal with the use of anti-epileptic drugs during the peri-operative phase, the risk of intra-operative epileptiform discharge remains unknown. METHODS Five consecutive cases of surgically resected brain metastases treated with IORT underwent electrocorticography via direct cortical electrode recordings adjacent to the resection cavity with paddle electrodes used for mapping of phase reversal. Continuous recordings were made before, during, and after radiation delivery and analyzed for evidence of radiation-associated changes. RESULTS No evidence of significant electrophysiological change was noted in any of the cases, nor was there any clinical evidence of seizure in the immediate peri-operative period. These data represent the first direct cortical recordings in human subjects during the delivery of radiation. CONCLUSIONS In this small cohort of IORT treated resected brain metastases, the delivery of intra-operative radiation does not appear to impact cortical activity or precipitate post-operative seizures. Further studies are needed to determine the long-term incidence of treatment associated changes if they exist.
20
Polito, Angelo, Zaccaria Ricci, Tiziana Fragasso, and Paola E. Cogo. "Balloon atrial septostomy and pre-operative brain injury in neonates with transposition of the great arteries: a systematic review and a meta-analysis." Cardiology in the Young 22, no. 1 (November 9, 2011): 1–7. http://dx.doi.org/10.1017/s1047951111001909.
Full textAbstract:
AbstractObjectiveTo perform a systematic review and a meta-analysis of the effects of balloon atrial septostomy on peri-operative brain injury in neonates with transposition of the great arteries.Data sourceWe conduct a systematic review of the literature to identify all observational studies that included neonates born with transposition of the great arteries who had peri-operative evidence of brain injury.Study selection and data extractionThe search strategy produced three prospective and two retrospective cohort studies investigating the association between balloon atrial septostomy and brain injury totalling 10,108 patients. In two studies, the outcome was represented by the presence of a coded diagnosis of a clinically evident stroke at discharge, whereas in three studies the outcome was represented by the finding of pre-operative brain injury identified by magnetic resonance scans.Data synthesisThe overall brain injury rate for neonates who underwent balloon atrial septostomy versus control patients was 60 of 2273 (2.6%) versus 45 of 7835 (0.5%; pooled odds ratio, 1.90; 95% confidence intervals, 0.93–3.89; p = 0.08). A subgroup analysis of the three studies that used pre-operative brain injury as the primary outcome found no significant association between balloon atrial septostomy and brain injury (pooled odds ratio, 2.70; 95% confidence intervals, 0.64–11.33; p = 0.17). Balloon atrial septostomy frequency was 22.4% (2273 of 10,108), with reported rates ranging from 20% to 75%.ConclusionOur analysis shows that balloon atrial septostomy is not associated with increased odds for peri-operative brain injury. Balloon atrial septostomy should still be used for those patients with significant hypoxaemia, haemodynamic instability, or both.
21
Shivji, Salma, Philip Chiang, Lana A. Castellucci, and Elianna Saidenberg. "The Peri-Operative Management of Anticoagulants: Systemic Review of Guidelines." Blood 134, Supplement_1 (November 13, 2019): 4974. http://dx.doi.org/10.1182/blood-2019-128395.
Full textAbstract:
Introduction Venous thromboembolism (VTE) and atrial fibrillation are thrombotic disorders resulting in significant morbidity and mortality, if left untreated. In Canada, 45,000 people, or 1-2 cases per 1000 people, per year will experience an acute VTE, and it is estimated that 200,000 Canadians have atrial fibrillation. The treatment of VTE and atrial fibrillation often includes the use of anticoagulants. Patients on anticoagulation may need interruption of treatment for surgeries and procedures. To evaluate differences in perioperative anticoagulation management strategies we conducted a systematic review of the peri-operative clinical practice guidelines for anticoagulants. Methods A protocol using the Preferred Reporting Items for Systematic review and Meta-analysis Protocols (PRISMA-P) was developed. Relevant primary clinical practice guidelines were identified using MEDLINE, EMBASE, and guideline-specific databases. All guidelines from the preceding 20 years up to January 11, 2019 were screened. Eligible manuscripts were reviewed by two independent reviewers. Data abstraction was independently completed in duplicate for included guidances and categorized according to thrombotic risks and bleeding risks. Guidances on emergency surgeries were not included for the purposes of this review. Information on anticoagulation interruption, bridging regimens, laboratory testing, and reversal strategies were collected. Results Eight guidelines met inclusion criteria and 6 contained sufficient information for peri-operative management of anticoagulants. One guideline focused on patients presenting with bleeding events and restated the same peri-operative guidelines as had been published a year prior by the same group, and was excluded. Another guideline only addressed emergency surgeries and was also excluded from this review. The majority of the guidelines had similar definitions of risk factors for venous and arterial thrombotic events (see table 1). There were no conflicting guidance recommendations identified, but there were differences in the component of peri-operative management addressed by each guideline, ie bridging, reversal agents, laboratory tests. The levels of evidence used to develop recommendations varied between guidelines. All guidelines provided recommendations on warfarin and low molecular weight heparins (LMWH) management and only one guideline provided suggestions for direct oral anticoagulants (DOACs). The findings for perioperative anticoagulation management for patients with atrial fibrillation and VTE are presented in Tables 2 and 3, respectively. For high bleeding risk surgeries, most guidelines cited similar studies resulting in similar recommendations for interruption of warfarin and bridging in high venous and arterial thrombotic risk patients. In high bleeding risk procedures and low thrombotic risk patients, no bridging is recommended. For low bleed risk procedures, regardless of thrombotic risk, guidelines recommended for continuation of anticoagulant therapy. Discussion This systematic review identified 6 guidelines of non-urgent peri-operative management recommendations of primarily warfarin and LMWH in patients with VTE and atrial fibrillation. While no major discrepancies in the guideline suggestions were noted, the scope of data examined (medication management, bridging, blood tests, reversal of agents) differed amongst the various agencies. The guidelines that were most consistent for recommendations of anticoagulant management and bridging tended to be from hematologic societies. The only guideline that addressed perioperative management of DOACs was the 2018 ASH guideline on management of VTE which was against measurement of DOAC levels prior to procedures. The lack of thorough guidance for DOACs is likely due to the year of publication of the guidelines examined and paucity of contributing studies. In terms of reversal agents, all clinical practice guidelines except for the ASH guidelines were prior to specific DOAC reversal agents such as idaracizumab. Future Directions We anticipate that there will be other guidelines developed that address specifically the use of DOACs in the perioperative setting, as well as their reversal agents. Disclosures Shivji: BMS-Pfizer Thrombosis Canada: Other: Fellowship award. Castellucci:BMS: Honoraria; Pfizer: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria; Sanofi: Honoraria; Aspen: Honoraria; Servier: Honoraria.
