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Results for “prophylactic surgery”

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PubMed1975

Prophylactic antibiotic therapy in surgery.

Prophylactic (preventive) antibiotic therapy initiated preoperatively, with antibiotics administered in moderately high dosage for short periods, is recommended on the basis of experimental and prospective, randomized clinical trials for patients who require surgery that is likely to expose tissue planes to contamination. The value of prophylactic antibiotics in clean operations is not presently supported but must be considered in patients with decreased resistance and in those in whom infection of a prosthesis would have catastrophic results. In these patients topical antibiotics might prove useful and less dangerous. It is clear that surgical technique remains an important but as yet unmeasured factor in wound infection.

Ampicillin↗

PubMed2006

Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.

BACKGROUND: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone. OBJECTIVE: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance. DESIGN: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. DATA SOURCES: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services). TARGET POPULATION: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age. TIME HORIZON: Lifetime. PERSPECTIVE: Health policy, societal. INTERVENTIONS: Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance. OUTCOME MEASURES: Cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of 2352 dollars per life-year for BRCA1 and 100 dollars per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of 2281 dollars per life-year for BRCA2. RESULTS OF SENSITIVITY ANALYSIS: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to 73,755 dollars per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes. LIMITATIONS: Results are dependent on the accuracy of model assumptions. CONCLUSION: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively.

Adult↗

PubMed1994

[Prophylactic antibiotic therapy in ocular surgery].

Prophylactic antibiotics have been used by ophthalmic surgeons routinely before and after surgery. However, the optimal type of antibiotics and route of administration have not yet been clearly established. In this article, ocular surgery patterns, bacteriology and pharmacokinetics of antibiotics within the eye are reviewed, to try to provide rationale for antimicrobial prophylaxis.

Anti-Bacterial Agents↗

PubMed2006

[Symptomatic surgery].

We can distinguish between symptomatic and aetiological surgery. Symptomatic surgery includes operations, which remove the symptoms of a disease or at least palliate them albeit without removing their underlying pathology. On the other hand aetiological surgery means the curative removal of a pathology. It can be argued that any type of a surgery is symptomatic in nature, but that a part of the symptomatic surgery is curative as well. In addition to symptomatic and curative surgery, we also apply prophylactic surgery. Prophylactic surgery constitutes a controverse chapter. The question is whether an indication for prophylactic surgery does exist. One can argue, that it is difficult to improve the life of a well being patient by operating on him. On the other hand the question is whether it would not be more intelligent to improve the condition of a patient by removing the pathological aspects before symptoms appear. In addition, a pathological situation should not be allowed to progress to the stage where neither surgery nor conservative treatment offer sufficient benefit to patients.

Anastomosis, Surgical↗

PubMed2006

[Prophylactic pancreas surgery].

The goal of prophylactic surgery is to prevent malignant growth in patients with hereditary tumor predisposition. The pancreas presents as particularly challenging, due to the difficulty of operation and comparatively high risk of morbidity and even mortality. In addition, partial operative procedures and, more significantly, total resection lead to exocrine pancreas insufficiency and secondary diabetes, with grave consequences for the patient. Hereditary tumor predisposition syndromes that can result in pancreaticoduodenal endocrine tumors (PET) include multiple endocrine neoplasia type 1 syndrome and von Hippel-Lindau syndrome. As penetrance is maximally 70-80% and the 10-year survival rate over 80%, prophylactic pancreatic resection without evidence of a tumor is not indicated. However, prophylactic extension of a resection would be advised, should a PET be diagnosed. Patients predisposed to developing ductal pancreatic carcinoma (PC) are at risk of familial pancreatic cancer syndrome (FPC), hereditary pancreatitis, and other hereditary tumor predisposition syndromes such as Peutz-Jeghers syndrome and familial atypical multiple mole-melanoma syndrome. As the gene defect responsible for FPC has yet to be identified and the penetrance of PC in the other tumor predisposition syndromes is low or unknown, a prophylactic pancreatectomy based on today's knowledge is not indicated. Prophylactic extension of the resection is advisable should PC or high-grade PanIN lesions be diagnosed, as these patients often present with multifocal dysplasia and even carcinoma.

