RESUMEN
BACKGROUND AND PURPOSE: Periprosthetic femoral fracture (PFF) is a significant complication of total hip arthroplasty (THA). Although biomechanical studies have indicated that the technique by which the femoral canal is prepared plays a role, few clinical studies have reported on how this might affect the fracture risk. This study compares the fracture risk between compaction and broaching with toothed instruments in cementless THA. METHODS: Prospectively collected data from the quality register of a high-volume hospital was used. All primary arthroplasties using the Corail stem (DePuy Synthes) were included. All femoral fractures occurring within the first 90 days after the operation were included in the analysis. We determined the relative risk of sustaining PFF with compaction compared with broaching and adjusted for confounders (sex, age group, BMI, and use of a collared stem) using multivariable Poisson regression. RESULTS: 6,788 primary THAs performed between November 2009 and May 2023 were available for analysis. 66% were women and the mean age was 65.0 years. 129 (1.9%) fractures occurred during the first 90 days after the operation, 92 (2.3%) in the compaction group and 37 (1.3%) in the broaching group. The unadjusted relative risk of fracture in the compaction group compared with the broaching group was 1.82 (95% confidence interval [CI] 1.25-2.66), whereas the adjusted relative risk was 1.70 (CI 1.10-2.70). CONCLUSION: Compaction was associated with more periprosthetic fractures than broaching (2.3% versus 1.3%) within 90 days after surgery.
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Artroplastia de Reemplazo de Cadera , Fracturas del Fémur , Fracturas Periprotésicas , Complicaciones Posoperatorias , Humanos , Femenino , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Masculino , Anciano , Fracturas del Fémur/cirugía , Fracturas del Fémur/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Prótesis de Cadera/efectos adversos , Factores de Riesgo , Estudios Prospectivos , Complicaciones Intraoperatorias/etiologíaRESUMEN
OBJECTIVE: Prewarming has been recommended to reduce intraoperative hypothermia. However, the evidence is unclear. This review examined if prewarming can prevent intraoperative hypothermia in patients undergoing thoracoscopic and laparoscopic surgeries. METHODS: PubMed, CENTRAL, Web of Science, and Embase databases were searched for randomized controlled trials (RCTs) up to 15th January 2024. The primary outcome of interest was the difference in intraoperative core temperature. The secondary outcomes were intraoperative hypothermia (<36°) and postoperative shivering. RESULTS: Seven RCTs were eligible. Meta-analysis showed that intraoperative core temperature was significantly higher at the start or within 30mins of the start of the surgery (MD: 0.32 95% CI: 0.15, 0.50 I2 = 94% p = 0.0003), 60 mins after the start of the surgery (MD: 0.37 95% CI: 0.24, 0.50 I2 = 81% p<0.00001), 120 mins after the start of the surgery (MD: 0.34 95% CI: 0.12, 0.56 I2 = 88% p = 0.003), and at the end of the surgery (MD: 0.35 95% CI: 0.25, 0.45 I2 = 61% p<0.00001). The incidence of shivering was also significantly lower in the prewarming group (OR: 0.18 95% CI: 0.08, 0.43 I2 = 0%). Prewarming was also associated with a significant reduction in the risk of hypothermia (OR: 0.20 95% CI: 0.10, 0.41 I2 = 0% p<0.0001). The certainty of the evidence assessed by GRADE was "moderate" for intraoperative core temperatures at all time points and "low" for minimal intraoperative core temperature, shivering, and hypothermia. CONCLUSION: Moderate to low-quality evidence shows that prewarming combined with intraoperative warming, as compared to intraoperative warming alone, can improve intraoperative temperature control and reduce the risk of hypothermia and shivering in patients undergoing thoracoscopic and laparoscopic procedures.
