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Revista Brasileira de Enfermagem 2020to identify the main complications in the late postoperative period of surgical patients. (Review)
Review
OBJECTIVE
to identify the main complications in the late postoperative period of surgical patients.
METHOD
an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction.
RESULTS
ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed.
CONCLUSION
infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies.
Topics: Humans; Pneumonia; Postoperative Complications; Surgical Wound Infection; Urinary Tract Infections
PubMed: 32609217
DOI: 10.1590/0034-7167-2019-0290 -
Cirugia Pediatrica : Organo Oficial de... Oct 2022The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis.
OBJECTIVE
The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis.
MATERIALS AND METHODS
A retrospective analysis of the perforated appendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperative serum lipase levels were available were included. The variables collected were statistically assessed by means of a descriptive, univariate analysis.
RESULTS
A total of 88 patients were studied. They were divided into 3 groups according to postoperative lipase levels - 57 were allocated to Group 1 (lipase: 70-194.0 U/L, normal range), 20 were allocated to Group 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (lipase: > 582 U/L, which triples normal levels). Statistically significant differences were found in the following variables: sex, postoperative abscess, postoperative subocclusion/intestinal occlusion, preoperative lipase levels, days of parenteral nutrition, days of ICU stay, and days of hospital stay. Postoperative lipase had a moderate correlation with preoperative lipase, and none of the cases met acute pancreatitis diagnostic criteria.
CONCLUSIONS
Hyperlipasemia in the postoperative period of perforated appendicitis is not associated with developing clinical pancreatitis, but it is associated with worse progression in terms of increased complications, such as subocclusion/intestinal occlusion and intra-abdominal abscess, and longer ICU stay, hospital stay, and parenteral nutrition. There is a moderate correlation between preoperative and postoperative lipase, which means they could both prove useful as prognostic markers.
Topics: Acute Disease; Appendectomy; Appendicitis; Child; Humans; Intestinal Obstruction; Lipase; Pancreatitis; Postoperative Complications; Postoperative Period; Retrospective Studies
PubMed: 36217785
DOI: 10.54847/cp.2022.04.15 -
Archives de Pediatrie : Organe Officiel... May 2021Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related...
BACKGROUND
Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity.
AIM
To compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children.
METHODS
A retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10cm) and NGHC (<10cm).
RESULTS
In the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1-9, IQR 3-14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P=0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P≤0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P=0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group.
CONCLUSION
GHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.
Topics: Adolescent; Child; Cystectomy; Echinococcosis; Echinococcosis, Pulmonary; Female; Humans; Male; Pediatrics; Postoperative Complications; Postoperative Period; Retrospective Studies; Tunisia
PubMed: 33773892
DOI: 10.1016/j.arcped.2021.02.017 -
The Canadian Journal of Urology Dec 2020
Topics: Anti-Bacterial Agents; Humans; Male; Postoperative Period; Urethra; Urinary Incontinence; Urinary Sphincter, Artificial
PubMed: 33325345
DOI: No ID Found -
Anesthesia and Analgesia Feb 2020
Topics: Dexamethasone; Humans; Lidocaine; Pharyngitis; Postoperative Period
PubMed: 31764160
DOI: 10.1213/ANE.0000000000004550 -
The Canadian Journal of Neurological... May 2021Patients with Parkinson's disease (PD) may undergo several elective and emergency surgeries. Motor fluctuations, the presence of a wide range of non-motor symptoms... (Review)
Review
Patients with Parkinson's disease (PD) may undergo several elective and emergency surgeries. Motor fluctuations, the presence of a wide range of non-motor symptoms (NMS), and the use of several medications, often not limited to dopaminergic agents, make the perioperative management of PD challenging. However, the literature on perioperative management of PD is sparse. In this descriptive review article, we comprehensively discuss the issues in the pre-, intra-, and postoperative phases which may negatively affect the PD patients and discuss the approach to their prevention and management. The major preoperative challenges include accurate medication reconciliation and administration of the dopaminergic medications during the nil per os (NPO) state. While the former can be addressed with staff education and PD-specific admission protocols, knowledge of non-oral formulations of dopaminergic agents (apomorphine, inhalational levodopa, and rotigotine transdermal patch) is the key to the management of the Parkinsonian symptoms in NPO state. Deep brain stimulation (DBS) devices should be turned off to avert potential electromagnetic interference with surgical appliances. Choosing the appropriate anesthesia and avoiding and managing respiratory issues and dysautonomia are the major intraoperative challenges. Timely reinitiation of dopaminergic medications, adequate management of pain, nausea, and vomiting, and prevention of postoperative infections and delirium are the postoperative challenges. Overall, a multidisciplinary approach is pivotal to prevent and manage the perioperative complications in PD. Administration of anti-Parkinson medications during NPO state, prevention of anesthesia-related complications, and timely rehabilitation remain the key to healthy surgical outcomes.
Topics: Antiparkinson Agents; Deep Brain Stimulation; Dopamine Agents; Humans; Levodopa; Parkinson Disease; Postoperative Complications; Postoperative Period
PubMed: 32959743
DOI: 10.1017/cjn.2020.211 -
Surgical Endoscopy Jun 2022Transversus abdominis release (TAR) is an effective procedure for the repair of complex ventral hernias. However, TAR is not a low risk operation, particularly in older...