22
Clapp, Benjamin L., Robert Cullen, Christopher Dodoo, Carl Devemark, Elizabeth De La Rosa, Jesus Gamez, and Alan Tyroch. "Comparison of peri-operative bariatric complications using two large databases: does the data add up?" Surgery for Obesity and Related Diseases 14, no. 11 (November 2018): S66. http://dx.doi.org/10.1016/j.soard.2018.09.102.
Full text
23
Lordan, Jeffrey T., Tim R. Worthington, Nial Quiney, William J. Fawcett, and Nariman D. Karanjia. "Operative Mortality, Blood Loss and the Use of Pringle Manoeuvres in 526 Consecutive Liver Resections." Annals of The Royal College of Surgeons of England 91, no. 7 (October 2009): 578–82. http://dx.doi.org/10.1308/003588409x432473.
Full textAbstract:
INTRODUCTION Centres with high volumes of high-risk surgery have significantly better outcomes than low-volume centres for pancreatic resection, oesophagectomy and pelvic exenteration. However, this has not to date been conclusively demonstrated for hepatic resection. With increased experience, operative practice can change. The use of the Pringle manoeuvre reduced substantially over a 12-year period in a single centre as it was felt anecdotally that its use increased the incidence of hepatic insufficiency and operative mortality. This study was designed to review 12 years of experience in a single hepatobiliary centre PATIENTS AND METHODS Data regarding 526 consecutive liver resections were prospectively recorded and retrospectively analysed in a high-volume referral unit over a 12-year period. Patients' demographics, operative mortality and morbidity were analysed on an annual basis. RESULTS Overall peri-operative mortality was 1.9%. Operative mortality in the first 6 years compared to the latter 6 years was 4.1% and 1.2%, respectively (P = 0.13). The morbidity rate was 26.8% and 20.3% in the first and second halves of the study, respectively (P = 0.15). With increased experience, intra-operative blood loss and patients receiving blood transfusions decreased (P = 0.047 and 0.03, respectively) while the number of intra-operative Pringle manoeuvres also decreased (P < 0.0001). Hospital stay decreased significantly over the 12 years (P = 0.049). CONCLUSIONS High-volume centres are the safest environment for hepatic resection. With increased experience, it may be possible to reduce the intra-operative use of the Pringle manoeuvre without increasing the intra-operative blood loss. This may be associated with a decrease in hepatic insufficiency and peri-operative mortality.
24
Quigley, Robert L., David W. Fried, Jan L. Kramer, Richard Y. Highbloom, John Pym, Steven J. Weiss, and Janet Gonzalez. "Passive Retrograde Cerebral Perfusion (PRCP)Following Routine Cardiac Valve Surgery Eliminates the Risk of Peri-Operative Cerebral Vascular Accidents." Stroke 32, suppl_1 (January 2001): 378. http://dx.doi.org/10.1161/str.32.suppl_1.378-d.
Full textAbstract:
P215 A post-operative neurologic event, in the open heart patient, is second only to a low cardiac output state as the complication most highly associated with in-hospital death. In the elderly, the incidence of a cerebral vascular accident (CVA), following cardiac valve surgery in particular, may be as high as 11%. This may be the result of either macro-embolism (air/debris) or inadequate perfusion pressure. We have previously demonstrated in a cohort of valve patients that upon discontinuation of cardiopulmonary bypass (CPB) the risk of peri-operative stroke could virtually be eliminated by opening a shunt for three minutes between the arterial (in-flow) and venous (out-flow) limbs of the extra-corporeal circuit. This phenomenon, passive retrograde cerebral perfusion (PRCP), reverses blood flow in the middle cerebral arteries. In this study, we have further evaluated PRCP in an older population with more co-morbidities to determine if there exists any limitations to the procedure. One hundred eight consecutive patients with a mean age of 68 years (range 38- 90 years) underwent elective valve repair/replacement and PRCP was instituted. The mean shunt flow rate was 2.6 Liters/minute (L/m) with a range of 1.9–4.0 L/m. The incidence of peri-operative CVA (30 day) was 0% (0/108). The incidence of CVA in published retrospective data is 0.7–3.8% and 4.8–5.2% in prospective data. In this report, we confirm that PRCP following valve surgery eliminates the risk of peri-operative CVA. We frequently perform the procedure as an adjunct to on-pump coronary artery bypass surgery in the context of suspected intra-ventricular thrombus or an artheromatous ascending aorta. We hypothesize that the principles of PRCP could easily be applied to Port surgery now that the instrumentation is trans-thoracic since aortic occlusion is still performed with an intra-vascular device.
25
Lau, JC, and JF Megyesi. "P.092 Ommaya reservoir placement for intraventricular chemotherapy: a retrospective case series in the image-guidance era." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S2 (June 2016): S41—S42. http://dx.doi.org/10.1017/cjn.2016.194.
Full textAbstract:
Background: In 1963, Ayub Ommaya proposed a surgical technique for placement of a subcutaneous reservoir and pump to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion in adults is for patients with hematologic or leptomeningeal disorders who require repeated injection of chemotherapy into the CSF space. Historically, the intraventricular catheter has been inserted blindly based on anatomical landmarks. The purpose of this study was to determine short-term complication rates from Ommaya reservoir placement in the image-guidance era. Methods: We retrospectively evaluated all operative cases of image-guided Ommaya reservoir insertion from 2004-2014 by the senior author (JFM). Patient demographic data and peri-operative complications were collected. Results: We identified 28 patients over the study period (43.3+/-17.3 years; 64.3% male). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There was one asymptomatic peri-operative intracranial hemorrhage (3.6%), and one early infection (3.6%). All catheters were well-positioned and functional. Conclusions: In our retrospective single-centre case series, all catheters were placed accurately. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective Ommaya reservoir placement for intraventricular chemotherapy.
26
Brown, Audrey E., Amy M. Shui, Dieter Adelmann, Neil Mehta, Garrett R. Roll, Ryutaro Hirose, and Shareef M. Syed. "Number of Local Regional Therapies for Hepatocellular Carcinoma and Peri-Operative Outcomes after Liver Transplantation." Cancers 15, no. 3 (January 19, 2023): 620. http://dx.doi.org/10.3390/cancers15030620.
