Search

The ongoing COVID-19 pandemic has had profound effects on the provision of surgical care. The potential perioperative mortality associated with surgical procedures in patients with COVID-19 has been estimated at 20%, but the data come from jurisdictions that experienced very high surges of COVID-19 patients. A rapid assessment of the types of surgical care for patients with COVID-19 in Ontario was carried out using administrative data, and we found that during the initial wave in the spring of 2020, surgical interventions were required in 0.6% of patients with COVID-19, and mortality was higher (20%) in patients who underwent surgery in the 2 weeks before or after a positive nasopharygeal swab than in those who had surgery more than 2 weeks after COVID-19 was diagnosed., The COVID-19 pandemic led to unprecedented changes to surgical care. The increased risk of death while providing necessary surgical care to patients in the time shortly before and after a [...]

Background: Older patients are increasingly presenting for surgical evaluation. Although age is independently associated with morbidity, mortality and adverse postoperative outcomes, much of the variation may be attributable purely to [...]

Author(s): Lauren Lapointe-Shaw 1,*, Chaim M. Bell 1,2 Who would have thought that outcomes for elective surgery would differ according to the day of admission? In this issue of PLOS [...]

Background Healthcare interventions on weekends have been associated with increased mortality and adverse clinical outcomes, but these findings are inconsistent. We hypothesized that patients admitted to hospital on weekends who have surgery have an increased risk of death compared with patients who are admitted and have surgery on weekdays. Methods and findings This matched cohort study included 318,202 adult patients from Ontario health administrative and demographic databases, admitted to acute care hospitals from 1 January 2005 to 31 December 2015. A total of 159,101 patients who were admitted on weekends and underwent noncardiac surgery were classified by day of surgery (weekend versus weekday) and matched 1:1 to patients who both were admitted and had surgery on a weekday (Tuesday to Thursday); matching was based on age (in years), anesthesia basic unit value for the surgical procedure, median neighborhood household income quintile, resource utilization band (a ranking system of overall morbidity), rurality of home location, year of admission, and urgency of admission. Of weekend admissions, 16.2% (25,872) were elective and 53.9% (85,744) had surgery on the weekend of admission. The primary outcome was all-cause mortality within 30 days of the date of hospital admission. The 30-day all-cause mortality for patients admitted on weekends who had noncardiac surgery was 2.6% (4,211/159,101) versus 2.5% (3,901/159,101) for those who were admitted and had surgery on weekdays (adjusted odds ratio [OR] 1.05; 95% CI 1.00 to 1.11; P = 0.03). However, there was significant heterogeneity in the increased odds of death according to the urgency of admission and when surgery was performed (weekend versus weekday). For urgent admissions on weekends (n = 133,229), there was no significant increase in odds of mortality when surgery was performed on the weekend (adjusted OR 1.02; 95% CI 0.95 to 1.09; P = 0.7) or on a subsequent weekday (adjusted OR 1.05; 95% CI 0.98 to 1.12; P = 0.2) compared to urgent admissions on weekdays. Elective admissions on weekends (n = 25,782) had increased risk of death both when surgery was performed on the weekend (adjusted OR 3.30; 95% CI 1.98 to 5.49; P < 0.001) and when surgery was performed on a subsequent weekday (adjusted OR 2.70; 95% CI 1.81 to 4.03; P < 0.001). The main limitations of this study were the lack of data regarding reason for admission and cause of increased time interval from admission to surgery for some cases, the small number of deaths in some subgroups (i.e., elective surgery), and the possibility of residual unmeasured confounding from increased illness severity for weekend admissions. Conclusions When patients have surgery during their hospitalization, admission on weekends in Ontario, Canada, was associated with a small but significant proportional increase in 30-day all-cause mortality, but there was significant heterogeneity in outcomes depending on the urgency of admission and when surgery was performed. An increased risk of death was found only for elective admissions on weekends; whether this is a function of patient-level factors or represents a true weekend effect needs to be further elucidated. These findings have potential implications for resource allocation in hospitals and the redistribution of elective surgery to weekends., Author(s): James D. O'Leary 1,2,3,*, Hannah Wunsch 1,4, Anne-Marie Leo 1,2, David Levin 1,2, Asad Siddiqui 1,2, Mark W. Crawford 1,2 Introduction Healthcare interventions on weekends have been associated with [...]