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Abdomen , Hipotermia , Humanos , Hipotermia/prevención & control , Hipotermia/etiología , Abdomen/cirugía , Laparoscopía/métodos , Complicaciones Intraoperatorias/prevención & control , Complicaciones Intraoperatorias/epidemiología , Tiritona , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cuidados Intraoperatorios/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Procedimientos Quirúrgicos Torácicos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Temperatura CorporalRESUMEN
Prompt recognition and management of critical events is pivotal for the provision of safe anesthetic care. This requires a well-functioning team that focuses on effective communication, timely decision-making, and escalation of potential complications. We believe that variation in bedside care leads to "near-misses," adverse outcomes, and serious safety events (SSEs). The principles of an escalation culture have been used successfully in other highly reliable industries such as aviation, military, and manufacturing. We discuss here the introduction of a unique and compelling thought-process for developing an intraoperative escalation protocol that is specifically tailored for our institution. Inspired by a critical intraoperative event, this departmental protocol was developed based on an analysis of multispecialty literature and expert opinion to decrease the incidence of SSEs. It includes a stepwise approach and incorporates patient-specific information to guide team members who encounter dynamic clinical situations. The implementation of the protocol has facilitated continuous quality improvement through iterative education, improving communication, and enhancing decision-making. Concurrently, we have plans to incorporate technology and electronic decision support tools to enhance real-time communication, monitor performance, and foster a culture of safety.
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Anestesiología , Humanos , Anestesiología/normas , Anestesiología/métodos , Cuidados Intraoperatorios/normas , Cuidados Intraoperatorios/métodos , Protocolos Clínicos/normas , Grupo de Atención al Paciente/normas , Complicaciones Intraoperatorias/prevención & control , Seguridad del Paciente/normasRESUMEN
Objective: To compare outcomes of minimally invasive gynaecological surgeries with open gynaecological surgical techniques in a low-resource setting. METHODS: The quasi-experimental study was conducted at a tertiary care public-sector hospital in Rawalpindi, Pakistan, from September 2022 to August 2023, and comprised women with benign gynaecological conditions. The subjects were divided into two groups. Group-I included participants who underwent minimally invasive gynaecological surgeries, while Group- II patients underwent open gynaecological surgical intervention. Outcome variables included pre-discharge pain score, post-operative mobility, operative time, blood-loss during surgery, length of hospital stay and intraoperative as well as postoperative complications. Data was analysed using SPSS 25. RESULTS: Of the 319 women, 146(45.7%) were in Group-I with mean age 30.83±5.47 years, and 173(54.2%) were in group-II with mean age 44.87±10.46 years. Body mass index, length of marriage, history of previous surgery, comorbidities and menopausal status were significantly different between the groups (p<0.05). Duration of surgery and hospital stay were lower in Group-I compared to Group-II (p<0.05). Intra-operative complications were not significantly different between the groups (p<0.05), while the differences in post-operative complications were significant (p<0.05). Conclusion: Better clinical outcomes were observed for minimally invasive gynaecological surgeries than open surgeries among women diagnosed with benign gynaecological diseases.
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Enfermedades de los Genitales Femeninos , Procedimientos Quirúrgicos Ginecológicos , Tiempo de Internación , Procedimientos Quirúrgicos Mínimamente Invasivos , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Femenino , Adulto , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Ginecológicos/métodos , Persona de Mediana Edad , Enfermedades de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Pakistán , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Resultado del Tratamiento , Complicaciones Intraoperatorias/epidemiologíaRESUMEN
Ruptured cerebral aneurysms have a higher incidence of direct surgery-related adverse events compared to unruptured aneurysms owing to challenging surgical conditions, such as difficulties in surgical exposure, cerebral edema, and intraoperative aneurysmal rupture, that increase the intraprocedural difficulty. The most common surgical adverse event is intraoperative rupture, with uncontrolled ruptures(during pre-dissection or from a tear in the aneurysm neck) often resulting in poor clinical outcomes. The key strategies for intraoperative rupture include staying calm, controlling bleeding, and ensuring hemostasis through appropriate methods. Given the advances in endovascular therapy for intracranial aneurysms, the number of microsurgical procedures has been decreasing. Thus, neurosurgeons at each facility need to prepare and gain experience in handling intraoperative ruptures.
