PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Prophylactic Surgical Procedures”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Evaluation of new cephalosporins for prophylaxis of surgical infection.

The appropriate use of recently marketed cephalosporins for antimicrobial prophylaxis during surgery is discussed. New cephalosporins (cefamandole, cefoxitin, cefotaxime, moxalactam, and cefoperazone) are often substituted in situations where older, "first-generation" cephalosporins or other antimicrobials traditionally have been used. Adoption of these newer agents for routine use in prophylaxis of surgical infection has led to concerns of substantially increased costs as well as development of bacterial resistance. To date, some of the newer cephalosporins have been investigated for prophylaxis of postoperative infection in cesarean section, vaginal hysterectomy, gastrointestinal surgery, open-heart surgery, and total-hip replacement. Assessment of new cephalosporins for surgical prophylaxis should include: (1) the nature of infection with each specific type of procedure, (2) the effect of antimicrobials on prevention of infection with specific procedures, and (3) factors related to the institutional environment. For the surgical procedures listed above, newer cephalosporins either have not been studied or studies have not demonstrated a reduction in postoperative infection rates in comparisons with "first-generation" cephalosporins. Valid prophylactic uses for the newer agents may arise if comparative studies demonstrate postoperative infection rates lower than with regimens using the older cephalosporins or with other established regimens. Currently, none of the newer cephalosporins can be recommended for routine use in the prophylaxis of surgical infection.

Cardiac Surgical Procedures↗
PubMed2004

Practicing surgeons lead in quality care, safety, and cost control.

OBJECTIVE: To report the experiences of 66 surgical specialists from 15 different hospitals who performed 43 CPT-based procedures more than 16,000 times. SUMMARY BACKGROUND DATA: Surgeons are under increasing pressure to demonstrate patient safety data as quantitated by objective and subjective outcomes that meet or exceed the standards of benchmark institutions or databases. METHODS: Data from 66 surgical specialists on 43 CPT-based procedures were accessioned over a 4-year period. The hospitals vary from a small 30-bed hospital to large teaching hospitals. All reported deaths and complications were verified from hospital and office records and compared with benchmarks. RESULTS: Over a 4-year inclusive period (1999-2002), 16,028 elective operations were accessioned. There was a total 1.4% complication rate and 0.05% death rate. A system has been developed for tracking outcomes. A wide range of improvements have been identified. These include the following: 1) improved classification of indications for systemic prophylactic antibiotic use and reduction in the variety of drugs used, 2) shortened length of stay for standard procedures in different surgical specialties, 3) adherence to strict indicators for selected operative procedures, 4) less use of costly diagnostic procedures, 5) decreased use of expensive home health services, 6) decreased use of very expensive drugs, 7) identification of the unnecessary expense of disposable laparoscopic devices, 8) development of a method to compare a one-surgeon hospital with his peers, and 9) development of unique protocols for interaction of anesthesia and surgery. The system also provides a very good basis for confirmation of patient safety and improvement therein. CONCLUSIONS: Since 1998, Quality Surgical Solutions, PLLC, has developed simple physician-authored protocols for delivering high-quality and cost-effective surgery that measure up to benchmark institutions. We have discovered wide areas for improvements in surgery by adherence to simple protocols, minimizing death and complications and clarifying cost issues.

Adult↗
PubMed2002

Multiple endocrine neoplasia 2A syndrome: Surgical management.

BACKGROUND/PURPOSE: Currently, molecular genetic diagnostics allow familial types of medullary thyroid carcinoma to be detected at an asymptomatic stage and surgery thus to be performed at a time when prognosis is good. The current report aims to determine the appropriate age for safe prophylactic thyroidectomy in children with multiple endocrine neoplasia (MEN) 2A and mutations at codon 609 according to genotype-phenotype correlations and will discuss surgical procedures. METHODS: The authors describe the case of a family with hereditary MEN 2A syndrome. A DNA analysis of 7 family members confirmed the diagnosis by a mutation at codon 609 of the RET proto-oncogene. RESULTS: A phaeochromocytoma developed in 2 family members. Four had medullary thyroid carcinoma. A grandson underwent a prophylactic thyroidectomy at the age of 5 on account of genetic evidence. Despite the negative preoperative and intraoperative findings he already had an invasive medullary thyroid carcinoma. CONCLUSIONS: Few genotype-phenotype correlations have been established for MEN 2A disease. According to the natural history of the disease, families with the genotype RET cys609gly should have a more benign disease than high-risk families (mutations at codon 634, 618). From this report the authors conclude that prophylactic thyroidectomy in "609" families should be performed earlier than actually recommended, favorably at the age of 2 to 4 years. Further multicenter studies are needed to provide more clinical and prognostic data for less frequent (codon 609, 630, 791, and 891) RET genotypes.