Full textAbstract:
The wait times for patients with hepatocellular carcinoma (HCC) listed for liver transplant are longer than ever, which has led to an increased reliance on the use of pre-operative LRTs. The impact that multiple rounds of LRTs have on peri-operative outcomes following transplant is unknown. This was a retrospective single center analysis of 298 consecutive patients with HCC who underwent liver transplant (January 2017 to May 2021). The data was obtained from two institution-specific databases and the TransQIP database. Of the 298 patients, 27 (9.1%) underwent no LRTs, 156 (52.4%) underwent 1-2 LRTs, and 115 (38.6%) underwent ≥3 LRTs prior to LT. The patients with ≥3 LRTs had a significantly higher rate of bile leak compared to patients who received 1-2 LRTs (7.0 vs. 1.3%, p = 0.014). Unadjusted and adjusted regression analyses demonstrated a significant association between the total number of LRTs administered and bile leak, but not rates of overall biliary complications. The total number of LRTs was not significantly associated with any other peri-operative or post-operative outcome measure. These findings support the aggressive use of LRTs to control HCC in patients awaiting liver transplant, with further evaluation needed to confirm the biliary leak findings.
27
Melnikoff, Anna K., David W. Doo, Alexander C. Cohen, Emily Landers, Christen Walters-Haygood, Gerald McGwin, J. Michael Straughn, Jr., and Kenneth H. Kim. "Timing of robotic hysterectomy after cervical excisional procedure." International Journal of Gynecologic Cancer 29, no. 7 (July 30, 2019): 1110–15. http://dx.doi.org/10.1136/ijgc-2019-000559.
Full textAbstract:
IntroductionWhile traditional teaching has been to wait 6 weeks between cervical excisional procedure and hysterectomy, studies have produced conflicting evidence, with data supporting a delay of anywhere between 48 hours to 6 weeks depending on surgical approach. Our study sought to evaluate if the time between cervical excisional procedure and robotic hysterectomy impacts peri-operative complication rates.MethodsA retrospective cohort of patients who underwent robotic hysterectomy from August 2006 to December 2013 for cervical dysplasia or International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1–B1 cervical cancer at a single tertiary care center was performed. Patients were categorized into three groups: early surgical intervention (<6 weeks from excisional procedure), delayed surgical intervention (≥6 weeks from excisional procedure), and no excisional procedure. Secondary analysis was performed by hysterectomy type (simple vs radical). Peri-operative outcomes and complications were compared. Statistical analysis included Chi-square, Fisher’s exact test, and Wilcoxon rank sum test.ResultsA total of 160 patients were identified. Of these, 32 (20.0%) had early surgical intervention, 52 (32.5%) had delayed surgical intervention, and 76 (47.5%) had no excisional procedure. There was no difference between groups in complication rates, including average estimated blood loss (82 vs 55 vs 71 mL; p=0.07), urologic injury (0% in all groups; p=1.0), anemia (3% vs 0% vs 1%; p=0.47), infection (0% vs 2% vs 3%; p=1.0), vaginal cuff separation (0% in all groups; p=1.0), or venous thromboembolism (0% vs 0% vs 1%; p=1.0). Additionally, there were no differences in length of stay (p=0.18) or 30-day readmission rates (p=1.0). Finally, there were no significant differences in peri-operative outcomes when stratified by radical versus simple hysterectomy.DiscussionWaiting 6 weeks between cervical excisional procedure and robotic hysterectomy does not impact peri-operative complication rates. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy.
28
Rezaianzadeh, Abbas, Behzad Maghsoudi, Hamidreza Tabatabaee, Sareh Keshavarzi, Zahra Bagheri, Javad Sajedianfard, Hamid Gerami, and Javad Rasouli. "Factors associated with extubation time in coronary artery bypass grafting patients." PeerJ 3 (December 3, 2015): e1414. http://dx.doi.org/10.7717/peerj.1414.
Full textAbstract:
Background and Objectives.Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG) has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis.Method.This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients’ information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software.Results.The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB), packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU.Conclusion.Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients’ prognosis.
29
Farnworth, MJ, JK Walker, KA Schweizer, C.-L. Chuang, S.-J. Guild, CJ Barrett, MC Leach, and NK Waran. "Potential behavioural indicators of post-operative pain in male laboratory rabbits following abdominal surgery." Animal Welfare 20, no. 2 (May 2011): 225–37. http://dx.doi.org/10.1017/s0962728600002712.
Full textAbstract:
AbstractThis study aimed to identify behaviours that could be used to assess post-operative pain and analgesic efficacy in male rabbits. In consideration of the ‘Three Rs’, behavioural data were collected on seven male New Zealand White rabbits in an ethically approved experiment requiring abdominal implantation of a telemetric device for purposes other than behavioural assessment. Prior to surgery, rabbits were anaesthetised using an isoflurane/oxygen mix and given Carprofen (2 mg kg−1) as a peri-operative analgesic. Rabbits were housed individually in standard laboratory cages throughout. Data were collected at three time periods: 24-21 h prior to surgery (T1) and, post-surgery, 0-3 h (T2) and 3-6 h (T3). Behavioural changes were identified using Observer XT, significance of which was assessed using a Friedman's test for several related samples. The frequency or duration of numerous pre-operative behaviours was significantly reduced in T2 and T3, as compared to T1. Conversely, novel or rare behaviours had either first occurrence or significant increase in T2 into T3 as compared to T1, these include ‘full-body-flexing’, ‘tight-huddling’, ‘hind-leg-shuffling’. We conclude that reduced expression of common pre-operative behaviours and the appearance of certain novel post-operative behaviours may be indicative of pain in rabbits. Behaviours identified as increased in T2 as compared to T1 but not consistently elevated into T3 were considered separately due to the potentially confounding effect of anaesthesia recovery. These included lateral lying, ‘drawing-back’, ‘staggering’ and ‘closed eyes’. We postulate that for effective application of best-practice post-operative care, informed behavioural observation can provide routes by which carers may identify requirements for additional post-operative analgesia. Additionally, improvement of the peri-operative pain management regimen may be required to ameliorate the immediate effects of abdominal surgery. Comparisons with other studies into post-operative pain expression in rabbits suggest behavioural indicators of pain may differ, depending on housing and surgical procedure.
30
S., Ravi K., Kiran M. Naik, Nikethan ., and Aniketh V. R. "A clinical study of effect of peri-tonsillar infiltration of ropivacaine on tonsillectomy haemorrhage." International Journal of Otorhinolaryngology and Head and Neck Surgery 8, no. 2 (January 25, 2022): 96. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20220041.