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Aneurisma Roto , Aneurisma Intracraneal , Complicaciones Intraoperatorias , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Roto/cirugía , Complicaciones Intraoperatorias/prevención & control , Complicaciones Intraoperatorias/etiología , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversosRESUMEN
In aneurysmal subarachnoid hemorrhage, the highest therapeutic priority is to ensure immediate hemostasis without intraprocedural complications. This article outlines the possible intraoperative coil embolization complications for ruptured intracranial aneurysms and discuss strategies for their prevention and treatment.
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Aneurisma Roto , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/terapia , Aneurisma Roto/cirugía , Aneurisma Roto/terapia , Procedimientos Endovasculares/métodos , Embolización Terapéutica/métodos , Complicaciones Intraoperatorias/prevención & control , Hemorragia Subaracnoidea/cirugía , Hemorragia Subaracnoidea/terapiaRESUMEN
BACKGROUND: In spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient's outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery. METHODS: We retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications. RESULTS: A total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events. CONCLUSIONS: This study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient's safety, without compromising the technical achievement of the procedure.
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Tempo Operativo , Complicaciones Posoperatorias , Enfermedades de la Columna Vertebral , Humanos , Persona de Mediana Edad , Masculino , Femenino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Estudios Retrospectivos , Incidencia , Adulto , Enfermedades de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Factores de Riesgo , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodosRESUMEN
OBJECTIVE: Our objective was to propose a laparoscopic modified simple ureteroneocystostomy for repairing iatrogenic ureteral injuries. In laparoscopic modified simple ureteroneocystostomy, the highest point of the bladder was found by cystoscopy, then we implanted a "fish mouth" ureter end into the bladder, leaving at least 1 cm of ureter end in the bladder as an anti-reflux procedure. CASE REPORT: We retrospectively reviewed a case series of lower third iatrogenic ureter injury during gynecology surgery of 11 patients who received laparoscopic modified simple ureteroneocystostomy at Da Lin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, from January 2011 to December 2020. One patient needs percutaneous nephrotomy due to infection and had the ureteroneocystostomy two months later. No obstruction, ureter stenosis/stricture, bladder leakage or other renal complications were noted after repair. CONCLUSION: Laparoscopic modified simple ureteroneocystostomy is technically feasible for repairing lower third ureter injuries, with no major complications.
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Cistostomía , Enfermedad Iatrogénica , Laparoscopía , Uréter , Humanos , Femenino , Uréter/lesiones , Uréter/cirugía , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Adulto , Cistostomía/métodos , Cistostomía/efectos adversos , Persona de Mediana Edad , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/efectos adversosRESUMEN
INTRODUCTION: Intraoperative Hypotension (IOH) poses a substantial risk during surgical procedures. The integration of Artificial Intelligence (AI) in predicting IOH holds promise for enhancing detection capabilities, providing an opportunity to improve patient outcomes. This systematic review and meta analysis explores the intersection of AI and IOH prediction, addressing the crucial need for effective monitoring in surgical settings. METHOD: A search of Pubmed, Scopus, Web of Science, and Embase was conducted. Screening involved two-phase assessments by independent reviewers, ensuring adherence to predefined PICOS criteria. Included studies focused on AI models predicting IOH in any type of surgery. Due to the high number of studies evaluating the hypotension prediction index (HPI), we conducted two sets of meta-analyses: one involving the HPI studies and one including non-HPI studies. In the HPI studies the following outcomes were analyzed: cumulative duration of IOH per patient, time weighted average of mean arterial pressure < 65 (TWA-MAP < 65), area under the threshold of mean arterial pressure (AUT-MAP), and area under the receiver operating characteristics curve (AUROC). In the non-HPI studies, we examined the pooled AUROC of all AI models other than HPI. RESULTS: 43 studies were included in this review. Studies showed significant reduction in IOH duration, TWA-MAP < 65 mmHg, and AUT-MAP < 65 mmHg in groups where HPI was used. AUROC for HPI algorithms demonstrated strong predictive performance (AUROC = 0.89, 95CI). Non-HPI models had a pooled AUROC of 0.79 (95CI: 0.74, 0.83). CONCLUSION: HPI demonstrated excellent ability to predict hypotensive episodes and hence reduce the duration of hypotension. Other AI models, particularly those based on deep learning methods, also indicated a great ability to predict IOH, while their capacity to reduce IOH-related indices such as duration remains unclear.