Adult↗
PubMed1986

Asymptomatic carotid disease in patients undergoing major cardiovascular operations: can prophylactic endarterectomy be justified?

This article reviews the published experience supporting or refuting the value of prophylactic endarterectomy in patients with asymptomatic carotid disease who are candidates for major cardiovascular operations. Reports of 1,483 patients subjected to staged or concomitant carotid endarterectomy and coronary artery bypass grafting reveal a perioperative stroke rate of 2.9%. Timing of carotid endarterectomy did not influence stroke rate, but staged procedures were associated with a significantly greater incidence of perioperative myocardial infarction and death. Studies of patients undergoing major cardiovascular surgical operations without prophylactic carotid endarterectomy reported a perioperative stroke rate of 2.7%, which is not significantly different from that of patients undergoing prophylactic carotid endarterectomy. However, the author's prospective study of such patients showed a significant incidence of late postoperative neurologic deficits, which are usually transient ischemic attacks. There is no evidence to justify routine prophylactic carotid endarterectomy of asymptomatic carotid disease before major cardiovascular operations. Patients not undergoing endarterectomy, however, should be given careful postoperative follow-up, because transient ischemic attacks may occur that require surgical intervention.

Cardiovascular Diseases↗
PubMed1990

[Can the individual risk of the patient for thromboembolic complications be estimated? What references can be used for differential therapeutic procedure?].

In 1988 and 1989 4581 patients had been hospitalized in the surgical department of the Stadtkrankenhaus Neuwied. These patients were treated prophylactically with a combination of low molecular weight heparin and dihydroergotamine in order to prevent deep vein thrombosis. The observed incidence of DVT and pulmonary embolism was extremely low. In patients who died during hospitalization, death was mainly caused by cancer or multimorbidity. Although some risk factors for developing DVT are recognized, we are at present not able to calculate the individual risk of a patient. Therefore, we need an effective and safe prophylaxis regimen for all patients undergoing surgical operations.

Aged↗
PubMed2006

Antibiotic use in tonsillectomies: therapeutic or prophylactic? Required or excessive?

Adenotonsillectomy is one of the most commonly performed surgeries in the pediatric and young adult populations. The postoperative morbidity of this surgical procedure is often significant, including odynophagia, dysphagia, fever, halitosis, loss of weight and reduced oral intake. After tonsillectomy, with or without adenoidectomy, the colonization of the open tonsillar fossae by the bacterial population of the oral cavity would cause an exacerbation of the local inflammatory response worsening postoperative pain. The hypothesis that a reduction of the bacterial population of an open surgical wound could minimize the local inflammation, stimulate the healing process and hasten recovery triggered a considerable number of studies addressing the relation between the use of perioperative antibiotics and postoperative morbidity of adenotonsillectomy. In spite of the fact that those studies claim to perform an assessment of the surgical prophylactic use of antibiotics, their outline is not in compliance with the worldwide-accepted principles of surgical antibiotic prophylaxis. By performing a critical review of the literature, the authors discuss the advantages and disadvantages of using antibiotics in tonsillectomies or adenotonsillectomies, as well as the most appropriate definition for its utilization.

Adenoidectomy↗
PubMed1998

Anterior compartment syndrome of the leg, a clinical-anatomical perspective: a case report.

Decompression of the fascial compartments of the leg is a fairly common procedure that is carried out therapeutically and prophylactically. It is submitted that the guidance offered by the average surgical texts are unclear and imprecise. A junior surgeon would be led to believe that all four compartments require decompression, whereas it is distinctly uncommon for compartments other than the anterior to suffer compression. Anatomic reasons are offered for this predilection. The incisions advised often extend the full length of the leg; not only is this unnecessary but considerable morbidity may result. A case report is presented which underlines the result of an ill placed incision and unfamiliarity with the detailed anatomy of the anterolateral leg muscles. An incision is suggested which is very unlikely to lead to failure to decompress and which should avoid complications.

Adult↗
PubMed1999

[Elective stenting of "unprotected" left main coronary stenosis in patients without contraindication to bypass surgery].