Full textAbstract:
<p><strong>Background:</strong> The aim of this study to determine the relationship between the peritonsillar infiltration of ropivacaine hydrochloride and haemorrhage in patients undergoing tonsillectomy.</p><p><strong>Methods </strong>This prospective study was conducted in the department of otorhinolaryngology and head and neck surgery, Adichunchanagiri institute of medical sciences, B. G. Nagara, Mandya district. A sample size of 30 patients which satisfied the inclusion criteria were included in the study. <strong></strong></p><p>Ropivacaine (0.75%)<strong> </strong>was locally infiltrated on the right side (R-side) in the peri-tonsillar region before the surgery. The left side was considered as the control side. Intra-operative blood loss was estimated separately for both the sides. The data from the study will be analysed using chi square test and Student t test technique.</p><p><strong>Results:</strong> The 17 (56.7%) females and 13 (43.3%) males participated in the study. Majority of the cases belonged to <10 years of age group. By analysing the data, blood loss was found to be higher on the left side (control side) compared to the right side on which peri-tonsillar infiltration of ropivacaine was given. The association between the blood loss on the right side and the left side (control side) was found to be significant (p<0.0001).<strong></strong></p><p><strong>Conclusions: </strong>Based on the result of our study it can be derived that the peri-tonsillar infiltration of Ropivacaine (0.75%) is very effective in reducing intra-operative bleeding and at the same time providing a better bloodless field during surgery. Hence, we recommend the use of peri-tonsillar infiltration of Ropivacaine (0.75%) in view of better management of intra-operative blood lossissn.2454-5929.ijohns20220041</p>
31
Albaini, Obey, Achraf Jardaly, Rola Husni, and Bassem Safadi. "COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature." International Journal of Clinical Research 2, no. 1 (June 25, 2021): 37–44. http://dx.doi.org/10.38179/ijcr.v2i1.66.
Full textAbstract:
Background: COVID-19 caused the suspension of elective surgeries in several hospitals around the world, in an attempt to help contain the spread of the virus. However, a safe resumption of such surgeries is warranted to reduce further burden on patients. It is important to understand when, how and where to resume elective surgeries, as published data suggested that peri-operative COVID-19 infection incurred an increased risk of morbidity and mortality to surgical patients. Case Report: A 25-year-old patient presented for fever 5 days post Laparoscopic Sleeve Gastrectomy. He was diagnosed with COVID-19 using a PCR test. The patient was managed at home with symptomatic therapy. No life-threatening complications were reported during or after his infection. Conclusion: Based on available data, our literature review regarding peri-operative COVID-19 complications, bariatric surgeons have to balance between the risk of undergoing an elective surgery like metabolic bariatric surgeries and the risk of postponing this procedure and thus delaying the resolution of obesity along with its comorbidities.
32
Cole, Duncan S., Andrew Watts, David Scott-Coombes, and Tony Avades. "Clinical Utility of Peri-Operative C-Reactive Protein Testing in General Surgery." Annals of The Royal College of Surgeons of England 90, no. 4 (May 2008): 317–21. http://dx.doi.org/10.1308/003588408x285865.
Full textAbstract:
INTRODUCTION C-reactive protein (CRP) is an acute-phase protein used clinically to diagnose infectious and inflammatory disease and monitor response to treatment. CRP measurement in the peri-operative period was audited and patterns of change analysed for elective general surgical patients. PATIENTS AND METHODS General surgical patients (201) admitted for elective general surgery over a 3-month period were considered for the study. CRP results pre- and postoperatively were recorded, and data on co-morbid conditions and surgical procedure were noted. RESULTS CRP was requested pre-operatively on 84% of patients. A high CRP was more likely to be found in patients with co-morbidity. Postoperatively, CRP was requested during the first 3 days on 69% of patients. CRP peaked at postoperative days two or three, and then fell. In patients who had a high pre-operative CRP, the peak CRP was higher and occurred later, than those who had a normal pre-operative CRP. CONCLUSIONS CRP requesting pre-operatively is common, but is not recommended in NICE guidelines. Postoperatively, CRP levels rise; as a result, its use as a tool to screen for infection is limited. CRP has a role in diagnosis of infection after the first three postoperative days and in monitoring response to treatment. Therefore, routine use of CRP measurements pre-operatively and in the first 2 or 3 days post-operatively is not recommended. A peri-operative CRP should only be requested if there is a clear clinical indication.
33
Reynolds, John V., Shaun R. Preston, Brian O'Neill, Maeve Aine Lowery, Lene Baeksgaard, Thomas Crosby, Moya Cunningham, et al. "Neo-AEGIS (Neoadjuvant trial in Adenocarcinoma of the Esophagus and Esophago-Gastric Junction International Study): Preliminary results of phase III RCT of CROSS versus perioperative chemotherapy (Modified MAGIC or FLOT protocol). (NCT01726452)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 4004. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.4004.
Full textAbstract:
4004 Background: The optimum combination curative approach to locally advanced adenocarcinoma of the esophagus and esophago-gastric junction (AEG) is unknown. A key question is whether neoadjuvant multimodal therapy, specifically CROSS (carboplatin/paclitaxel, 41.4Gy radiation therapy), is superior to optimum peri-operative chemotherapeutic regimens including modified MAGIC (epirubicin, cisplatin (oxaliplatin), 5-FU (capecitabine)) and more latterly FLOT (docetaxel, 5-FU, leucovorin, oxaliplatin). Neo-AEGIS was designed as the first randomised controlled trial to address this question. Methods: 377 patients with cT2-3N0-3M0 AEG were randomly assigned to CROSS or peri-operative chemotherapy (ECF/ECX/EOF/EOX pre-2018, FLOT option 2019/20) at 24 sites (Ireland, UK, Denmark, France, Sweden). The primary outcome was overall survival. The initial power calculation was based on CROSS superiority of 10%. This was modified after the first futility analysis (70 events) to a non-inferiority margin of 5%. Secondary end points included toxicity, pathologic measures of response, and postoperative complications as per the Esophageal Complications Consensus Group (ECCG) definitions and Clavien-Dindo severity grade. Results: Of 362 evaluable patients, 178 CROSS, 184 MAGIC/FLOT (157/27), 90% were male, median (range) age 64 (35-83), 84% were cT3, and 58% cN1. At a median (range) follow up of 24.5 (1-92) months, at the second futility analysis (60% of planned events), there were 143 deaths, 70 CROSS and 73 MAGIC/FLOT arm, with 3-year estimated survival probability of 56% (95% CI 47,64) and 57% (95% CI 48,65), respectively [(HR 1.02 (95%CI. 0.74-1.42))]. Based on the absence of futility evidenced in this data the DSMB recommended closure of recruitment in December 2020. Conclusions: This RCT reveals no evidence that peri-operative chemotherapy is unacceptably inferior to multimodal therapy, notwithstanding greater proxy markers of local tumour response in the CROSS arm. Oncologic and operative outcomes were consistent with optimum modern benchmarks. These data strongly suggest non-inferiority and support equipoise in decision making in modern practice. Clinical trial information: NCT01726452. [Table: see text]
34
Kim, Haerin, Christian K. Kollmannsberger, Devin Schellenberg, Winson Y. Cheung, and Howard John Lim. "Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 103. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.103.
Full textAbstract:
103 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: The Table summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]
35
Kim, Hae Rin, Christian K. Kollmannsberger, Devin Schellenberg, Winson Cheung, and Howard John Lim. "Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e14537-e14537. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14537.
