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emergency surgical risk

Mina Alvandipour, Farzad Mokhtari-Esbuie, Afshin Gholipour Baradari, Abolfazl Firouzian, Mehdi Rezaie
PURPOSE: Despite the use of different surgical methods, surgical site infection is still an important cause of mortality and morbidity in patients and imposes a considerable cost on the healthcare system. Administration of supplemental oxygen during surgery has been reported to reduce surgical site infection (SSI); however, that result is still controversial. This study was performed to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of wound infection...
February 2019: Annals of Coloproctology
Tom Knauf, Benjamin Bücking, Mathias Bargello, Sebastian Ploch, Christopher Bliemel, Matthias Knobe, Steffen Ruchholtz, Daphne Eschbach
The incidence of hip fractures is increasing due to demographic transition. Data on long-term survival and influencing factors are sparse. Our prospective observational study with 395 patients shows a survival of 38% after 5 years. Significant risk factors were male gender, higher age, lower Barthel Index, lower Charlson Comorbidity Score, lower Mini-Mental State Examination, and delirium during hospitalization. PURPOSE: The incidence of hip fractures is increasing due to demographic transition...
March 16, 2019: Archives of Osteoporosis
Diana Martins Oliveira, Catarina Correia, Flávia Cunha, Patrícia Dias
An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia...
March 16, 2019: BMJ Case Reports
Manuel F Granja, Guilherme Jose Agnoletto, Andre Monteiro, Alejandra Jaume, Mark Hanly, Esther Bit-Ivan, Mohammad Chmayssani, Eric Sauvageau, Amin Aghaebrahim, Ricardo A Hanel
BACKGROUND: A cardiac myxoma (CM) is the most common primary tumor of the heart. This case report highlights that for metastatic cardiac myxomas, even after a successful total resection, there is a small but real risk of recurrence that can manifest as late as 10 years after initial tumor resection. CASE DESCRIPTION: We present the case of a 53-year-old woman who visited the emergency room after a 4-day worsening right-sided weakness. The patient was diagnosed with a left cardiac myxoma 10 years ago and a complete surgical resection was performed at that time...
March 13, 2019: World Neurosurgery
Russell E Holzgrefe, Jacob M Wilson, Christopher A Staley, Travis L Anderson, Eric R Wagner, Michael B Gottschalk
BACKGROUND: Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. We hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA). METHODS: We identified patients aged 50 years or older who underwent TSA in the American College of Surgeons National Surgical Quality Improvement Program database...
March 13, 2019: Journal of Shoulder and Elbow Surgery
Jared P Beller, Robert B Hawkins, J Hunter Mehaffey, William Z Chancellor, Clifford E Fonner, Alan M Speir, Mohammed A Quader, Jeffrey B Rich, Leora T Yarboro, Nicholas R Teman, Gorav Ailawadi
OBJECTIVE: Transfer from hospital to hospital for cardiac surgery represents a large portion of some clinical practices. Previous literature in other surgical fields has shown worse outcomes for transferred patients. We hypothesized that transferred patients would be higher risk and demonstrate worse outcomes than those admitted through the emergency department. METHODS: All patients undergoing cardiac operations with a Society of Thoracic Surgeons Predicted Risk of Mortality were evaluated from a multicenter, statewide Society of Thoracic Surgeons database...
February 11, 2019: Journal of Thoracic and Cardiovascular Surgery
Xun Xu, Hai-Long Zhang, Qiu-Ping Liu, Shu-Wen Sun, Jing Zhang, Fei-Peng Zhu, Guang Yang, Xu Yan, Yu-Dong Zhang, Xi-Sheng Liu
BACKGROUND & AIMS: Microvascular invasion (MVI) impairs surgical outcomes in hepatocellular carcinoma (HCC) patients. As a single highly reliable factor to preoperatively predict MVI is lacking, we developed a computational approach integrating large-scale clinical and imaging modalities, especially radiomic features from contrast-enhanced CT, to predict MVI and clinical outcomes in HCC patients. METHODS: In total, 495 surgically resected patients were retrospectively included...