Coronary surgery is at this point of time the standard therapy of unprotected left main coronary artery stenosis. Coronary angioplasty (PTCA) is performed only in bail out situations. The number of publications of successful percutaneous intervention in unprotected left main coronary stenosis is increasing because of increasing use of stents and ticlopidine to avoid stent-thrombosis. From 9/96 to 7/98, 13 patients with unprotected left main coronary stenosis were treated with stents. All of them were accepted by the heart surgeon for bypass surgery but were not considered to be optimal candidates due to advanced age of more than 80 years (n = 5), significant co-morbidity (n = 2) or diffuse diseased peripheral coronary segments (n = 6). Mean age of patients was 74 +/- 10 years, 9 were male, and all patients presented with angina III-IV (CCS). Mean ejection fraction was 55 +/- 15%. Localization of stenoses were classified as ostial (n = 5), middle (n = 3), and bifurcational (n = 6). One patient had stenoses both in the ostium and in the bifurcation. In all cases a PTCA of the culprit stenosis was performed prior to stent implantation. The mean diameter of the stents used was 3.3 +/- 0.3 mm and the mean length was 11 +/- 4 mm. In 6 patients a PTCA of either left anterior descendens (LAD) or right coronary artery was performed in the same session. In 4 of these patients it was followed by a stent implantation. All procedures were performed with surgical stand-by, an intraaortal balloon pump was available, but was not uses prophylactically. Stent implantation could be performed successfully in 12 out of the 13 patients (success rate 92%). In bifurcational stenoses stents were positioned with the proximal end in the left main and the distal end in the LAD. Significant injury or occlusion of the circumflex artery was not observed. In one patient with bifurcational stenosis with severe calcification it was not possible to cross the lesion with an accurate sized balloon. Trying to cross with a smaller balloon (2.5 mm) resulted in dissection of the left main coronary artery which could not be reopened again by catheter technique. This patient was transferred to the operating room under conditions of cardiopulmonary resuscitation and a bypass surgery was performed. He was dismissed from the hospital with no evidence of perioperative myocardial infarction. The mean time for follow-up was 12 +/- 7 months, all patients are still alive. In 6 patients an angiography was performed during follow-up because of suspicion of recurrent ischemia. Two patients out of these 6 had restenoses in the left main coronary artery which were re-dilated (17%). Another 2 patients had stenoses in other coronary segments and were also dilated. Thus, stenting of left main coronary artery stenoses is feasible, however, with acceptable risks and could be considered in selected patients as an alternative to coronary artery surgery.

Aged↗
PubMed1985

Neonatal circumcision.

Because of an economically motivated study, there has been an attempt to shift insurance dollars from neonatal circumcision to neonatal intensive care. Negative comments regarding the advisability of early circumcision have created confusion for both physicians and parents. Neonatal circumcision is the most common surgical operation in the United States, with probably fewer complications than any other. I believe this valid prophylactic procedure is falling victim to an unwarranted bias.

Attitude↗
PubMed1999

[Clinical analysis of parotid cancer].

A clinical study was performed on 42 patients with parotid cancers initially treated in our hospital from 1972 to 1997. The five-year cumulative survival rate was 69% in the whole group and 72% in the radical surgical treatment group (n = 40). The five-year survival rates according to stage were as follows: stage I, 95% (21); stage II, 75% (4); stage III, 0% (1); and stage IV, 37% (16). The factors influencing prognosis were cases of T3 and T4 (p < 0.05), stage III and IV (p < 0.01), and cervical lymph node metastasis (p < 0.01). Regarding treatment modalities, a partial parotidectomy appeared to be a curable surgical procedure for T1 cases. However, a lobectomy is recommended for T2 cases. Furthermore our study proposed that prophylactic supraomohyoid neck dissection should be necessary for mucoepidermoid carcinoma (high-grade malignancy) and undifferentiated carcinoma of T4N0 cases.

Adult↗
PubMed1987

Dr. P. Siva Reddy Oration. Diabetic keratopathy.

Diabetes mellitus, which affects millions of people all over the world, produces significant ocular morbidity. Corneal complications such as tear film dysfunction, elevated glucose in tears, different forms of epitheliopathy, neurotrophic ulcers, corneal edema, wrinkles in Descemet's membrane and decrease in corneal sensitivity have been reported. While a few reports described altered epithelial morphology as the possible basis for epithelial disease, all other clinical phenomena have been unexplained thus far. In this first-ever multifaceted approach to study the pathogenesis of diabetic keratopathy, striking abnormalities were observed in corneal nerves, corneal epithelium and corneal endothelium of diabetics. We have clearly demonstrated the existence of neuropathy in diabetic cornea, both in an animal model and in the humans, -- the first demonstration of such an abnormality. Our in vivo specular microscopic observations on epithelium confirmed in vitro observations in our study as well as of others while the analysis of endothelium provided the basis for the problems noticed in the diabetic cornea following intraocular surgical procedures. Our observations should help the clinician in the understanding of diabetic keratopathy and in developing better prophylactic and therapeutic strategy against some recalcitrant forms of corneal disease in this group of individuals.