Full textAbstract:
e14537 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: Table 1 summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]
36
Paillaud, Elena, Frederique Peschaud, Tristan Cudennec, Philippe Caillet, Mathilde Gisselbrecht, Laure De Decker, Nicola De Angelis, et al. "Implementation of complex perioperative intervention in older patients with cancer (IMPROVED program)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): TPS11630. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.tps11630.
Full textAbstract:
TPS11630 Background: Nearly 50% of patients are older than 70 years at diagnosis of digestive cancer. Surgical resection is the first line strategy of treatment. Despite improvement in surgical techniques and development of rehabilitation programs, the rate of postoperative complications remains high. Peri-operative involvement of geriatricians may improve care management older cancer patients. Methods: During a 6 months run-up period (emerging project), we structured a multi-professional network (digestive surgeons, anesthetists, geriatricians, digestive oncologists, epidemiologists), we elaborated a innovative peri-operative geriatric intervention (Improved program) in digestive surgery setting based on evidence-based data. We build a dedicated evaluation plan by determinate the best design for assessing geriatric intervention in this complex context and choose the more appropriate endpoints. Results: We will include 554 patients aged 75 or more with resectable digestive cancer in a stepped wedge cluster randomized trial. The intervention is based on 1/ a preoperative geriatric assessment, focusing on frailty parameters and developing a coordinated program of tailored geriatric interventions 2/ a postoperative shared care with an integrated care model where both surgeon and geriatrician share responsibility for the patient management in surgical ward. This geriatric postoperative management will be focus on prevention and correction of complications, early mobilization, optimal nutritional support. The main endpoint Is is Grade II or higher post-surgical complications rate according Clavien-Dindo classification within 30 days after the surgical procedure. Conclusion: We expected to demonstrate a benefit of a peri-operative shared management model to decrease the risk of post-surgical complications In older patients with digestive cancer.
37
Nutescu, Edith, and Cathy Helgason. "Outpatient Dalteparin Peri-Procedure Bridge Therapy In Patients Maintained On Long Term Warfarin." Stroke 32, suppl_1 (January 2001): 328–29. http://dx.doi.org/10.1161/str.32.suppl_1.328-e.
Full textAbstract:
70 Background: Peri-operative anticoagulation management for patients maintained on chronic warfarin therapy in need for surgery or invasive procedures is controversial. Such data is lacking in patients with documented hypercoagulable states and history of ischemic stroke. Methods: This prospective cohort study evaluated the feasibility, efficacy, safety, and cost-effectiveness of peri-operative dalteparin bridge therapy in patients maintained on long-term warfarin undergoing surgical or invasive diagnostic procedures. Twenty one consecutive patients with documented hypercoagulable states (protein C defficiency, protein S defficiency, antiphospholipid antibody syndrome) and a history of ischemic stroke were included in the study. Warfarin was stopped 4 days prior to surgery and was restarted the night of surgery , once hemostasis was achieved, at the pre-operative dose. Dalteparin 100 IU/Kg given subcutaneously every 12 hours was initiated 3 days prior surgery and continued until a therapeutic international normalized ratio was reached after surgery. On the day of surgery, the morning dalteparin dose was held. Data was recorded at the completion of dalteparin therapy and at 3 months of follow-up on recurrent thromboembolic events, and major and minor bleeding events. An economic analysis compared outpatient dalteparin bridge therapy with inpatient intravenous unfractionated heparin therapy. Results: The 21 patients underwent 29 surgical procedures: dental surgery (15), colonoscopy (5), eye surgery (3), vascular surgery (4), surgical biopsies (2). No patients suffered an embolic event during the 3 month follow-up period. There were no major bleeding events, and there were 8 (38%) patients with a minor bleeding event (bruising at injection site). All patients self administered the injections. An average of 6.5 hospital days were avoided per patient. This resulted in cost savings of $3250.00 per patient treated with dalteparin. Conclusion: Dalteparin appears to be a feasible, safe, and cost-effective alternative to inpatient intravenous heparin for peri-procedure bridge anticoagulation therapy in stroke patients.
38
Dhakal, Binod, Sunitha Sukumaran, Rafael Santana-Davila, George Haasler, Daniel Eastwood, William Tisol, Mario Gasparri, and Nicholas W. Choong. "How safe is surgery in obese lung cancer patients?" Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e17555-e17555. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e17555.
Full textAbstract:
e17555 Background: Obesity is a risk factor for increased peri-operative morbidity and mortality in surgery. There have been limited studies to correlate morbidity of lung cancer resection with obesity. Methods: We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin from 2006 to 2010. Data on patient demographics, weight, pathology findings and hospital course were abstracted after appropriate IRB approval. Peri-operative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism or any medical complications arising within 30 days after surgery. Fisher’s exact test was used to test the association between BMI and perioperative morbidities. Results: Between 2006 and 2010, 320 lung resections were performed for lung cancer. Median age was 67 (25-88) years and 185 (57.8%) were females. The body mass index (BMI) distribution was 121 (37.8%) in BMI<25 and 199(62.18%) in BMI≥25. In patients with BMI < 25, surgical procedures consisted 76 (23.75%) lobectomy, 38 (11.8%) wedge resection and 7 (2.18%) pneumonectomy. In patients with BMI ≥ 25, surgical procedures consisted: 131 (40.93%) lobectomy, 61 (19.06%) wedge resection and 7 (2.18%) pneumonectomy. Tumor histology was: adenocarcinoma 138 (42.9%), squamous cell cancer 107 (33.3%), bronchoalveolar 25 (7.7%), large cell 19 (5.9%) and mixed 31 (9.68%). The 30-day mortality rate was 1.8 % (6 patients), out of which only 2 had BMI ≥ 25. Peri-operative morbidity occurred in 28 (23.14%) of normal BMI patients and 47 (23.6%) of BMI ≥ 25 patients (p=0.54). Specific morbidities encountered by patients with normal vs. BMI ≥ 25 were: atrial fibrillation 11(9.09%) vs. 24(12.06%) (p=0.46), pulmonary embolism 1(0.83%) vs. 3(1.51%) (p=1.0), congestive heart failure 2(1.65%) vs. 2(1.01%) (p=0.63), respiratory failure 12(9.92%) vs. 17(8.54%) (p=0.69) and ARDS 2(1.65%) vs. 1(0.50%) (p=0.55).Median hospital stay was 5 days in lower BMI group and 4 days in BMI ≥25 groups (p=0.52). Conclusions: Potential curative surgical resections can be offered to even significantly overweight patients as there is no significant difference in the peri-operative morbidities and length of stay as compared to normal BMI patients.
