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Results for “Surgical Procedures, Operative”

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At least 343 records · Page 19Linked to original sources
PubMed1985

Abdominal midline incision closure. A multicentric randomized prospective trial of 3,135 patients, comparing continuous vs interrupted polyglycolic acid sutures.

A randomized prospective multicentric study was organized to compare results between techniques using continuous sutures and interrupted sutures in closing abdominal midline incisions. The suture material employed was polyglycolic acid. This study included 3,135 patients who were randomized between the two methods of closure and who were stratified according to the type of wound: clean, clean-contaminated, and contaminated. The overall dehiscence rate was 1.6% in the continuous sutures group vs 2% in the interrupted sutures group. The dehiscence rate in the interrupted sutures group was significantly higher than in the continuous sutures group only in the stratum of contaminated wounds. The death rate was significantly higher in the interrupted sutures group. The number of needle sets was significantly less important when the continuous sutures technique was used. Continuous closure is preferable because it is more economic and expedient and also because it has the same incidence of wound dehiscence as interrupted sutures closure.

Adult↗
PubMed1986

Decreasing the incidence of surgical wound infections. Validation of a surveillance-notification program.

In an attempt to validate the observations of a previously published ten-year study of surgical wounds, we studied 8,474 wounds over an 18-month period using a protocol nearly identical to that of the previous study. Our study corroborated the following predictors of clean-wound infection: increasing duration of surgery, age less than 1 or greater than 50 years, increasing duration of preoperative hospitalization, use of drains, and shaving and emergency surgery. We failed to corroborate use of wound irrigation as a protective measure or time of preoperative shaving as a significant variable. Most importantly, we found a 42% reduction in the clean-wound infection rate during the study period (1.9% to 1.1%), adding support to the concept that a wound surveillance program with surgeon notification is both efficacious and cost-effective.

Adolescent↗
PubMed1996

Host defense mechanisms of surgical patients. Friend or foe?

Surgeons and members of this society commonly deal with 2 types of infections of great concern in hospitalized patients. These are hospital-acquired pneumonia and intra-abdominal infections. Both of these infections have the potential for severe morbidity and mortality. We have learned how to classify the types of intra-abdominal infections into primary peritonitis, localized abscess with or without peritonitis, diffuse suppurative peritonitis, or combinations of these classifications. Each of these conditions carries a different mortality risk proportional to its severity. We have also learned how to diagnose surgical infections by properly taking medical history and performing physical examination, appropriate laboratory testing, and sophisticated imaging techniques. The treatment of intra-abdominal infections has become fairly standardized and includes surgical or percutaneous drainage of the infected material, correction of the underlying pathologic symptoms, and broad-spectrum empirical antibiotic therapy.

Abdominal Abscess↗
PubMed2004

Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial.

CONTEXT: Surgical site infection (SSI) in the general surgical population is a significant public health issue. The use of a high fractional inspired concentration of oxygen (FIO2) during the perioperative period has been reported to be of benefit in selected patients, but its role as a routine intervention has not been investigated. OBJECTIVE: To determine whether the routine use of high FIO2 during the perioperative period alters the incidence of SSI in a general surgical population. DESIGN, SETTING, AND PATIENTS: Double-blind, randomized controlled trial conducted between September 2001 and May 2003 at a large university hospital in metropolitan New York City of 165 patients undergoing major intra-abdominal surgical procedures under general anesthesia. INTERVENTIONS: Patients were randomly assigned to receive either 80% oxygen (FIO2 of 0.80) or 35% oxygen (FIO2 of 0.35) during surgery and for the first 2 hours after surgery. MAIN OUTCOME MEASURES: Presence of clinically significant SSI in the first 14 days after surgery, as determined by clinical assessment, a management change, and at least 3 prospectively defined objective criteria. RESULTS: The study groups were closely matched in a large number of clinical variables. The overall incidence of SSI was 18.1%. In an intention-to-treat analysis, the incidence of infection was significantly higher in the group receiving FIO2 of 0.80 than in the group with FIO2 of 0.35 (25.0% vs 11.3%; P =.02). FIO2 remained a significant predictor of SSI (P =.03) in multivariate regression analysis. Patients who developed SSI had a significantly longer length of hospitalization after surgery (mean [SD], 13.3 [9.9] vs 6.0 [4.2] days; P<.001). CONCLUSIONS: The routine use of high perioperative FIO2 in a general surgical population does not reduce the overall incidence of SSI and may have predominantly deleterious effects. General surgical patients should continue to receive oxygen with cardiorespiratory physiology as the principal determinant.

Anesthesia, General↗
PubMed2000

Hemicorporectomy.

In hemicorporectomy, or translumbar amputation, the bony pelvis, pelvic contents, lower extremities, and external genitalia are removed following disarticulation of the lumbar spine and transection of the spinal cord. Malignancies of the pelvic organs, skin, or musculoskeletal structures, usually locally advanced, may be indications for hemicorporectomy. The absence of systemic metastasis must be demonstrated before considering hemicorporectomy. Sacral decubitus ulcers and other complications of paraplegia represent the most frequent benign indications. Hemicorporectomy is a complex, multistep procedure with significant physiologic and psychologic implications. Postoperative morbidity and mortality rates are high, partly because of the complexity of the procedure itself and partly due to the underlying disease. Detailed planning, from preoperative evaluation to rehabilitation, is the key to a successful outcome. The procedure may be carried out in one stage or in multiple stages, depending on the clinical circumstances. Multidisciplinary collaboration of many health care professionals should be part of the planning process and must be carefully coordinated. Postoperative management requires particular attention to fluid replacement, temperature control, and pulmonary care. Posthospitalization rehabilitation includes the design and construction of a bucket prosthesis. Long-term management issues involve hypertension, weight gain, temperature control, stoma management, and skin care.

Amputation, Surgical↗
PubMed1989

Need for surgical wound dressing.

The need for dressings on clean and clean contaminated surgical wounds was investigated. A total of 1202 patients with 1202 clean or clean contaminated surgical wounds were randomized into two groups: 633 wounds were covered by dressings up until the time of suture removal, and 569 wounds were treated without dressings after the first postoperative day. In the group characterized by long dressing time, the rate of postoperative wound infections was 4.9 per cent. The rate was 4.7 per cent in the group represented by short dressing time. Using short dressing time not only reduces the number of nursing hours but also limits the need for costly dressing material. In addition, both wound observation and patients' personal hygiene are made easier.

Bandages↗
PubMed2005

The evolving role of gene-based treatment in surgery.

BACKGROUND: The completion of the sequencing of the human genome in 2003 marked the dawn of a new era of human biology and medicine. Although these remarkable scientific advances improve the understanding of human biology, the question remains how this rapidly expanding knowledge of functional genomics affects the role of surgeons. This article reviews the potential therapeutic application of gene therapy for various surgical conditions. METHODS: The core of this review was derived from a Medline database literature search. RESULTS AND CONCLUSION: The currently available vectors in the field of gene therapy and their limitations for clinical applications were analysed. The achievements of gene therapy in clinical trials and the future ramifications for surgery were also explored. Whether gene therapy takes a major role in surgical practice will depend greatly on the success of future vector development. Advances in viral vector technology to reduce the inflammatory effect, and improvements in the efficiency of gene delivery using non-viral vector technology, would allow this form of therapy to become more clinically applicable.

Drug Resistance↗