BACKGROUND
Transversus abdominis release (TAR) is an effective procedure for the repair of complex ventral hernias. However, TAR is not a low risk operation, particularly in older adults who are disproportionately affected by multiple age-related risk factors. While past studies have suggested that age alone inconsistently predicts patient outcomes, data regarding age's effect on postoperative outcomes and wound complications following a TAR are lacking.
METHODS
Patients who underwent either an open or robotic bilateral TAR from 1/2018 to 9/2020 were eligible for the study. Patients were stratified by age groups (≥ 60 years vs. < 60 years and < 60, 60-70, and ≥ 70) and by both age and operative approach. The rates of key postoperative outcomes and wound morbidity were compared between the various cohorts.
RESULTS
A total of 300 patients were included: 165 patients were ≥ 60 and 135 patients were < 60. Cohorts stratified by age were well-matched for important hernia factors: defect size (p = 0.31), BMI ≥ 30 (p = 0.46), OR time (p = 0.25), percent open TAR (p = 0.42), diabetes (p = 0.45) and history of prior surgical site infection (p = 0.40). The older cohort had significantly higher rates of coronary artery disease, hypertension, and COPD. On univariate analysis, cohorts stratified by age had similar rates of key postoperative and wound complications including in-hospital complications (p = 0.62), length of stay (p = 0.47), readmissions (p = 0.66), and surgical site occurrences (p = 0.68). Additionally, cohorts stratified by both age and operative approach also had similar outcomes. Multivariate analysis showed that chronological age was not independently associated with surgical site occurrences (p = 0.22), readmissions (p = 0.99), in-hospital complications (p = 0.15), or severe complications (p = 0.79).
CONCLUSION
Open and robotic TARs can be safely performed in older adults and chronological age alone is a poor predictor of patient morbidity following TAR. Further investigation of alternative preoperative screening tools that do not rely solely on age are needed to better optimize surgical outcomes in older adults following TAR.
Topics: Abdominal Muscles; Abdominal Wall; Aged; Hernia, Ventral; Herniorrhaphy; Humans; Middle Aged; Postoperative Period; Retrospective Studies; Surgical Mesh; Surgical Wound Infection
PubMed: 34519894
DOI: 10.1007/s00464-021-08734-1 -
Radiographics : a Review Publication of... Oct 2019During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number... (Review)
Review
During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number of postoperative imaging studies to interpret. CT is accurate for identifying the location and integrity of implants, assessing the success of decompression and intervertebral arthrodesis procedures, and detecting and characterizing related complications. Although postoperative spinal CT is often limited owing to artifacts caused by metallic implants, parameter optimization and advanced metal artifact reduction techniques, including iterative reconstruction and monoenergetic extrapolation methods, can be used to reduce metal artifact severity and improve image quality substantially. Commonly used and recently available spinal implants and prostheses include screws and wires, static and extendable rods, bone grafts and biologic materials, interbody cages, and intervertebral disk prostheses. CT assessment and the spectrum of complications that can occur after spinal surgery and intervertebral arthroplasty include those related to the position and integrity of implants and prostheses, adjacent segment degeneration, collections, fistulas, pseudomeningoceles, cerebrospinal fluid leaks, and surgical site infections. Knowledge of the numerous spinal surgery techniques and devices aids in differentiating expected postoperative findings from complications. The various types of spinal surgery instrumentation and commonly used spinal implants are reviewed. The authors also describe and illustrate normal postoperative spine findings, signs of successful surgery, and the broad spectrum of postoperative complications that can aid radiologists in generating reports that address issues that the surgeon needs to know for optimal patient management.RSNA, 2019.
Topics: Adult; Aged; Child; Equipment Design; Female; Humans; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Postoperative Period; Spine; Tomography, X-Ray Computed
PubMed: 31589573
DOI: 10.1148/rg.2019190050 -
Thoracic Surgery Clinics May 2022The early postoperative period after lung transplantation is a critical time. Prompt recognition and treatment of primary graft dysfunction can alter long-term allograft... (Review)
Review
The early postoperative period after lung transplantation is a critical time. Prompt recognition and treatment of primary graft dysfunction can alter long-term allograft function. Cardiovascular, gastrointestinal, renal, and hematologic derangements are common and require close management to limit their negative sequelae.
Topics: Extracorporeal Membrane Oxygenation; Humans; Lung; Lung Transplantation; Postoperative Period; Retrospective Studies; Transplant Recipients
PubMed: 35512937
DOI: 10.1016/j.thorsurg.2021.11.006 -
Clinical Spine Surgery May 2020In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding...
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Topics: Allografts; Anti-Bacterial Agents; Bone Substitutes; Humans; Meningitis, Bacterial; Orthopedics; Philadelphia; Postoperative Period; Prostheses and Implants; Prosthesis Design; Prosthesis Failure; Risk Factors; Spine; Surgical Wound Infection
PubMed: 31404014
DOI: 10.1097/BSD.0000000000000855