Duodenal Neoplasms↗

PubMed1995

[Antibiotic prophylaxis in biliary surgery].

Prophylactic antibiotics in gallbladder surgery is designed to reduce the incidence of postoperative wound infections. Bacteria isolated from the biliary tract are generally the same as those found in the pus of wounds. Prospective and placebo-controlled trials have shown the efficacy of prophylactic antibiotics in high-risk patients presenting one or more of the following criteria: age over 70 years, recent episode of acute chollecystitis, emergency cholecystectomy, presence of common duct stones, jaundice or diabetes mellitus in patients with no risk factors for gallbladder surgery, prophylactic antibiotics may not be essential. The efficacy of antibiotics in the prevention of wound infections has been demonstrated with first, second and third generation cephalosporins, ampicillin associated with clavulanate, ureido-penicillins, aminoglycosides, sulfonamides and quinolones. A single injection of antibiotic given one hour before incision is as effective as multiple-dose regimens. Currently, the choice of antibiotic should be mainly based on its cost. There is no evidence at the present time for systematic prophylactic antibiotics in laparoscopic surgery. Endoscopic procedures of the biliary tract do not require prophylactic antibiotics when obstruction has not been demonstrated.

Anti-Bacterial Agents↗

PubMed1992

A comparison of prophylactic, topical and subconjunctival treatment in cataract surgery.

Prophylactic subconjunctival antibiotics and steroids have been used in cataract surgery since the early 1950s. However despite their widespread acceptance, there has, to date, been no direct comparison of subconjunctival and topical routes of administration. We therefore carried out a prospective comparison of the effects of subconjunctival and topical administration of antibiotics and steroids in sixty patients undergoing elective, uncomplicated, extracapsular cataract extraction and posterior chamber lens implantation. The patients were examined by a single observer on the first and third post-operative days and two and six weeks following surgery. The observer was blinded to the patient treatment group. Significantly higher degrees of conjunctival injection and anterior chamber activity were noted in those who received subconjunctival injections compared with those who received topical treatment. There were no significant differences between the two groups in best corrected visual acuity, central corneal oedema, cystoid macular oedema, intraocular pressure and infection. We conclude that prophylactic subconjunctival therapy in uncomplicated cataract surgery is not necessary.

Administration, Topical↗

PubMed1997

[Results of prophylactic and curative antibiotic therapy in biliary surgery].

Prophylactic antibiotic regimen (gentamicin, clindamycin) was assessed in a group of 104 patients operated electively on biliary lithiasis (cholecysto- and choledocholithiasis). Antibiotic prophylaxis was performed in group of 20 patients, in 6 of them antibiotics were continued postoperatively. Intraoperatively antibiotics were given in a group of 20 patients--curative treatment. Control group consisted of 58 patients. We concluded that "one shoot" antibiotic therapy is valuable in controlling of wound infections. But the most effective method of reducing local septic complications rate combines prophylaxis with prolonged antibiotic administration.

Anti-Bacterial Agents↗

PubMed2005

The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery.

