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Results for “Surgical Procedures, Operative”

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PubMed2003

Topical cyclosporine in pediatric keratoplasty.

PURPOSE: To evaluate the efficacy and safety of combined treatment with 2% topical cyclosporine (CsA) and topical corticosteroid compared to treatment with topical corticosteroids only after pediatric keratoplasty. METHODS: Twenty-two grafts in 16 pediatric patients were evaluated retrospectively. The eyes were divided into a CsA group (9 eyes) and a control group (13 eyes) based on the postoperative treatment regimen. Information reviewed included patient age and sex, clinical diagnosis; preoperative and postoperative intraocular pressure and lens status; previous, concurrent, and subsequent surgical procedures; operative and postoperative complications; number of graft rejections, timing of suture removal, and length of follow-up. The clinical outcome of penetrating keratoplasty (PK) was evaluated by the rate of rejection-free graft survival and graft survival evaluation by the Kaplan-Meier log-rank test. RESULTS: The rejection-free graft survival rate was 88.9% in the CsA group and 38.5% in the control group. This difference in rejection-free graft survival rate between the groups was statistically significant (P =.0465). The graft survival rate was 88.9% in the CsA group and 46.2% in the control group. The difference in the graft survival rate was not statistically significant between the groups (P =.6). No clinical signs of systemic or local toxicity were seen with the topical CsA treatment. CONCLUSIONS: Two percent topical CsA is safe and effective in reducing the risk of allograft rejection in pediatric recipients.

Administration, Topical↗
PubMed2005

Preoperative antibiotics and mortality in the elderly.

OBJECTIVE AND BACKGROUND: It is generally thought that the use of preoperative antibiotics reduces the risk of postoperative infection, yet few studies have described the association between preoperative antibiotics and the risk of dying. The objective of this study was to determine whether preoperative antibiotics are associated with a reduced risk of death. METHODS: We performed a multivariate matched, population-based, case-control study of death following surgery on 1362 Pennsylvania Medicare patients between 65 and 85 years of age undergoing general and orthopedic surgery. Cases (681 deaths within 60 days from hospital admission) were randomly selected throughout Pennsylvania using claims from 1995 and 1996. Models were developed to scan Medicare claims, looking for controls who did not die and who were the closest matches to the previously selected cases based on preoperative characteristics. Cases and their controls were identified, and charts were abstracted to define antibiotic use and obtain baseline severity adjustment data. RESULTS: For general surgery, the odds of dying within 60 days were less than half in those treated with preoperative antibiotics within 2 hours of incision as compared with those without such treatment: (odds ratio = 0.44; 95% confidence interval, 0.32-0.60), P < 0.0001). For orthopedic surgery, no significant mortality reduction was observed (OR = 0.85; 95% confidence interval, 0.54-1.32; P < 0.464). INTERPRETATION: Preoperative antibiotics are associated with a substantially lower 60-day mortality rate in elderly patients undergoing general surgery. In patients who appear to be comparable, the risk of death was half as large among those who received preoperative antibiotics.

Age Factors↗
PubMed2006

Perioperative glucose control in the diabetic or nondiabetic patient.

Patients with diabetes are more likely to undergo surgery than nondiabetics, and maintaining glycemic control in subjects with diabetes can be challenging during the perioperative period. Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality. In addition, several observational and interventional studies have indicated that hyperglycemia is associated with adverse clinical outcomes in surgical and critically ill patients. This paper reviews the pathophysiology of hyperglycemia during trauma and surgical stress and will provide practical recommendations for the preoperative, intraoperative, and postoperative care of diabetic patients.

Blood Glucose↗
PubMed1988

ELISA method for measurement of airborne levels of major laboratory animal allergens.

Three types of air-sampling apparatus (the Air-Sentinel, Burkard Personal Sampler and Casella Personal Sampler) were compared for their use in sampling the air in situations where individuals are exposed to laboratory animals, and a cascade impactor was used to determine the sizes of particles carrying the allergens under investigation. An ELISA, using monospecific antisera raised to selected major allergens of the mouse, rat and rabbit, i.e. mouse Ag 1 (mouse urinary prealbumin), rat Ag 4 (rat urinary prealbumin) and rabbit Ag R1, was developed to assay the extracts obtained from the samplers. This ELISA system was able to detect greater than 5 ng/m3 of allergen in sampled air. The rat and mouse allergens were shown to be carried mainly on particles of 6-18 micron, whereas the rabbit allergen was also found on particles of 2 micron and smaller. Allergen levels correlated well with the number of animals present in the room and the degree of activity during sampling. A protective filtered-air hood, when worn during surgical operation procedures, was shown to reduce effectively the level of rat allergen breathed by an individual.

