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World Journal of Emergency Surgery :... 2018Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are... (Review)
Review
Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.
BACKGROUND
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups.
METHODS
The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion.
RECOMMENDATIONS
Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention.
DISCUSSION
This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
Topics: Disease Management; General Surgery; Guidelines as Topic; Humans; Intestinal Obstruction; Tissue Adhesions; Treatment Outcome
PubMed: 29946347
DOI: 10.1186/s13017-018-0185-2 -
British Journal of Anaesthesia Jul 2000
Review
Topics: Anesthesia; Anesthesia, Conduction; Hormones; Humans; Stress, Physiological; Surgical Procedures, Operative; Treatment Outcome; Wounds and Injuries
PubMed: 10927999
DOI: 10.1093/bja/85.1.109 -
The New England Journal of Medicine Jan 2009Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often...
BACKGROUND
Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.
METHODS
Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.
RESULTS
The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).
CONCLUSIONS
Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
Topics: Humans; Outcome and Process Assessment, Health Care; Postoperative Complications; Prospective Studies; Safety Management; Surgical Procedures, Operative
PubMed: 19144931
DOI: 10.1056/NEJMsa0810119 -
International Journal of Surgery... Sep 2019It is human nature to make mistakes, all people in all works make errors, but an amputation of the wrong leg or an inadvertently retained needle in the abdominal cavity... (Review)
Review
It is human nature to make mistakes, all people in all works make errors, but an amputation of the wrong leg or an inadvertently retained needle in the abdominal cavity are unanticipated incidents, that no physician in the world wants to experience. Such catastrophic events, except for the consequences on the patient's health and the physician's career, have severe financial implications on the healthcare system. Human nature, apart from making mistakes, is also able to find solutions to minimize adverse incidents. A systematic time-out in the operating room just before incision has been introduced the last two decades to help prevent wrong site surgeries and other surgical never events. Despite its effectiveness in increasing patient safety, compliance issues remain a major problem in its implementation and gaps in its daily use still occur. The current review presents patterns of wrong time-out procedures, emphasizes the problem of poor compliance and reviews the suggested strategies to increase compliance for safer operating rooms.
Topics: Checklist; Humans; Medical Errors; Patient Safety; Practice Guidelines as Topic; Surgical Procedures, Operative; World Health Organization
PubMed: 31310820
DOI: 10.1016/j.ijsu.2019.07.006 -
Blood Advances Dec 2019Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.
BACKGROUND
Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.
OBJECTIVE
These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.
METHODS
ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.
RESULTS
The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).
CONCLUSIONS
For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.
Topics: Hematology; History, 21st Century; Hospitalization; Humans; Surgical Procedures, Operative; United States; Venous Thromboembolism
PubMed: 31794602
DOI: 10.1182/bloodadvances.2019000975 -
Chinese Journal of Traumatology =... Aug 2018The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical...
The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h.
Topics: Debridement; Fractures, Open; Humans; Plastic Surgery Procedures; Surgical Wound Infection; Therapeutic Irrigation
PubMed: 29555119
DOI: 10.1016/j.cjtee.2018.01.002 -
British Journal of Anaesthesia Mar 2022During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes.
METHODS
Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
RESULTS
The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=-0.72 days; 95% CI, -1.10 to -0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence.
CONCLUSIONS
Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.
Topics: Anesthesia, General; General Surgery; Hemodynamics; Humans; Postoperative Complications
PubMed: 34916049
DOI: 10.1016/j.bja.2021.10.046 -
Annals of the Royal College of Surgeons... Mar 2021Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in... (Review)
Review
INTRODUCTION
Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19.
METHODS
A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure".
FINDINGS
Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.
Topics: Air Filters; COVID-19; Environment, Controlled; Humans; Operating Rooms; Orthopedic Procedures; Patient Isolators; SARS-CoV-2; Surgical Procedures, Operative; Surgical Wound Infection; Ventilation
PubMed: 33645287
DOI: 10.1308/rcsann.2020.7146 -
British Journal of Hospital Medicine... Sep 2023Medical errors resulting in treatment-related harm have been a challenge for many years, with particularly severe consequences in surgery. Efforts to improve safety...
Medical errors resulting in treatment-related harm have been a challenge for many years, with particularly severe consequences in surgery. Efforts to improve safety should focus on system-based changes to response and rescue pathways, and will require further research and adequate engagement by clinical staff.
Topics: Humans; Medical Errors; Surgical Procedures, Operative
PubMed: 37769265
DOI: 10.12968/hmed.2023.0180 -
World Journal of Emergency Surgery :... Feb 2020Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over... (Review)
Review
BACKGROUND
Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections.
METHODS
The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.
RESULTS
Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.
CONCLUSIONS
The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
Topics: Humans; Intraabdominal Infections; Intraoperative Care; Operating Rooms; Practice Guidelines as Topic; Surgical Wound Infection
PubMed: 32041636
DOI: 10.1186/s13017-020-0288-4