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Hipotensión , Aprendizaje Automático , Humanos , Hipotensión/diagnóstico , Hipotensión/fisiopatología , Complicaciones Intraoperatorias/diagnóstico , Curva ROCRESUMEN
BACKGROUND: We aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients' data were collected from the hospital's medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram. RESULTS: 43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram. CONCLUSION: We constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.
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Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Complicaciones Intraoperatorias , Nomogramas , Úlcera por Presión , Humanos , Estudios Retrospectivos , Puente Cardiopulmonar/efectos adversos , Lactante , Preescolar , Masculino , Femenino , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Úlcera por Presión/etiología , Úlcera por Presión/prevención & control , Factores de Riesgo , Recién Nacido , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , China , Curva ROC , Medición de Riesgo/métodosRESUMEN
PURPOSE: Laparoscopic cholecystectomy, introduced in 1985 by Prof. Dr. Erich Mühe, has become the gold standard for treating chronic symptomatic calculous cholecystopathy and acute cholecystitis, with an estimated 750,000 procedures performed annually in the United States of America. The risk of iatrogenic bile duct injury persists, ranging from 0.2 to 1.3%. Risk factors include male gender, obesity, acute cholecystitis, previous hepatobiliary surgery, and anatomical variations in Calot's triangle. Strategies to mitigate bile duct injury include the Critical View of Safety and fundus-first dissection, along with intraoperative cholangiography and alternative approaches like subtotal cholecystectomy. METHODS: This paper introduces the shoeshine technique, a maneuver designed to achieve atraumatic exposure of anatomical structures, local hemostatic control, and ease of infundibulum mobilization. This technique involves the use of a blunt dissection tool and gauze to create traction and enhance visibility in Calot's triangle, particularly beneficial in cases of severe inflammation. Steps include using the critical view of safety and Rouviere's sulcus line for orientation, followed by careful dissection and traction with gauze to maintain stability and reduce the risk of instrument slippage. RESULTS: The technique, routinely used by the authors in over 2000 cases, has shown to enhance patient safety and reduce bile duct injury risks. CONCLUSION: The shoeshine technique represents a simple and easy way to apply maneuver that can help surgeon during laparoscopic cholecystectomies exposing the hepatocystic area and promote blunt dissection.
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Colecistectomía Laparoscópica , Conducto Cístico , Disección , Humanos , Colecistectomía Laparoscópica/métodos , Conducto Cístico/cirugía , Disección/métodos , Complicaciones Intraoperatorias/prevención & control , Reproducibilidad de los ResultadosRESUMEN
Median arcuate ligament syndrome (MALS) is rare syndrome and is diagnosis of exclusion. Though first robotic median arcuate ligament release (MALR) was described in 2007, there are only a few case reports (CR), case series (CS), and retrospective cohort studies (RCS) in the published literature. The purpose of this study was to assess the feasibility and safety of robotic-assisted MALR (r-MALR). PubMed, Embase, and Cochrane databases were searched (last search December 2023) for articles reporting r-MALR. All studies including CR, CS, RCS reporting technical feasibility (operating time and rate of conversions), safety (intra-operative complications, blood loss, post-operative complications), and outcome (length of stay [LoS]) were included (PROSPERO: CRD42024502792). A total of 23 studies (8-CR, 5-CS, 10-RCS) with total 290 patients were available in the literature. Except 1-RCS, all studies reported age and mean age for CR was 40.38 ± 17.7, 36.08 ± 15.12 for CS, 39.72 ± 7.35 years for RS; except 2-RCS, all studies reported gender distribution and there were 57 males and 214 females. Operating time: 3-CR, 4-CS, 9-RCS reported operating time, and mean time was 111 ± 54, 131.69 ± 7.51, 117.34 ± 35.03 min, respectively. Conversion rate: All studies reported data on conversion and only four (1.37%) cases were converted-one to laparoscopic approach, three to open approach (1-inadvertent celiac arteriotomy, 2-reasons not mentioned). Intraoperative complications: only 5-CR, 4-CS, and 9-RCS reported data on intra-operative complications, and there were only 6 complications (1.5%): 1-inadvertent celiac arteriotomy converted to open; 3-unnamed vascular injuries (2 managed robotically, 1 converted to open); 1-bleeding managed robotically; there were no other reported injuries. Estimated blood loss ranged from 5 to 30 ml. Post-operative complications: 5-CR, 4-CS, 8-RCS described post-operative complications in 21 (7%) patients. Twenty cases were grade I, one was grade IIIa, and all managed successfully. LoS stay: 2-CR, 4-CS, 10-RCS reported LoS and overall, it was 2 days. r-MALR is reasonable, technically feasible, safe, and has acceptable outcomes. In addition, robotic approach provided superior vision, improved dexterity, precise, and easy circumferential dissection.PROSPERO registration: The protocol was registered in the PROSPERO database (CRD42024502792).