Air Pollutants↗
PubMed2005

An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implication.

OBJECTIVE: To assess the appropriateness of use of antimicrobial prophylaxis in paediatric surgery in Singapore. METHODS: A prospective evaluation of the use of antimicrobial prophylaxis in paediatric patients undergoing surgery in KK Hospital, Singapore was carried out from September and December 2001. Process measures for the study included adherence to local or international guidelines, choice and dose of antimicrobial agent and timing and duration of prophylaxis. Outcome measures included surgical site and other related infections. A cost analysis was also performed to look at the extra expenditure due to any excessive use of antimicrobials. RESULTS: A total of 171 patients with a mean age of 5.7 years (SD=4.5) were included in the study. Among the 117 (68.4%) elective and 54 (31.6%) emergency procedures, 22 cases (12.8%) were fully compliant with the guidelines. The most frequently encountered non-compliance types were unnecessary prolongation of prophylaxis (54.4%), inappropriate choice of antibiotics (42.7%) and overdose of antibiotics (26.3%). The estimated extra cost to patients for the study period was Sing$13,879.41 (US 8164.36). CONCLUSION: The results showed a significantly high level of inappropriate use of antimicrobial prophylaxis in paediatric surgery in Singapore. However, when the individual factors such as appropriate choice of antibiotics, appropriate timing and duration were considered, the situation was very similar to the results obtained from overseas studies.

Antibiotic Prophylaxis↗
PubMed2004

Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia--efficient, sufficient, and persistent.

OBJECTIVE: Optimal surgical treatment for chronic pilonidal sinus (PS) disease should be easy and efficient. The purpose of this study was to establish the feasibility of and results after ambulatory simple midline excision and primary wound closure under local anaesthesia. PATIENTS AND METHODS: The prospective nonrandomised single institution study included 131 consecutive PS patients admitted for surgery. After standardized surgery, all patients were prospectively followed until fully healed. Complications were registered. Results after 41 months (mean, range 36-59) were evaluated by questionnaire. RESULTS: 95% were primary closed. All were ambulatory treated and 98% under local anaesthesia. 88% healed in two weeks. 5.6% exhibited minor wound healing defects and 6.4% demanded full debridement of the wound. Mean delayed healing time was 7.5 weeks (range 3-12). 8% developed a recurrence. 10% of the remainders reported a slight tenderness in the scar area. 90% were symptom-free. CONCLUSION: PS treatment as of above is readily achieved. Wound related complications were reasonably few and in the same magnitude as after more complex excision techniques and induced no significant long-term sequels. Recurrences could, however, be more common. Prospective randomised studies are warranted to determine if there are any significant differences between excision techniques in and out of the midline.

Ambulatory Surgical Procedures↗
PubMed2006

Use of W-plasty in stenotic stoma: a new solution for an old problem.

INDICATION: Amongst late complications of stomas, stenosis can be difficult to treat. Repeated dilatations rarely achieve long-term resolution and re-fashioning is not always successful. Application of an existing plastic surgical technique to treat stomal stenosis is described. METHOD: After marking the skin, a W-plasty is made with a number of consecutive small triangular flaps through the skin. The corresponding mucosal margin is then made to interdigitate with this configuration and fixed using a Gillies corner stich with 5/0 Vycril rapide on a compound curved needle. RESULTS: Five patients underwent W-plasty reconstruction for a stenotic stoma. Median follow up was 12.5 months (range 11-15). No patient had stenosis of the stoma on review and the patient satisfaction rate was high. CONCLUSION: The W-plasty technique is a new treatment for stenotic stoma.

Adult↗
PubMed2004

Surgical site infection - a European perspective of incidence and economic burden.