39
Caccianiga, Gianluigi, Gérard Rey, Paolo Caccianiga, Alessandro Leonida, Marco Baldoni, Alessandro Baldoni, and Saverio Ceraulo. "Peri-Implantitis Management: Surgical versus Non-Surgical Approach Using Photodynamic Therapy Combined with Hydrogen Peroxide (OHLLT—Oxygen High Level Laser Therapy): A Retrospective Controlled Study." Applied Sciences 11, no. 11 (May 30, 2021): 5073. http://dx.doi.org/10.3390/app11115073.
Full textAbstract:
Peri-implantitis management could be performed either with a surgical or non-surgical approach to the implant surfaces. Various treatment options have been proposed in the literature, such as antiseptic and antibiotic therapies, chemical agents, curettes, ultrasonic, air abrasive, rotary titanium brushes and laser treatments; in particular, photodynamic therapy combined with hydrogen peroxide (OHLLT) has proved to be efficient in the removal of bacterial biofilm from implant surfaces. The aim of our study is to compare OHLLT performed with a surgical approach to a non-surgical approach. We selected a cluster of 227 implants affected by peri-implantitis: 139 implants were treated with a non-surgical approach and 88 implants with a surgical approach. Bone loss pre-operative and post-operative (with a follow-up of five years) have been registered. The collected data were entered on the Statistical Package for Social Sciences (SPSS) version 11.5. The results indicate a statistically significant difference between the two groups, with a mean bone loss after treatment of 2.3 mm for OHLLT with a surgical approach and 3.8 mm for OHLLT with a non-surgical approach; according to the Kolmogorov–Smirnov test, the overall data followed a normal distribution (value of the Kolmogorov–Smirnov test statistic = 0.0891; p = 0.35794). Thus, a surgical approach in the case of peri-implantitis seems to be more effective, probably due to the possibility of a deeper sanitization of implant surfaces, hardly reachable with only non-surgical approach.
40
Gautam, Binod. "Spinal anaesthesia in elderly for laparoscopic cholecystectomy." Journal of Kathmandu Medical College 6, no. 3 (May 5, 2018): 83–89. http://dx.doi.org/10.3126/jkmc.v6i3.19820.
Full textAbstract:
Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia.Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy.Methodology: In this cross-sectional study, fifty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fifth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done.Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in five patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days.Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is efficient for uncomplicated cholelithiasis with minimal modifications in surgical technique.
41
van Kessel, Charlotte S., and Michael J. Solomon. "Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking." Cancers 14, no. 20 (October 15, 2022): 5058. http://dx.doi.org/10.3390/cancers14205058.
Full textAbstract:
Pelvic exenteration surgery has become a widely accepted procedure for treatment of locally advanced (LARC) and locally recurrent rectal cancer (LRRC). However, there is still unwarranted variation in peri-operative management and subsequently oncological outcome after this procedure. In this article we will elaborate on the various reasons for the observed differences based on benchmarking results of our own data to the data from the PelvEx collaborative as well as findings from 2 other benchmarking studies. Our main observation was a significant difference in extent of resection between exenteration units, with our unit performing more complete soft tissue exenterations, sacrectomies and extended lateral compartment resections than most other units, resulting in a higher R0 rate and longer overall survival. Secondly, current literature shows there is a tendency to use more neoadjuvant treatment such as re-irradiation and total neoadjuvant treatment and perform less radical surgery. However, peri-operative chemotherapy or radiotherapy should not be a substitute for adequate radical surgery and an R0 resection remains the gold standard. Finally, we describe our experiences with standardizing our surgical approaches to the various compartments and the achieved oncological and functional outcomes.
42
Swart, Eric, Chris Adair, Rachel B. Seymour, and Madhav A. Karunakar. "Clinical Practice Guidelines on Ordering Echocardiography Before Hip Fracture Repair Perform Differently from One Another." HSS Journal ® 16, S2 (June 8, 2020): 378–82. http://dx.doi.org/10.1007/s11420-020-09762-8.
Full textAbstract:
Abstract Background Osteoporotic hip fractures typically occur in frail elderly patients with multiple comorbidities, and repair of the fracture within 48 h is recommended. Pre-operative evaluation sometimes involves transthoracic echocardiography (TTE) to screen for heart disease that would alter peri-operative management, yet TTE can delay surgery and is resource intensive. Evidence suggests that the use of clinical practice guidelines (CPGs) can improve care. It is unclear which guidelines are most useful in hip fracture patients. Questions/Purposes We sought to evaluate the performance of the five commonly used CPGs in determining which patients with acute fragility hip fracture require TTE and to identify common features among high-performing CPGs that could be incorporated into care pathways. Patients and Methods We performed a retrospective study of medical records taken from an institutional database of osteoporotic hip fracture patients to identify those who underwent pre-operative TTE. History and physical examination findings were recorded; listed indications for TTE were compared against those given in five commonly used CPGs: those from the American College of Cardiology/American Heart Association (ACC/AHA), the British Society of Echocardiography (BSE), the European Society of Cardiology and the European Society of Anaesthesiology(ESC/ESA), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Scottish Intercollegiate Guidelines Network (SIGN). We then calculated the performance (sensitivity and specificity) of the CPGs in identifying patients with TTE results that had the potential to change peri-operative management. Results We identified 100 patients who underwent pre-operative TTE. Among those, the patients met criteria for TTE 32 to 66% of the time, depending on the CPG used. In 14% of those receiving TTE, the test revealed new information with the potential to change management. The sensitivity of the CPGs ranged from 71% (ESC/ESA and AAGBI) to 100% (ACC/AHA and SIGN). The CPGs’ specificity ranged from 37% (BSE) to 74% (ESC/ESA). The more sensitive guidelines focused on a change in clinical status in patients with known disease or clinical concern regarding new-onset disease. Conclusions In patients requiring fixation of osteoporotic hip fractures, TTE can be useful for identifying pathologies that could directly change peri-operative management. Our data suggest that established CPGs can be safely used to identify which patients should undergo pre-operative TTE with low risk of missed pathology.
43
Ebbens, F. A., S. Toppila-Salmi, E. J. J. de Groot, J. Renkonen, R. Renkonen, C. M. van Drunen, M. G. W. Dijkgraaf, and W. J. Fokkens. "Predictors of post-operative response to treatment: a double blind placebo controlled study in chronic rhinosinusitis patients." Rhinology journal 49, no. 4 (October 1, 2011): 413–19. http://dx.doi.org/10.4193/rhino10.211.