Prophylactic inferior vena cava filter (IVCF) placement is advocated in some high-risk groups. We sought data regarding safety and efficacy for prophylactic IVCF placement in patients at high risk for venous thromboembolism (VTE) following major spinal reconstruction. Seventy-four spine surgery patients with contraindication to anticoagulation (44 females, 30 males; mean age 56.2) received prophylactic IVCFs. Criteria were (1) history of thromboembolism, (2) diagnosed thrombophilia, (3) malignancy, (4) bedridden >2 weeks prior to surgery, (5) staged procedures or multiple levels, (6) combined anterior/posterior approaches, (7) expected need for significant iliocaval manipulation during exposure, and (8) single-stage anesthetic time >8 hr. Seventy patients had at least two risk factors. All received IVCFs prior to the first stage of spine reconstruction. Patients were evaluated for filter complications, deep vein thrombosis (DVT), and pulmonary embolism (PE). Patients' lower extremity veins from groin to ankle were imaged weekly until discharge using duplex ultrasound (DUS). One-third also underwent thoracic and pelvic computed tomography scans, and the pelvic veins, IVC, and pulmonary vasculature were evaluated for VTE. Multiple DUS (n = 198, mean 2.6 studies per patient) were performed in 68 patients. At a mean follow-up of 11 months, one of the patients developed PE. Twenty-seven limbs in 23 patients developed DVT. Five limbs had isolated calf DVT, and 22 had proximal vein involvement. Insertion site DVT accounted for nearly one-third of the DVTs. Six patients died from unrelated complications. There was one technical error with an IVCF deployed in the iliac vein. Despite a high incidence of DVT following high-risk spinal surgery, prophylactic IVCF placement appears to protect patients from PE.

Adolescent↗

PubMedDate not supplied

Comparison of arterial systolic pressure variation with other clinical parameters to predict the response to fluid challenges during cardiac surgery.

Prophylactic optimization of stroke volume during surgery has been thought by some to reduce complications following surgery. Mechanical ventilation has been shown to induce variations in systolic systemic arterial blood pressure. Measuring such variations in systolic pressure (SPV) might serve as an attractive method for guiding fluid therapy intraoperatively. It is unknown if variations in systolic pressure following the rapid intravenous administration of a specific volume of fluid would lead to changes in pressure measurements obtained from a pulmonary artery with sufficient sensitivity to predict or guide the need for expansion of the intravascular volume to optimize stroke volume as an index of cardiac function. The purpose of this study was to determine if such measurements of changes in systolic pressures would be useful in optimizing stroke volume. Nineteen patients undergoing cardiac surgery were enrolled in a prospective cohort study. Following induction of general anesthesia, one or more 250 mL boluses of 6% hetastarch were administered. Stroke volume was calculated from the cardiac output obtained by thermodilution using a pulmonary artery catheter. If the patient s stroke volume increased by less than 10% as a result of a given fluid challenge, the patient was classified as a non-responder. However, if the stroke volume increased by more than 10%, the patient was classified as a responder. The variations in systolic pressure and echocardiographic indices were simultaneously measured before and after the administration of each 250 mL fluid bolus. Pulmonary artery occlusion pressure (PAOP) values were significantly lower in patients who responded to fluid boluses (p=0.0085) than in those who did not. Similarly SPV and SPVdown values (defined as the decrease in systolic pressure with ventilation) were significantly greater in the responders (p<0.05). No significant intergroup differences were observed in SPVup (increase in systolic pressure with ventilation) or echocardiographic-derived left ventricular end diastolic area. A PAOP value less than 10 mm Hg predicted a response (sensitivity 68%, specificity 79%). Although significant intergroup differences in the extent of systolic pressure variations were observed, no appropriate threshold values could be determined that would accurately predict the response to a fluid bolus. There is a relationship between SPV and SPVdown values and intravascular volume status. SPV and echocardiographic-derived values did not predict the response to a fluid bolus as well as values obtained from the pulmonary artery catheter.

Blood Pressure↗

PubMed2005

[Prophylactic gastric surgery].

A premalignant condition with high risk of gastric cancer is the basis for prophylactic gastric surgery. The germline mutation carrier in the E-cadherin gene has a lifetime risk of 70-80% for diffuse-type gastric cancer, and high-grade intraepithelial neoplasia has a 60-70% gastric cancer risk. Other premalignant conditions such as HNPCC syndrome (5% gastric cancer) and low-grade intraepithelial neoplasia (10% risk) are moderate risk factors for developing gastric cancer. They do not justify prophylactic surgery, but surveillance is required. In case high-grade intraepithelial neoplasia or early gastric cancer is detected, an option is extended radicality with total gastrectomy instead of subtotal gastric resection. Positive family history and early-onset of gastric cancer are risk factors to consider when discussing prophylactic gastrectomy or extended radicality.

