RESUMEN
OBJECTIVE: To evaluate a modified technique for carotid body tumor (CBT) resection. BACKGROUND: Resection of CBT can lead to substantial postoperative morbidity because of a rich vascularization and close connection to neurovascular structures. The impact of a modified surgical technique on postoperative outcome was evaluated and compared with a historical group and the literature. METHODS: Medical records of patients who underwent CBT surgery at Leiden University Medical Center between 1963 and 2005 were retrospectively reviewed. Before 1992, a standard approach was conducted. After 1992, most tumors were resected using an alternative technique, working in a craniocaudal fashion from skull base to carotid bifurcation. Data were reported as details of the pre, intra-, and postoperative periods. RESULTS: A total of 111 CBT resections (69 standard, 42 craniocaudal) were performed in 94 patients (44 male/50 female, mean age 41). The standard group consisted of 39 Shamblin I (56%), 22 II (32%), and 8 III (12%) tumors. The craniocaudally approached CBT included 12 Shamblin I (29%), 13 II (31%), and 17 III (40%) tumors. The mean blood loss was 901 mL (standard operations) versus 281 mL (craniocaudal approach, P < 0.0005). Persistent cranial nerve damage was encountered after 26 (23%) of 111 operations; 21 after the standard operations (30% within this group, including 3 preexistent nonresolved cranial nerve deficits); and 5 (12%, including 2 due to additional vagal body resections) after the craniocaudal operations (P = 0.025). CONCLUSIONS: The craniocaudal dissection technique of a CBT can be applied with little blood loss, thereby reducing the risk of postoperative morbidity.
Asunto(s)
Tumor del Cuerpo Carotídeo/cirugía , Disección/métodos , Procedimientos Neuroquirúrgicos , Procedimientos Quirúrgicos Vasculares , Adolescente , Adulto , Anciano , Pérdida de Sangre Quirúrgica/prevención & control , Tumor del Cuerpo Carotídeo/irrigación sanguínea , Tumor del Cuerpo Carotídeo/patología , Estudios de Cohortes , Traumatismos del Nervio Craneal/etiología , Traumatismos del Nervio Craneal/prevención & control , Disección/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Since 1996, a standard registration is used to obtain a clear understanding of the complications that occur after colorectal surgery. In our registration system the cause of a complication and the detrimental effect to the patient's health are coded. METHODS: The treatment of colorectal diseases was evaluated to analyze the quality of medical care. RESULTS: From 1996 to 2000, a total of 169 complications were documented in 108 of the 353 patients operated on. Leakage of the anastomosis occurred in 22 cases (6%) and wound infection occurred in 11 cases (3%). Most of the complications required no or little medical attention (n = 101, 59%). 51% of the complications could be attributed to the physical condition of the patient. Surgical complications were the cause in 31% of the cases and management problems in 16% of the cases. CONCLUSION: A registration system provides good insight into the frequency and severity of the complications after colorectal surgery. Extensive registration is mandatory to provide reliable information, comparing the results year by year. This provides the basis for continuous improvement of medical protocols on the surgical ward.
Asunto(s)
Colectomía , Complicaciones Posoperatorias , Sistema de Registros , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Control de Calidad , Enfermedades del Recto/cirugíaRESUMEN
The objective of this study was to determine the role of a mortality registration in the quality control of patients who died after peripheral bypass surgery. We developed a mortality registration to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between pre- and postmortem findings. In a 10-year period, 28 of the 1,022 patients (2.7%) who underwent peripheral arterial reconstruction died. Fifty-three percent of the patients died owing to postoperative complications, most frequently a myocardial infarction. A shortcoming in the medical treatment was observed in only one patient. Forty-three percent of the relatives gave permission for an autopsy. In only two cases, the autopsy report revealed a myocardial infarction that had remained unnoticed during the clinical course. In this selected group of patients undergoing a peripheral bypass operation, the causes of death and the shortcomings in medical care could usually be identified without the help of autopsy data.
Asunto(s)
Enfermedades Vasculares Periféricas/cirugía , Garantía de la Calidad de Atención de Salud/métodos , Procedimientos Quirúrgicos Vasculares/mortalidad , Anciano , Anciano de 80 o más Años , Autopsia , Causas de Muerte , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Países Bajos , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Control de Calidad , Factores de Riesgo , Procedimientos Quirúrgicos Vasculares/normasRESUMEN
OBJECTIVE: To evaluate treatment and complications which is essential for good medical practice. DESIGN: Prospective audit. SETTING: City hospital, The Netherlands. SUBJECTS: All the patients who died on the surgical ward between 1994 and 1998 and were classified according to four categories of mortality recording. INTERVENTIONS: The causes of death, inaccuracies in treatment and the extent of agreement between premortem and postmortem findings were documented. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Of the 11,195 patients admitted, 420 (4%) deceased during their hospital stay. Most patients died of the disease with which they presented at admission (n = 176, 42%) or of complications (n = 167, 40%). In 20% (n = 83) of the cases a shortcoming in the clinical course was found. 251 of the 420 patients who died (60%) had a necropsy. 53 of the 251 reports (21%) gave information that could have had an effect on the treatment or the clinical course. CONCLUSIONS: Recording mortality is a way of testing the diagnostic and therapeutic accuracy in our quest for a high quality of care.