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Estudios de Factibilidad , Síndrome del Ligamento Arcuato Medio , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Síndrome del Ligamento Arcuato Medio/cirugía , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Masculino , Tempo Operativo , Tiempo de Internación/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/epidemiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Arteria Celíaca/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH). METHODS: We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group. RESULTS: Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n = 48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n = 2); and skin burns (n = 1). Injured organs included the spleen (n = 30; 62% of organ injuries), liver (n = 7), lungs (n = 4), intestine (n = 4), adrenal gland (n = 2), and thoracic wall (n = 2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1-4.9). CONCLUSION: Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury.
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Hernias Diafragmáticas Congénitas , Complicaciones Intraoperatorias , Humanos , Hernias Diafragmáticas Congénitas/cirugía , Japón/epidemiología , Masculino , Femenino , Recién Nacido , Complicaciones Intraoperatorias/epidemiología , Laparotomía/métodos , Toracotomía/métodos , Toracotomía/efectos adversos , Estudios RetrospectivosRESUMEN
AIM: Hypothermia is one of the common complications of cesarean section, which has a serious impact on intraoperative surgical safety and postoperative recovery of pregnant women. Mitigation of the risk factors of hypothermia in pregnant women undergoing cesarean section may reduce the probability of its occurrence and improve the perioperative comfort of pregnant women. Therefore, this study systematically evaluates the influencing factors of hypothermia in patients undergoing cesarean section, aiming to provide references for the prevention of hypothermia in pregnant women undergoing cesarean section. METHODS: A systematic search was conducted across various databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature databases to gather observational studies on the factors affecting hypothermia in pregnant women undergoing cesarean section. The search deadline was January 30, 2024. Two researchers independently screened literature, extracted data, evaluated quality, and crosschecked the outcomes. Meta analysis was conducted using RevMan 5.3 and Stata17.0. RESULTS: Twelve studies were included in this review, all of which were case-control studies conducted from 2014 to 2022, encompassing a total of 5561 pregnant women. The quality of the studies included was average or above. The meta-analysis results showed that body mass index (mean difference (MD) = -1.47; 95% confidence interval (CI) [-2.84, -0.11]; p = 0.03), operating room temperature (odds ratio (OR) = 2.08; 95% CI [1.56, 2.76]; p < 0.00001), anesthesia method (OR = 1.84; 95% CI [1.40, 2.42]; p < 0.0001), fluid loss (MD = 160.09; 95% CI [77.31, 242.87]; p = 0.0002), flushing volume (MD = 66.43; 95% CI [8.46, 124.40]; p = 0.02), and hypothyroidism (OR = 2.29; 95% CI [1.61, 3.27]; p < 0.00001) were risk factors for perioperative hypothermia in pregnant women undergoing cesarean section (p < 0.05). CONCLUSIONS: The occurrence of hypothermia in pregnant women during the perioperative period is influenced by factors such as low body mass index, spinal anesthesia, low operating room temperature, intraoperative fluid loss, large flushing volume, and hypothyroidism.