Full textAbstract:
BACKGROUND: In the majority of CRS patients suffering from primary or recurrent CRS, topical glucocorticoids are highly effective. A subset of CRS patients, however, does not respond to (topical) glucocorticoids and requires surgical intervention. Although surgery is highly effective in those individuals, recurrence of disease is observed in some. In this study we describe our search for one or more predictors predicting the response to surgery in combination with peri-operative oral glucocorticoids in CRS patients. METHODS: Thirty-five inferior turbinate specimens were randomly selected from a larger group of CRS patients requiring FESS for persistent disease that either responded favorably or demonstrated recurrent disease. Tissue biopsies were taken at the time of surgery and compared for inflammatory markers, endothelial cell markers, and various leukocyte subsets using immunohistochemistry. RESULTS: Compared to non-responders, the baseline level of lamina propria activated eosinophils is significantly increased in CRS patients responding to surgery in combination with peri-operative oral glucocorticoids treated or not treated post-operatively with topical glucocorticoids. No significant differences were observed for all other studied parameters. Post-operative treatment with FPANS 100 μg q.i.d. was significantly associated with response to treatment. A trend towards association was observed for increased numbers of eosinophils at baseline. CONCLUSION: Our data suggest that CRS patients with higher levels of eosinophils are less likely to suffer from post-operative recurrent sinonasal disease when treated post-operatively with FPANS 100 μg q.i.d.
44
Douketis, James, Sabina Murphy, Elliott Antman, Laura Grip, Michele Mercuri, Christian Ruff, Jeffrey Weitz, Eugene Braunwald, and Robert Giugliano. "Peri-operative Adverse Outcomes in Patients with Atrial Fibrillation Taking Warfarin or Edoxaban: Analysis of the ENGAGE AF-TIMI 48 Trial." Thrombosis and Haemostasis 118, no. 06 (May 3, 2018): 1001–8. http://dx.doi.org/10.1055/s-0038-1645856.
Full textAbstract:
Background Peri-operative management of anticoagulated patients with atrial fibrillation (AF) is challenging. To gain information on the peri-operative management of edoxaban, we compared outcomes in patients on warfarin or edoxaban enrolled in ENGAGE AF-TIMI 48 who underwent a surgery or invasive procedure. Methods Data from patients undergoing their first surgery/procedure were analysed and results compared by anticoagulant (warfarin vs. higher- or lower-dose edoxaban regimen [HDER and LDER, respectively]). Patients were classified by procedural management: anticoagulant interrupted (last dose 4–10 days pre-procedure) or anticoagulant continued (last dose ≤ 3 days pre-procedure). Stroke/systemic embolism (SSE), major bleeding (MB), MB or clinically relevant non-MB (CRNMB) and death were assessed from 7 days pre- until 30 days post-procedure. The chi-square test was used to compare outcomes across treatment groups. Results A total of 7,193 patients (34%) underwent surgery/procedure: 3,116 had anticoagulant interrupted, 4,077 had anticoagulant continued. Among patients on warfarin, HDER and LDER who had anticoagulant interrupted, rates of SSE were 0.6, 0.5 and 0.9% (p = 0.53), rates of MB were 1.0, 1.2 and 1.1% (p = 0.94) and rates of MB or CRNMB were 3.9, 4.2 and 3.6% (p = 0.78); among patients on warfarin, HDER and LDER who had anticoagulant continued, rates of SSE were 1.1, 0.7 and 0.9% (p = 0.51), rates of MB were 3.6, 2.6 and 2.4% (p = 0.13) and rates of MB or CRNMB were 8.5, 7.9 and 6.6% (p = 0.17). Conclusion In patients requiring surgery/procedure in ENGAGE AF-TIMI 48, peri-operative rates of SSE, MB and death were not significantly different in patients who received edoxaban or warfarin.
45
Shrestha, Malakh, Hassina Baraki, Nawid Khaladj, Nurbur Koigeldiyev, Axel Haverich, and Christian Hagl. "Do Patients Profit from Third Time CABG?" Open Journal of Cardiovascular Surgery 2 (January 2009): OJCS.S2277. http://dx.doi.org/10.4137/ojcs.s2277.
Full textAbstract:
Introduction It has been shown that in experienced hands repeated CABG is doable procedure. However the quality of life after third time CABG has not been evaluated so far. Patients and Methods The peri-operative data of 25 (22 male, mean age of 65.5 ± 8.0 years) consecutive patients in a single centre undergoing third time-CABG from 4/96 to 11/06 were studied. Quality of life (QoL) was assessed by Short Form (SF)-36 Questionnaire. Results 30 day mortality was 12% (3/25). Seven died during follow-up. In 15 survivors median follow-up was 94 months (2–122 months). 1-, 5-, and 10-year survival were 77.8%, 65.0%, and 53.1%, respectively. Present NYHA status was significantly improved in comparison to preoperative values (2.4 ± 0.8 vs. 3.2 ± 0.56, p = 0.012). QoL was comparable with an age matched general population with heart insufficiency. Conclusion Third time CABG can be performed with acceptable peri-operative mortality. Significant improvement of NYHA status and acceptable quality of life results justifies our surgical approach in this challenging patient cohort.
46
Uvin, P., J. M. de Meyer, and G. Van Holderbeke. "A Comparison of the Peri-Operative Data after Open Radical Retropubic Prostatectomy or Robotic-Assisted Laparoscopic Prostatectomy." Acta Chirurgica Belgica 110, no. 3 (January 2010): 313–16. http://dx.doi.org/10.1080/00015458.2010.11680623.
Full text
47
Zahra, Syeda Hina, Qudrat Ullah, Usman Ali Rehman, Asif Hanif, and Sami Ullah Bhatti. "Post-Operative Pain Comparison between Peri-Operative Bupivacaine Infiltration Vs Post-Operative Opioids Analgesics in Patient Undergoing Abdominal Surgery in First 6 Hours." International Journal of Frontier Sciences 2, no. 2 (July 1, 2018): 26–32. http://dx.doi.org/10.37978/tijfs.v2i2.39.
Full textAbstract:
Abstract:Background: To compare between opioids and wound infiltration to reduce post-operative painin abdominal surgery in first 6 hours, in appropriate treatment, contraindications of treatment and increase mortality of patients. This article presents novel approach to surgical site infiltration techniques and intravenous opioids for abdominal surgery to reduce pain. The main aim of this study is optimal patient comfort rather than reduce pain intensity, reduction offside effects is also an important goal in pain management.Methodology: Data was collected from surgical department of Gulab Devi Chest Hospital. Duringabdominal surgery bupivacaine was given to some patients while other were managed by postoperative opioids and by using designed performa it is concluded that which one of them is better method for post-operative pain management.Results: This is the descriptive study conducted in Gulab Devi Hospital Lahore.in this study, inthis study minimum age of the patients was 14 and maximum age of the patients was 80. The mean age was 32.16+12.32 years. In this study out of total 100 patients, 18(18.00%) were male patients and 82(82.00%) were females. Female gender predominated in this study. in this study, p-value is 0.00 (<0.05%) so pain relieving chances of bupivacaine infiltration as moderate pain scale were 84% and in distracting pain scale chances in bupivacaine infiltration were 16%.But pain relieving chances of opioids as moderate pain scale were 12.24 % and in distracting pain scale chances in opioids were 87.75%.so peri-operative pain management by bupivacaine infiltration is better than post –operative opioids management in patients undergoing abdominal surgery.Conclusion: According to my research bupivacaine wound infiltration is better method for postoperative pain management in abdominal surgeries. Our study was conducted at Gulab DeviHospital and Services Hospital in an area of pain management by opioids and infiltration, whichmay limit the applications of our findings in area of pain management by opioids and infiltrationprevalence.