Animals↗
PubMed1987

[Remote results of the surgical decompression of the posterior tibial nerve in the neuropathies of Hansen's disease].

Results are reported of surgery to the posterior tibial nerve affected by leprosy in 50 patients. A total of 90 neurolyses were performed using a similar technique. Study of the effect of surgery on the course of plantar sensitivity showed that 3 groups of nerves can be distinguished. Nerves in group 1 (21 totally paralyzed nerves) responded poorly to surgery (38% useful results) while on the contrary nerves in group 3 (non-paralyzed nerves) represented the ideal indication, surgery being truly prophylactic. In group 2 nerves a useful result was obtained in 82%. Indications for use of this surgical procedure are discussed, and more particularly the parameters affecting the quality of the results: severity of lesion, immunologic type of disease.

Adolescent↗
PubMed2004

Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment.

BACKGROUND AND AIMS: The role of antibiotic prophylaxis for invasive dental procedures in patients on dialysis therapy is unclear. We examined current clinical practice in Australia and New Zealand and compared our findings to a systematic review of the current literature. METHODS: Australian and New Zealand nephrology units were surveyed with regard to their use of antibiotic prophylaxis for dental procedures. A systematic review of the literature was performed by using an online web-based search engine (PubMed) using the key words: renal patients, dental and antibiotic prophylaxis. RESULTS: Forty-one per cent of respondents do not routinely give antibiotic prophylaxis to haemodialysis patients prior to dental surgery, but a majority (53%) would consider antibiotic prophylaxis if the patient had a synthetic arteriovenous fistula. CONCLUSIONS: The majority of clinicians follow the American Heart Association (AHA) guidelines with a single oral preoperative dose of 2 g amoxycillin or 600 mg clindamycin if patients are allergic to penicillin. From the literature and the data obtained by questionnaire, it would appear that renal patients receiving haemodialysis in Australia and New Zealand receive antibiotic prophylaxis prior to invasive dental procedures. The standard single dose of 2 g amoxycillin orally or 600 mg clindamycin orally 1 h preoperatively, as recommended by the AHA, is most frequently used. Peritoneal dialysis patients generally do not receive a prophylactic dose of antibiotics.

Antibiotic Prophylaxis↗
PubMed2004

Bilateral autogenous breast reconstruction using perforator free flaps: a single center's experience.

The authors present a single center's experience in bilateral breast reconstruction using perforator free flaps. The aim of this study was to show their indications, surgical technique, and results. A series of 53 patients underwent this procedure between February of 1996 and October of 2002. The surgical procedures were performed on patients with bilateral breast cancer (11 patients), patients with unilateral breast cancer and contralateral prophylactic mastectomy (22 patients), patients who had undergone bilateral prophylactic mastectomy (18 patients), a patient with Poland's syndrome, and a patient whose aesthetic breast augmentation had failed. Primary and secondary bilateral breast reconstructions were done in 18 and four patients, respectively. Eighteen patients who had earlier undergone breast reconstruction with implants had a tertiary breast reconstruction. Combined reconstruction (primary with secondary and primary with tertiary reconstruction) was done in 13 patients. Ninety-eight deep inferior epigastric perforator flaps and eight superior gluteal artery perforator flaps were used. The average operative time was 10 hours (range, 8 to 14.5 hours) for the simultaneous bilateral reconstruction. Total flap necrosis occurred in two cases (one deep inferior epigastric perforator flap and one superior gluteal artery perforator flap). Partial flap necrosis was not encountered, and fat necrosis was found in one deep inferior epigastric perforator flap (1 percent). Two pulmonary infections, one deep vein thrombosis, and one cardiac arrhythmia occurred as postoperative complications. The mean hospital stay was 9 days (range, 6 to 20 days). Abdominal bulging was reported in one patient. There were no recurrent disease or cancer manifestations, with an average follow-up of 3.5 years. This series clearly shows that perforator flaps are reliable and useful tools for bilateral breast reconstruction. This technique decreases the donor-site morbidity and offers an excellent aesthetic and long-term outcome and high patient satisfaction.