The study attempts to evaluate and compare the efficacy of neoadjuvant chemotherapy followed by interval debunking surgery as a treatment option in stage IIIC or IV ovarian cancer as against debunking surgery followed by chemotherapy. The results indicate that both forms of treatment had similar outcomes.

ABSTRACT Background: Electrodesiccation and curettage (ED&C) of low-risk, cutaneous squamous cell carcinoma (SCC) generally consumes less time and resources than excision. Review of the literature reveals few recent studies examining [...]

A study was conducted to evaluate the variation in hospital mortality associated with inpatient surgery and the different approaches to reducing mortality. Results indicated that variations in hospital mortality did exist and reducing complications was possible with greater focus on timely recognition and management of complications once they occur.

ABSTRACT Background: Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a challenge to repair. Objective: To present the authors' [...]

The article examines a case study to discuss the causes, symptoms and treatment of lumbar spinal stenosis. The treatment methods used, surgical and non-surgical are analyzed to understand the efficacy of each.

A study to examine the efficacy of surgery in the treatment for lumbar spinal stenosis against non surgical treatment methods is conducted. Results conclude that patients who underwent surgery showed great improvements as compared to those patients who did not undergo surgery.

The use of high-volume hospitals for certain procedures is advocated in an effort to improve the quality of surgical care in the United States and referral to high volume hospitals is recommended for operations with a demonstrated volume-outcome relationship. This method was resorted to because of numerous reports of a direct volume-outcome relationship for certain procedures with patients at high-volume hospitals consistently having better outcomes.

Background: Prospective randomized studies have suggested that surgery palliates esophageal achalasia more effectively than pneumatic dilatation, but for some dilatation is still the procedure of choice for initial treatment. We [...]

Background: We aimed to determine the rate of further surgery, the functional outcome and the factors associated with outcome after primary clubfoot surgery. Method: We conducted a retrospective study of [...]

The association between compensation status and outcome after surgery is investigated. Findings revealed that compensation status is associated with poor outcome after surgery.

Objectives. Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of SurgNEC and MedNEC with NoNEC at 18 to 22 months" corrected age. Methods. Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight Results. A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference Conclusions. Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months&apos; corrected age compared with NoNEC. MedNEC does not seem to confer additional risk. SurgNEC is likely to be associated with greater severity of disease. Pediatrics 2005;115:696-703; necrotizing enterocolitis, extremely low birth weight, neurodevelopmental outcome, cerebral palsy, Bayley Scales of Infant Development, growth., ABBREVIATIONS. NEC, necrotizing enterocolitis; ELBW, extremely low birth weight; VLBW, very low birth weight; SurgNEC, surgically managed necrotizing enterocolitis; MedNEC, medically managed necrotizing enterocolitis; NICHD, National Institute of Child Health [...]

Byline: Christian Lamer (1), Marc Harboun (2), Lyes Knani (1), David Moreau (2), Laurent Tric (1), Jean-Luc LeGuillou (1), Isabelle Gasquet (2), Thierry Moreau (2) Keywords: Critical care; Surgery; Post-operative complications; Outcome; Quality of life; Nottingham health profile Abstract: Objective To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors. Design Two-year prospective case-control study. Setting Twelve-bed ICU in a university-affiliated hospital. Patients Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications. Interventions None Measurements and results Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls P=0.24). NHP subscores showed significantly worse pain (P=0.03) and physical impairment (P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery (P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy (P=0.04). Conclusions Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation. Author Affiliation: (1) Departement de Reanimation Polyvalente, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75674, Paris, France (2) INSERM U 472, Villejuif, France Article History: Registration Date: 27/02/2004 Received Date: 30/05/2003 Accepted Date: 25/02/2004 Online Date: 15/04/2004