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Cesárea , Hipotermia , Complicaciones Intraoperatorias , Femenino , Humanos , Embarazo , Índice de Masa Corporal , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Hipotermia/epidemiología , Hipotermia/etiología , Hipotermia/prevención & control , Complicaciones Intraoperatorias/prevención & control , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/epidemiología , Factores de RiesgoRESUMEN
Aims: The primary objective of this study was to develop a validated classification system for assessing iatrogenic bone trauma and soft-tissue injury during total hip arthroplasty (THA). The secondary objective was to compare macroscopic bone trauma and soft-tissues injury in conventional THA (CO THA) versus robotic arm-assisted THA (RO THA) using this classification system. Methods: This study included 30 CO THAs versus 30 RO THAs performed by a single surgeon. Intraoperative photographs of the osseous acetabulum and periacetabular soft-tissues were obtained prior to implantation of the acetabular component, which were used to develop the proposed classification system. Interobserver and intraobserver variabilities of the proposed classification system were assessed. Results: The BOne trauma and Soft-Tissue Injury classification system in total Hip arthroplasty (BOSTI Hip) grades osseous acetabular trauma and periarticular muscle damage during THA. The classification system has an interclass correlation coefficient of 0.90 (95% CI 0.86 to 0.93) for interobserver agreement and 0.89 (95% CI 0.84 to 0.93) for intraobserver agreement. RO THA was associated with improved BOSTI Hip scores (p = 0.002) and more pristine osseous surfaces in the anterior superior (p = 0.001) and posterior superior (p < 0.001) acetabular quadrants compared with CO THA. There were no differences between the groups in relation to injury to the gluteus medius (p = 0.084), obturator internus (p = 0.241), piriformis (p = 0.081), superior gamellus (p = 0.116), inferior gamellus (p = 0.132), quadratus femoris (p = 0.208), and vastus lateralis (p = 0.135), but overall combined muscle injury was reduced in RO THA compared with CO THA (p = 0.023). Discussion: The proposed BOSTI Hip classification provides a reproducible grading system for stratifying iatrogenic bone trauma and soft-tissue injury during THA. RO THA was associated with improved BOSTI Hip scores, more pristine osseous acetabular surfaces, and reduced combined periarticular muscle injury compared with CO THA. Further research is required to understand if these intraoperative findings translate to differences in clinical outcomes between the treatment groups.
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Acetábulo , Artroplastia de Reemplazo de Cadera , Traumatismos de los Tejidos Blandos , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Traumatismos de los Tejidos Blandos/clasificación , Traumatismos de los Tejidos Blandos/etiología , Acetábulo/lesiones , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Variaciones Dependientes del Observador , Enfermedad Iatrogénica , Adulto , Complicaciones Intraoperatorias/clasificación , Complicaciones Intraoperatorias/etiología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Surgery for Crohn's disease (CD) is considered to have more complications due to the underlying inflammation, immunosuppression, and malnutrition. We sought to study the outcomes of right-sided colonic resection in patients with CD and patients with cancer at a high-volume tertiary center utilizing a standardized perioperative protocol. METHODS: This is a retrospective study of outcomes for all patients with CD or patients undergoing ileocolic resection or right hemicolectomy with ileocolic anastomosis at a single institution from 2013 to 2022. Patients were excluded if they simultaneously underwent another procedure or ostomy creation. Data were analyzed using Wilcoxon rank-sum and chi-squared tests for univariate analyses, and logistic and linear regressions for multivariate analyses. RESULTS: In total 141 patients with CD and 589 patients with cancer were included. Patients with CD were significantly younger with lower body mass index and less likely to have comorbidities, including diabetes and hypertension. Patients with CD were less likely to have a smoking history or prior abdominal surgery, but more likely to be on steroids. Both groups had similar rates of laparoscopy, intraoperative complications, and blood loss. Despite the preoperative and intraoperative differences, both patients with CD and patients with cancer had similar lengths of stay (LOS), readmission, reoperation, and mortality rates. None of the surgical outcomes differed significantly between the two groups. On multivariate analysis, CD diagnosis was not associated with reoperation, readmission, mortality, or LOS while controlling for other characteristics. CONCLUSIONS: With the use of standardized perioperative protocols, surgery for CD at a high-volume center with expertise in CD can be performed with comparable results to other indications like cancer.