Adolescent↗

PubMed1997

Prophylactic neonatal surgery and infectious diseases.

Infections worldwide are the primary cause of morbidity and mortality today. The need for prevention is essential. Prophylactic surgery with the reduction of infectious disease has been available for many millennia, but its recognition has been questionably accepted. This article presents evidence of former times when circumcision was performed in the ancient Egyptian, Coptic and Ethiopian cultures, probably as a therapeutic measure to combat the ravages of schistosomal infectious symptomatology. How this health measure was converted to a religious rite and the confusion caused by this misunderstanding is fully explored. The association of an operative procedure as a religious ritual among Jews, and Christian Biblical ambiguity toward it, has further clouded the issue. Neonatal circumcision has been perpetuated in many societies and cultures, not because of the Jews and their Covenant of Circumcision, but because of its merit as a secular surgical prophylactic health measure. This article explores an interesting issue from its beginning to contemporary research and findings that justify the procedure as a viable option in maintaining and promoting quality genital health care for males of all ages.

Circumcision, Male↗

PubMed1985

Penetration of penicillins into cardiac valves and auricles of patients undergoing open-heart surgery.

Prophylactic use of antibiotics in open-heart surgery for insertion of prosthetic valves is common, because of the serious consequences of postoperative staphylococcal infections, most notably prosthetic valve endocarditis. To ensure effective antibiotic cover during surgery, the penetration of cloxacillin and benzylpenicillin into the heart muscle and valves was studied intraoperatively. Both antibiotics were given intravenously (respective initial doses 2 g and 6 g) at induction of anesthesia to ten patients undergoing replacement of aortic or mitral valve, and the same doses were repeated after 4 hours. Serial serum samples and tissue samples from the right atrial auricle and the excised heart valve were analyzed for antibiotic concentrations. The mean serum concentrations of cloxacillin were 204 +/- 93 mg/l 10 min after the initial dose and less than or equal to 26 mg/l 30 min before the second dose. The corresponding values for benzylpenicillin were 323 +/- 145 and 43 +/- 24 mg/l. The cloxacillin concentrations in the auricle just before the start of extracorporeal circulation ranged from 4.5 to 80 mg/kg and (later) in the excised heart valves they were 8.5 to 45 mg/kg. The benzylpenicillin range was 16 to 153 mg/kg in auricle and 13 to 87 mg/kg in valve tissue. The authors conclude that the employed doses of the penicillins are adequate cover against the staphylococci which may be implicated in postoperative infections.

Cardiac Surgical Procedures↗

PubMed2004

Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy.

Investigators have used retrospective and prospective study designs to provide much needed data on the extent of risk reduction after prophylactic oophorectomy and mastectomy in women at increased risk for breast and ovarian cancer. In this publication we identify those women who may wish to consider prophylactic surgery, review data demonstrating the efficacy of prophylactic surgery, and discuss potential surgical complications. We also present data about the frequency of use and psychosocial impact of prophylactic surgery in this typically young group of women. Finally, we provide general treatment guidelines for the practicing clinician.

Breast Neoplasms↗

PubMed1990

Temporary gastrostomy tubes in major gynecologic surgery.

Prophylactic, temporary tube gastrostomy was done in 39 patients having major gynecologic surgery. Patients who were thought to be at high risk for postoperative ileus had a Foley catheter inserted intraoperatively through the greater curvature of the stomach. The procedure was found to be technically easy, well tolerated by the patients, and clinically useful, since postsurgical ileus was prevented or treated without the local and respiratory ill effects of the commonly used nasogastric tube.