This retrospective review of reported surgical site infection (SSI) rates in Europe was undertaken to obtain an estimated scale of the problem and the associated economic burden. Preliminary literature searches revealed incomplete datasets when applying the National Nosocomial Infection Surveillance System criteria. Following an expanded literature search, studies were selected according to the number of parameters reported, from those identified as critical for accurate determination of SSI rates. Forty-eight studies were analysed. None of the reviewed studies recorded all the data necessary to enable a comparative assessment of the SSI rate to be undertaken. The estimated range from selected studies analysed varied widely from 1.5-20% - a consequence of inconsistencies in data collection methods, surveillance criteria and wide variations in the surgical procedures investigated - often unspecified. SSIs contribute greatly to the economic costs of surgical procedures - estimated range: 1.47-19.1 billion Euro dollars. The analysis suggests that the true rate of SSIs, currently unknown, is likely to have been previously under-reported. Consequently, the associated economic burden is also likely to be underestimated. A significant improvement in study design, data collection, analysis and reporting will be necessary to ensure that SSI baseline rates are more accurately assessed to enable the evaluation of future cost-effective measures.

Anti-Bacterial Agents↗
PubMed2006

Validation of a diabetic foot surgery classification.

The purpose of this project was to evaluate associations of increasing diabetic foot surgery stage with postoperative outcome. This project, designed as a retrospective cohort model, was conducted at three large, urban referral-based diabetic foot clinics. The investigators abstracted medical records from 180 patients with diabetes, 76.1% male, aged 57.8 +/- 11.2 years, falling equally into four classes of a previously reported diabetic foot surgery classification system. These classes included class 1 (elective), class 2 (prophylactic), class 3 (curative) and class 4 (emergency). There was a significant trend towards increasing risk of ulceration/reulceration (chi2(trend) = 17.8, P = 0.0001), peri-postoperative infection (chi2(trend) = 96.9, P = 0.0001), all-level amputation (chi2(trend) = 41.7, P = 0.001) and major amputation (chi2(trend) = 8.6, P = 0.003), with increasing class of foot surgery. The results of this study suggest that a non vascular foot surgery classification system including variables such as the presence or absence of neuropathy, an open wound and acute infection may be predictive of peri- and postoperative complications. This may assist the surgeon in better identifying risk when determining a rationale for and type of surgery in persons with diabetes.

Aged↗
PubMed1983

Use of blood in elective general surgery: an area of wasted resources.

A prospective audit of the blood bank was carried out in Portsmouth to examine how efficiently blood was used in elective general surgery. The routine crossmatching of blood was found to be unnecessary for certain procedures such as cholecystectomy, thyroidectomy, mastectomy, and vagotomy. The most efficient use of blood was seen in vascular surgery despite the greater risk of severe haemorrhage. Completed detailed questionnaires returned by members of surgical teams in Wessex supported the Portsmouth data as being fairly typical and confirmed that substantial and unintentional overordering occurred, apparently due to poor communication, lack of discussion, and "force of habit." The place of a "half hour crossmatch" as a substitute for many routine orders has been explored and seems to be acceptable to most anaesthetists and surgeons. This study, by showing how inefficiently blood is used, has underlined the value of local audit. It also supports the general experience of centres throughout the world who have invoked similar methods and achieved considerable savings without harm to patients.

Blood Banks↗
PubMed1986

Effects of nutrient intake, surgery, sepsis, and long term administration of steroids on muscle function.

The stimulated contraction-relaxation characteristics of the adductor pollicis muscle were used to assess nutritional state in patients and healthy controls. In both groups insufficient nutrition resulted in abnormal muscle function. The ratio of force of contraction at 10 Hz to that at 20 Hz yielded the best combination of sensitivity (87%) and specificity (82%). Sepsis resulted in abnormal muscle function, but the changes were easily distinguishable from those in subjects taking an inadequate diet. Long term administration of steroids, trauma, and surgery had no effect on muscle function. A prospective study of 11 malnourished patients with abnormal muscle function showed that all variables of muscle function returned to normal values with total parenteral nutrition. This reversal correlated significantly with the duration of parenteral nutrition and occurred before any change in anthropometric variables or plasma albumin concentration. Muscle function studies are sensitive and specific indicators of malnutrition; results depend on energy intake but are not influenced by administration of steroids, trauma, or surgery.

Energy Metabolism↗