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Colectomía , Enfermedad de Crohn , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Colectomía/efectos adversos , Colectomía/métodos , Adulto , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Colon/cirugía , Neoplasias del Colon/cirugía , Neoplasias del Colon/mortalidad , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Readmisión del Paciente/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Íleon/cirugía , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Laparoscopía/efectos adversos , Complicaciones Intraoperatorias/etiologíaAsunto(s)
Colecistectomía Laparoscópica , Competencia Clínica , Complicaciones Intraoperatorias , Entrenamiento Simulado , Humanos , Colecistectomía Laparoscópica/educación , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Entrenamiento Simulado/métodos , Complicaciones Intraoperatorias/prevención & control , Complicaciones Intraoperatorias/etiología , Femenino , Masculino , AdultoRESUMEN
BACKGROUND: Appendicitis is one of the most common acute surgical conditions globally. However, the association between nighttime appendectomy and patients' morbidity and mortality is unclear. This study aims to compare outcomes following nighttime versus daytime appendectomy. METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases up to March 26, 2024 (updated on July 1, 2024) were searched. The primary outcomes were postoperative complications and mortality. Secondary outcomes included intraoperative complications, reoperation, readmission, conversion to laparotomy, hospital stay and operation time. Mean difference (MD) or odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: Fifteen studies totaling 33,596 patients were included. There were no differences between nighttime and daytime appendectomy for rates of overall postoperative complications (OR 0.93, 95% CI 0.87, 1.00, 14 studies), mortality (OR 1.70, 95% CI 0.37, 7.88, 7 studies), intraoperative complications (OR 0.88, 95% CI 0.08, 9.86; 2 studies), reoperation (OR 0.39, 95% CI 0.06, 2.55; 3 studies) and readmission (OR 0.86, 95% CI 0.65, 1.13; I2 = 0%, 5 studies). However, the conversion to laparotomy risks (OR 1.92, 95% CI 1.12, 3.29; 6 studies) among patients who underwent appendectomy during nighttime was significantly elevated compared to daytime. CONCLUSIONS: There was no increased risk or difference in postoperative mortality and complication rates associated with nighttime compared with daytime appendectomy. However, future studies should assess the reasons for higher conversion rates during the night.
Asunto(s)
Apendicectomía , Readmisión del Paciente , Complicaciones Posoperatorias , Reoperación , Humanos , Apendicectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Apendicitis/cirugía , Apendicitis/complicaciones , Factores de Tiempo , Femenino , Masculino , Tiempo de Internación , Tempo Operativo , Adulto , Persona de Mediana Edad , Complicaciones Intraoperatorias/etiologíaRESUMEN
OBJECTIVE: To assess the safety and effectiveness of the indocyanine green use in acute cholecystitis for identification of anatomical variants of the biliary tree; prevention and timely detection of intraoperative complications. MATERIAL AND METHODS: The medication of indocyanine green made by OOO «Ferment¼ domestic manufacturer was used. The drug dose from 2.5 mg to 10 mg was applied according to studied materials (8). Time of the surgery beginning was from 2 to 6 hours after intravenous injection of aqueous solution, respectively. In addition, it has been established that the optimal drug dose is 5 mg. The surgery should be performed not earlier than 3 hours after, but no later than 6 hours. This allows to achieve the most comfortable fluorescence of the extrahepatic biliary tract. The drug concentration in the liver cells decreases by this time and increases in the biliary tract. It is not always possible to perform the operation strictly within the specified time limit considering the urgency of the surgical intervention. In this connection, the surgery was carried out not earlier than 3 hours after the drug injection, but not later than 6 hours. Endoscopic equipment with the ability to display near-infrared fluorescence was used. A laser light source with a wavelength of 820 nm in the Arthrex imaging system with 4K resolution as well as the Olympus imaging system with HD resolution were used for fluorescence excitation. RESULTS: The implementation of intraoperative fluorescent navigation with indocyanine green contributes to the improvement of safety and effectiveness of surgical treatment through visualization of topography and identification of anatomical variants of the biliary tree; possibilities of prevention and timely detection of intraoperative complications. The use of indocyanine green allows to intraoperatively reveal atypical location and different variations of the extrahepatic biliary tract.