Adolescent↗

PubMed2004

Is surgery necessary for asymptomatic tethered cord in anorectal malformation patients?

BACKGROUND: Evidence supporting routine surgery for asymptomatic tethered cord in patients with anorectal malformation (ARM) is, at best, speculative. The authors therefore examined whether untethering is indicated for asymptomatic tethered cord in patients with ARM. METHODS: A retrospective analysis of all patients with ARM (n = 223) between 1992 and 2002 was conducted. During the same period, 435 patients had surgery for tethered cord. RESULTS: Tethered cord was detected radiologically in 22 (9.8%); 8 patients with a low conus, and 14 with a low conus with and thickened filum. Seven of 22 patients underwent untethering; 3 prophylatic (14%) and 4 for neuro/motor function deficits (18%). All 4 symptomatic patients had significant clinical improvement in their neuro/motor functions after surgery. However, bowel and urinary functions remained unchanged in all 7 patients with a mean follow-up of 6.4 years (range, 4 to 8 years). Fifteen patients with radiologically diagnosed tethered cord remain asymptomatic with a mean follow-up of 2.7 years (range, 8 months to 10 years). CONCLUSIONS: Neuro/motor functions clearly improved with surgery in symptomatic patients. However, bowel and urinary functions remained unchanged after surgery. Only 4 ARM patients with tethered cord required surgery, whereas prophylactic surgery appears to have minimal benefit. Expectant conservative approach in the management of asymptomatic tethered cord patient appears to be safe.

Abnormalities, Multiple↗

PubMedDate not supplied

Surgical treatment of portal hypertension in China.

In 3,263 cases of portal hypertension, various methods of porta-systemic shunt or portal-azygous disconnection were applied with reasonable results. In addition to the treatment for intractable ascites, peritoneal-jugular shunt and thoracic duct jugular anastomosis were employed in 132 cases. This is our approach to portal hypertension in the big city hospitals. There is much controversy over the suitability of prophylactic surgery and the ideal time for surgery. The reasons for prophylactic surgery and the management of bleeding varices are discussed in this paper.

China↗

PubMed1998

Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients.

PURPOSE: Young Ashkenazi Jewish women or those from high-risk families who test positive for BRCA1 or BRCA2 mutant genes have a significant risk of developing breast or ovarian cancer by the age of 70 years. Many question whether they should have prophylactic surgical procedures, ie, bilateral mastectomy and/or oophorectomy. METHODS: A Markov model was developed to determine the survival, quality of life, and cost-effectiveness of prophylactic surgical procedures. The probabilities of developing breast and ovarian cancer were based on literature review among women with the BRCA1 or BRCA2 gene and mortality rates were determined from Surveillance, Epidemiology, and End Results (SEER) data for 1973 to 1992. The costs for hospital and ambulatory care were estimated from Health Care Financing Administration (HCFA) payments in 1995, supplemented by managed care and fee-for-service data. Utility measures for quality-adjusted life-years (QALYs) were explicitly determined using the time-trade off method. Estimated risks for breast and ovarian cancer after prophylactic surgeries were obtained from the literature. RESULTS: For a 30-year-old woman, according to her cancer risks, prophylactic oophorectomy improved survival by 0.4 to 2.6 years; mastectomy, by 2.8 to 3.4 years; and mastectomy and oophorectomy, by 3.3 to 6.0 years over surveillance. The QALYs saved were 0.5 for oophorectomy and 1.9 for the combined procedures in the high-risk model. Prophylactic surgeries were cost-effective compared with surveillance for years of life saved, but not for QALYs. CONCLUSION: Among women who test positive for a BRCA1 or BRCA2 gene mutation, prophylactic surgery at a young age substantially improves survival, but unless genetic risk of cancer is high, provides no benefit for quality of life. Prophylactic surgery is cost-effective for years of life saved compared with other medical interventions that are deemed cost-effective.

Adult↗