Adult↗
PubMedDate not supplied

Transthoraco-phrenic esophageal transection with paraesophago-gastric devascularization and splenectomy using a stapler.

BACKGROUND/AIMS: Surgery remains the most reliable treatment for bleeding esophageal varices. The aim of this study was to introduce the operative technique of transthoraco-phrenic esophageal transection with paraesophagogastric devascularization using a stapler and to evaluate surgical results. METHODS: Forty-five patients underwent the procedure; an elective procedure was performed in 22 patients (bleeders) and a prophylactic procedure in 23 patients (nonbleeders). Twenty-nine patients were classified as Child's A, 15 as B and 1 as C. Previous sclerotherapy had been performed in 5 patients. RESULTS: No hospital deaths occurred. No patients developed postoperative anastomotic leakage, encephalopathy, or any complications related to phrenicotomy. Three patients bled postoperatively from recurrent esophageal varices. Cumulative 5-year bleeding rates were 5.0% in bleeders and 6.6% in non-bleeders. Two patients died due to bleeding varices. Cumulative 5-year survival rates were 72.1% and 78.8% in patients classified as Child's A and Child's B, respectively. CONCLUSIONS: This procedure may be indicated for a majority of Child's A or B patients. Although the advantages of this procedure must be evaluated further, it may be an alternative when injection sclerotherapy and endoscopic ligation fail.

Adult↗
PubMed1998

[Efficacy of short-term danazol treatment in hereditary angioneurotic edema patients undergoing maxillofacial and dental surgical procedures].

The authors evaluated the efficacy of short-term danazol prophylaxis in 12 hereditary angioedema patients undergoing maxillofacial or dental procedures. Hereditary angioedema is an autosomal dominant disorder resulting from the deficiency of the C1 esterase inhibitor. Characteristic clinical manifestations include the formation of subcutaneous and submucosal edema. The latter can lead to fatal upper airway obstruction. Edematous attacks can be precipitated by tissue injury from operative procedures, dental surgery in particular. In patients undergoing surgical and diagnostic procedures performed in the cephalic and cervical regions, such attacks can be prevented by appropriate drug therapy. Short-term danazol prophylaxis was effective in all 12 patients with a history of edematous complications that had occurred after dental procedures; none of them developed postoperative edema. The serum levels of complement components determined pre- and postoperatively as well as at 6- and 12-hour intervals also demonstrated the efficacy of prophylactic therapy.

Adult↗
PubMed2002

[Treatment outcome after surgical management of osseous breast carcinoma metastases. Preventive stabilization vs. management after pathological fracture].

UNLABELLED: AIM OF THE STUDY, METHOD: The advantages of a prophylactic care of fracture-endangered, osseous metastasis of the mammary cancer stand opposite to the perioperative risk and to conservative alternatives. As a pathologic fracture cannot surely be excluded while performing a conservative proceeding, a retrospective trial was set up to compare the results of treatment after a pathologic fracture (n = 35) with those undergoing a prophylactic attendance (n = 44). RESULTS: The intraoperative, cardio-pulmonary complications were distributed in balance totally amounting to 20.3% (n = 16). Intraoperative complications concerning surgical procedure (n = 3) exclusively occurred within the fracture group. Generally, postoperative complications arose in 20.3% (n = 16) of all cases, in which the patients belonging to the fracture group were increasingly afflicted [28.6% (n = 11/35) vs. 11.4% (n = 5/44); p < 0.02]. While there were no differences between both groups concerning the postoperative, surgery-technical complications, significantly more patients (91.8% [n = 40/44]) of the prophylactic-care group achieved a complete postoperative usability of the operated area than in the fracture-group [74.3% (n = 26/35)] (p < 0.05). The average survival time tended to be longer within the prophylactic-care group [19.3 +/- 15.6 month (prophylactic-care group) vs. 15.0 +/- 16.9 month (fracture group)]. CONCLUSIONS: The prophylactic treatment of fracture endangered, osseous metastasis of the mammary cancer leads to reduction of the general, postoperative complications compared to the patients with a pathologic fracture. Further, those patients have a better chance to recover full mobility after surgery. Considering the long survival time after the incidence of osseous metastasis at the mammary cancer a prophylactic treatment represents the method of first choice compared with the conservative treatment which persistently contains the risk of fracturing.

Adult↗