Byline: Frederique Ryckwaert (1,4), Pierre Alric (2), Marie-Christine Picot (3), Kela Djoufelkit (3), Pascal Colson (1,4) Keywords: Abdominal infrarenal aortic surgery; Postoperative renal failure; Mortality; Morbidity; Renal dysfunction; Renal failure Abstract: Objective To evaluate the incidence and the circumstances of a moderate increase in serum creatinine early after elective abdominal aortic surgery. Design Prospective clinical observational study. Setting Surgical intensive care unit in a university hospital. Patients Two hundred and fifteen consecutive adult patients operated on for infra-renal abdominal aortic surgery during 1 year. Interventions A moderate increase in plasma creatinine of 20% from preoperative value (renal dysfunction, RD) was systematically recorded during the first 3 days following surgery. Organ dysfunctions (cardiac, pulmonary, haematological, and neurological) were assessed. Measurements and results Forty-three patients (20%) experienced a postoperative RD six of these required dialysis. RD was associated with other organ dysfunctions in 60.5% patients. Mortality rate was significantly higher for patients who had a RD, than patients without RD (9.3% vs 1.2%, P Conclusion Our results suggest that a postoperative 20%-increase in plasma creatinine after abdominal aortic surgery is not rare and occurs frequently with other organ dysfunction. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Hopital Arnaud de Villeneuve, avenue du Doyen Giraud, 34295 , Montpellier, France (2) Department of Thoracic and Vascular Surgery, Hopital Arnaud de Villeneuve, Montpellier, France (3) Department of Biostatistics, Hopital Arnaud de Villeneuve, Universite Montpellier I, Montpellier, France (4) INSERM U 469, CCIPE, 34295, Montpellier, France Article History: Received Date: 08/04/2002 Accepted Date: 16/07/2003 Online Date: 27/08/2003

A method is illustrated for estimating the probability of occurrence of a run of poor surgical outcomes within some larger sequence of operations. The findings indicate that apparently poor runs of outcome would be encountered purely as a chance occurrence.

Byline: F. Baudo (1), T. M. Caimi (1), F. deCataldo (1), A. Ravizza (2), S. Arlati (2), G. Casella (2), D. Carugo (2), G. Palareti (3), C. Legnani (3), L. Ridolfi (4), R. Rossi (4), A. D'Angelo (5), L. Crippa (5), D. Giudici (6), G. Gallioli (6), A. Wolfler (6), G. Calori (7) Keywords: Acquired ATIII deficiency; ATIII replacement therapy; Septic shock Abstract: Background: ATIII is decreased in sepsis and/or shock and its baseline value correlates with mortality. The efficacy of ATIII therapy on mortality was assessed in a selected group of patients admitted to the intensive care unit (ICU) in a double-blind, randomized, multicenter study. Methods: 120 patients admitted to the ICU with an ATIII concentration < 70% were randomized to receive ATIII (total dose 24000 units) or placebo treatment for 5 days 56 patients had septic shock. Results: ATIII concentrations in the treated group remained constant throughout the treatment period (range 97--102%). The Kaplan-Meier analysis showed no difference in overall survival between the two groups: 50 and 46 % for ATIII and placebo, respectively. Septic shock and hemodynamic support were unbalanced in the two groups at admission. Therefore the Cox analysis was carried out after adjusting for these two variables. Treatment with ATIII decreases the risk of death with an odds ratio (OR) of 0.56. Of the covariates analyzed, septic shock and the baseline multiple organ failure score were negatively associated with survival and plasma activity level was positively associated with survival with an OR of 0.97 for each 1 % increase in the ATIII plasma concentration at baseline. Conclusions: The results of ATIII treatment in this population of patients suggests that replacement therapy reduces mortality in the subgroup of septic shock patients only. Author Affiliation: (1) Department of Hematology, Hemostasis and Thrombosis Unit, Ospedale Niguarda, Milano, Italy (2) Department of Intensive Care, Ospedale Niguarda, Milano, Italy (3) Department of Angiology, Ospedale S. Orsola, Bologna, Italy (4) Department of Intensive Care, Ospedale S. Orsola, Bologna, Italy (5) Hemostasis Laboratory, Ospedale S. Raffaele, Milano, Italy (6) Intensive Care Unit, Ospedale S. Raffaele, Milano, Italy (7) Epidemiology Unit, Ospedale S. Raffaele, Milano, Italy Article History: Registration Date: 23/03/2009 Received Date: 05/06/1997 Accepted Date: 06/01/1998