March 12, 2019: Journal of Hepatology
Sean Heywood, Ben Wagstaff, Noel Tait
INTRODUCTION: Gallstone spillage during laparoscopic cholecystectomy is a common occurrence. Complications due to spilled gallstones occur in up to 5% of laparoscopic cholecystectomy cases, with complications having been reported up to 20 years after laparoscopic cholecystectomy. CASE REPORT: We report the case of a 70 year old male who presented for elective right inguinal hernia repair. At the time of repair he was found to have multiple foreign bodies embedded within an indirect hernia sac...
March 5, 2019: International Journal of Surgery Case Reports
Deborah R Smith, Yandong Bian, Cheng-Chia Wu, Anurag Saraf, Cheng-Hung Tai, Tavish Nanda, Andrew Yaeh, Matthew E Lapa, Jacquelyn I S Andrews, Simon K Cheng, Guy M McKhann, Michael B Sisti, Jeffrey N Bruce, Tony J C Wang
PURPOSE: Non-small cell lung cancer (NSCLC) brain metastases are associated with substantial morbidity and mortality. During recent years, accompanying dramatic improvements in systemic disease control, NSCLC brain metastases have emerged as an increasingly relevant clinical problem. However, optimal surveillance practices remain poorly defined. This purpose of this study was to further characterize the natural history, clinical course and risk factors associated with earlier development of subsequent NSCLC brain metastases to better inform clinical practice and help guide survivorship care...
March 14, 2019: Journal of Neuro-oncology
Shahab Hajibandeh, Petya Popova, Sheik Rehman
OBJECTIVES: To compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. METHODS: We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials comparing outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy...
March 15, 2019: Surgical Innovation
Charles Hn Johnson, Ross C McLean, Iain McCallum, Daniel Perren, Alexander W Phillips
BACKGROUND: The management of perforated peptic ulcers has evolved over time and includes laparoscopic or open repair, and conservative management. The utilisation of, and outcomes from these strategies are not clear. Trends in epidemiology, management and outcomes for perforated peptic ulcer across the North of England over a 15-year period were analyzed. PATIENTS AND METHODS: Emergency General Surgical admissions data from nine NHS trusts in the North of England from 2002-2016 were collected and analyzed, including demographics, interventions and outcomes...
March 11, 2019: International Journal of Surgery
Giovanni Raffa, Antonino Scibilia, Alfredo Conti, Giuseppe Ricciardo, Vincenzo Rizzo, Adolfo Morelli, Filippo Flavio Angileri, Salvatore Massimiliano Cardali, Antonino Germanò
Navigated transcranial magnetic stimulation (nTMS) is an emerging tool for surgery of motor-eloquent intrinsic brain tumors, but a critical reappraisal of the literature evidence has never been performed, so far. A systematic review and meta-analysis was performed searching on PubMed/MEDLINE, and the Cochrane Central Register of Controlled Trials for studies that analyzed the impact of nTMS-based motor mapping on surgery of patients affected by motor-eloquent intrinsic brain tumors, in comparison with series of patients operated without using nTMS...
March 5, 2019: Clinical Neurology and Neurosurgery
Valeria Silvestri, Giuseppe Mazzesi, Rita Mele
INTRODUCTION: Aortic dissection is a rare cardiovascular complication in pregnancy. Most of the cases occur during the third trimester of pregnancy, whilst 33% of cases are reported during the postpartum period. PRESENTATION OF CASE: We report the case of a multiparous 35-year-old patient with gestational hypertension treated for a type A aortic dissection on the second postpartum day. A review of literature on non-syndromic sporadic aortic dissection during the postpartum period is presented...
March 6, 2019: International Journal of Surgery Case Reports
Philipp Gehwolf, Paul Hechenleitner, Murat Sanal, Christoph Profanter, Beatrice Häussler, Bettina Härter
BACKGROUND: Congenital gastric antral web and congenital pyloric atresia are rare reasons of congenital gastric outlet obstruction (CGOO). Depending on the different forms, the symptoms vary from unspecific epigastric pain to nonbilious "projectile" vomiting, ileus and failure to thrive. Throughout the years, many different treatment options are described, like simple surgical dilatation, incision or excision of the membrane, possibly combined with a pyloroplasty. PATIENTS AND METHODS: In this retrospective single-center observation study, we present 9 cases with different kinds of webs leading to CGOO...