48
Safwat, Mohab W., Rebecca O'Malley, Attwood Kristopher, Diana Mehedint, Ramkishen Narayanan, and Thomas Schwaab. "Oncologic kidney surgery in obese patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e15039-e15039. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e15039.
Full textAbstract:
e15039 Background: Obesity adds significant operative challenge to kidney surgery. Its impact on minimally invasive kidney surgery has not been well defined. We evaluated the impact of obesity on open and minimally invasive kidney surgery (MIS) for kidney tumors. Methods: Patients in our prospectively collected IRB-approved kidney database were divided into 5 groups as determined by the World health organization Body mass index (BMI) classification: less than 25.0, 25.0-30.0, 30.0-35.0, 35.0-40.0, and more than 40.0 Kg/m2. Patient characteristics, and peri-operative data were recorded and compared between the different groups and between surgical approches(open vs. MIS) using the Kruskal Wallis and Chi Square tests for continuous and categorical data, respectively. The potential association between BMI and the continuous measures of OR time, Post op stay and EBL were assessed using spearman Correlations. Results: Of the 620 patients identified, 142 (22.9 %) had healthy weight, 180 (29.0%) were overweight, and 298 (48.1%) were obese. Most had grade 1 obesity (BMI 30-34, 167, 26.9%), grade 2 obesity (BMI 35-40, 76, 12.3%), and grade 3 obesity (BMI > 40, 55, 8.9%). As expected, the ASA score rose with degree of obesity (p=<.001). EBL (estimated blood loss), OR (operative time) time, Room time and post-operative stay differed significantly in the 5 groups of patients (p=0.001, p=0.003, p=<0.002, p= <.001, p=.002), respectively. While intra-operative complications did not differ between the obesity groups, obese patients had a higher rate of high grade Clavien complications (p=0.026). Interestingly, the surgical approach (open vs. MIS) and type of nephrectomy ( radical vs. partial) did not correlate with degree of obesity or complications, even when adjusted for stage. Conversion rates for MIS did not correlate with degree of obesity. Conclusions: Nephrectomy in obese patients results in incresed high grade of postoperative complications. Surgical approach does not appear to have any impact on peri-operative outcomes.
49
Jegatheeswaran, Santhalingam, Panagiotis Stathakis, Harry V. M. Spiers, Fawwaz Mohammed, Panagiotis Petras, Thomas Satyadas, Michael J. Parker, et al. "Work-Up and Outcome of Hepatic Resection for Peri-Hilar Cholangiocarcinoma (PH-CCA) without Staging Laparoscopy." Cancers 14, no. 7 (April 6, 2022): 1841. http://dx.doi.org/10.3390/cancers14071841.
Full textAbstract:
Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscopy. Methods: This is a clinical case cohort series of patients undergoing surgical resection of PH-CCA without the use of staging laparoscopy in the work-up algorithm. During the 13 years from 1 January 2009 to 1 January 2022, 32 patients underwent laparotomy for planned surgical resection of PH-CCA. Data were collected on demographic profile, admission biochemistry, radiology, pre-operative intervention, operation and outcome, together with post-operative complications and disease-free and overall survival. Results: All patients underwent pre-operative contrast-enhanced CT. Twenty-four (75%) underwent pre-operative MR. Twenty-three (72%) underwent pre-operative biliary drainage. Twenty-nine patients (91%) had either type III or IV peri-hilar cholangiocarcinoma. One patient (3%) in this series underwent a non-resectional laparotomy. Twenty-nine (91%) had a final histopathological diagnosis of PH-CCA. One further patient had a final diagnosis of an intraductal papillary neoplasm of the biliary tree (IPNB) with high-grade dysplasia but no invasive cancer. Eleven patients (36%) received chemotherapy after surgery. The median (95% CI) time to recurrence was 14 (7–31) months. The median survival was 25 (18-upper limit not reached) months. Conclusion: This cohort of 32 patients undergoing attempted resection for PH-CCA without the use of staging laparoscopy in the work-up algorithm indicates that with careful attention to patient fitness and cross-sectional and interventional radiologic/endoscopic imaging, a very low non-therapeutic laparotomy rate of 3% can be achieved and sustained.
50
Rizk, N. P., M. Bains, R. Flores, B. Park, B. Minsky, D. Ilson, and V. Rusch. "Impact of pre-operative chemoradiotherapy on post-esophagectomy morbidity and mortality." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 4025. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.4025.
Full textAbstract:
4025 Background: While multimodality therapy prior to surgical resection for locally advanced esophageal cancer is increasingly utilized, there remains the perception in the literature that its use may contribute to increased peri-operative morbidity and mortality. The purpose of this study was to compare our experience with the use of pre-operative chemoradiation with surgery (CRT) to patients who underwent surgery alone (S). Methods: We performed a retrospective review of a prospectively maintained database of all patients in our institution who underwent either (S) or (CRT) between 1/96 and 5/05. Data collected included demographics (age, sex), co-morbidities (cardiac, pulmonary, diabetes), pre-operative treatment details (chemotherapy type, radiation dose), procedure type, post-operative complications (pneumonia, anastomotic leak), length of stay (LOS), and hospital mortality. Statistical analysis included chi-square analysis for categorical variables and analysis of variance for continuous variables, and multivariate analyses was done using a logistic regression model. Results: There were 701 patients who were appropriate for this analysis, 332 (47.3%) (CRT) and 369 (52.7%) (S). 76% of CRT patients received 5040cGy of radiation and 90% received concurrent cisplatin based chemotherapy. CRT patients were younger (p<0.001) and more often male (p=0.003). Univariate analysis indicated a similar incidence of pneumonia (p=0.78), leak rate (p=0.41), hospital length of stay (0.97), and hospital mortality (0.48). Multivariate analysis, controlling for demographics, co-morbidities, procedure type, and tumor location showed no significant difference in hospital mortality (p=0.84). Conclusions: The use of CRT does not appear to result in increased peri-operative morbidity or mortality. No significant financial relationships to disclose.