March 11, 2019: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Steven J Skube, Elliot G Arsoniadis, Megan L Sulciner, Scott R Gilles, Wolfgang B Gaertner, Robert D Madoff, Genevieve B Melton, Bruce A Peterson, Mary R Kwaan
BACKGROUND: Colon and rectal lymphomas are rare and can occur in the context of posttransplant lymphoproliferative disorder. Evidence-based management guidelines are lacking. OBJECTIVE: The purpose of this study was to characterize the presentation, diagnosis, and management of colorectal lymphoma and to identify differences within the transplant population. DESIGN: This was a retrospective review of patients evaluated for colorectal lymphoma between 2000 and 2017...
March 8, 2019: Diseases of the Colon and Rectum
Michele Pisano, Marco Ceresoli, Stefania Cimbanassi, Kurinchi Gurusamy, Federico Coccolini, Giuseppe Borzellino, Gianluca Costa, Niccolò Allievi, Bruno Amato, Djamila Boerma, Pietro Calcagno, Luca Campanati, Fabio Cesare Campanile, Alberto Casati, Osvaldo Chiara, Antonio Crucitti, Salomone di Saverio, Marco Filauro, Francesco Gabrielli, Angelo Guttadauro, Yoram Kluger, Stefano Magnone, Cecilia Merli, Elia Poiasina, Alessandro Puzziello, Massimo Sartelli, Fausto Catena, Luca Ansaloni
Background: Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim: The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population...
2019: World Journal of Emergency Surgery: WJES
Jonathan K Zoller, Stephen H Gregory, Tracey W Stevens, Luis A Sanchez, Rocco Hueneke
With advances in modern day imaging techniques for the aorta, there has been an increasing incidence of vascular diseases involving the aortic arch. Historically, the only treatment option for arch disease has been open arch replacement under circulatory arrest conditions with or without selective cerebral perfusion. However, this open procedure has significant morbidity and mortality, especially in elderly patients with multiple comorbidities. To potentially mitigate the risks associated with open replacement, endovascular arch repair has gained momentum as an alternative treatment option...
February 8, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Gladell P Paner, Jatin Gandhi, Bonnie Choy, Mahul B Amin
CONTEXT.—: Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging. OBJECTIVE.—: To present key updates in prostate carcinoma. DATA SOURCES.—: The study comprised a review of literature and our experience from routine and consultation practices. CONCLUSIONS.—: Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced...
March 13, 2019: Archives of Pathology & Laboratory Medicine
Karien Meier, Ask T Nordestgaard, Ahmed I Eid, Napaporn Kongkaewpaisan, Jae Moo Lee, Manansun Kongwibulwut, Kelsey R Han, Nikolaos Kokoroskos, April E Mendoza, Noelle Saillant, David R King, George C Velmahos, Haytham M A Kaafarani
BACKGROUND: Recent studies suggest that obesity is a risk factor for Clostridium Difficile infection, possibly due to disruptions in the intestinal microbiome composition. We hypothesized that BMI is associated with increased incidence of Clostridium Difficile infection in surgical patients. METHODS: In this nationwide retrospective cohort study in 680 ACS-NSQIP participating sites across the United States, the occurrence of Clostridium Difficile infection within 30 days postoperatively between different BMI groups was compared...
March 8, 2019: Journal of Trauma and Acute Care Surgery
Daniel Leas, Rachel B Seymour, Meghan K Wally, Joseph R Hsu
Background: Drug overdoses are the leading cause of death due to injury in the USA. Currently, 49 states have prescription drug-monitoring programs (PDMPs) available to prescribers. Questions/Purposes: We aimed to assess knowledge and practice of two groups of acute-care prescribers regarding controlled substances. Methods: A 16-question survey was distributed to a list of surgical and emergency medicine prescribers at our institution. The survey asked about prescriber demographics, previous experiences with a PDMP, and opinions about patient risk factors available within an electronic medical record (EMR)...
February 2019: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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