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International Journal of Surgery... Jul 2020During the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases....
BACKGROUND
During the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases. There is a lack of evidence-based literature providing clinical and organizational guidelines for the management of a general surgery department. Aim of our study was to review the available recommendations published by general Surgery Societies and Health Institutions and evaluate the underlying Literature.
MATERIALS AND METHODS
A review of the English Literature was conducted according to the AMSTAR and to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS
After eligibility assessment, a total of 22 papers and statements were analyzed. Surgical societies have established criteria for triage and prioritization in order to identify procedures that can be postponed after the pandemic and those that should not. Prioritization among oncologic cases represents a difficult task: clinicians have to balance a possible delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure. There is broad agreement among guidelines that indication to proceed with surgery should be discussed in virtual Tumor Boards taking into consideration alternative therapeutic approaches. Several guidelines deal with the role of laparoscopic surgery during the pandemic: a tailored approach is currently suggested, with a case-by-case evaluation provided that appropriate personal protective equipment is available in order to minimize the potential risk of transmission. Finally, there is a considerable agreement in the published Literature concerning the management of the personnel during the peri- and intraoperative phase and on the technical advices regarding the induction, operative and recover maneuvers in COVID-19 cases.
CONCLUSIONS
During COVID-19 pandemic, it is of paramount importance to face the emergency in the most effective and efficient manner, retrieving resources from non-essential settings and, at the same time, providing care to high priority non-COVID-19 related diseases.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Emergency Service, Hospital; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Laparoscopy; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2; Surgery Department, Hospital; Surgical Procedures, Operative; Triage
PubMed: 32454253
DOI: 10.1016/j.ijsu.2020.05.061 -
Seminars in Pediatric Surgery Jun 2019Hirschsprung disease affects many children every year around the world. Currently, there is an extensive menu of diagnostic methods, and surgical treatments. This... (Review)
Review
Hirschsprung disease affects many children every year around the world. Currently, there is an extensive menu of diagnostic methods, and surgical treatments. This situation compels the physicians to follow the rationale of these interventions. The comprehensive diagnosis and treatment of Hirschsprung disease need singular procedures. The clear understanding of how to perform each of these techniques, as well as to read the results is mandatory. Otherwise, the medical team may perform unconscious errors and fall into traps. Many errors still happen in patients with Hirschsprung, resulting in a spectrum of problems; from delayed diagnosis to unnecessary colectomies. In other patients, the damage to the anal canal results in fecal incontinence. When this is established, it is an unreversed and devastating social problem. This article describes why these errors occur and how to prevent them.
Topics: Biopsy; Diagnostic Techniques, Digestive System; Fecal Incontinence; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Intraoperative Complications; Medical Errors; Patient Safety; Postoperative Complications; Surgical Procedures, Operative
PubMed: 31171150
DOI: 10.1053/j.sempedsurg.2019.04.013 -
Cardiovascular Ultrasound May 2004Perioperative ischemia is a frequent event in patients undergoing major non-cardiac vascular or general surgery. This is in agreement with clinical, pathophysiological,... (Review)
Review
Perioperative ischemia is a frequent event in patients undergoing major non-cardiac vascular or general surgery. This is in agreement with clinical, pathophysiological, and epidemiological evidence and constitutes an additional diagnostic therapeutic factor in the assessment of these patients. Form a clinical standpoint, it is well known that multidistrict disease, especially at the coronary level, is a severe aggravation of the operative risk. From a pathophysiological point of view, however, surgery creates conditions able to unmask coronary artery disease. Prolonged hypotension, hemorrhages, and haemodynamic stresses caused by aortic clamping and unclamping during major vascular surgery are the most relevant factors endangering the coronary circulation with critical stenoses. From the epidemiological standpoint, coronary disease is known to be the leading cause of perioperative mortality and morbidity following vascular and general surgery: The diagnostic therapeutic corollary of these considerations is that coronary artery disease - and therefore the perioperative risk - in these patients has to be identified in an effective way preoperatively.
Topics: Cardiac Surgical Procedures; Cardiotonic Agents; Clinical Trials as Topic; Echocardiography; Exercise Test; Humans; Perioperative Care; Postoperative Complications; Prognosis; Risk Assessment; Risk Factors; Surgery, Computer-Assisted; Vascular Diseases; Vascular Surgical Procedures; Vasodilator Agents
PubMed: 15140258
DOI: 10.1186/1476-7120-2-4 -
Nutrition in Clinical Practice :... Apr 2015Sarcopenia, defined as a decrease in skeletal muscle mass and strength, is an important risk factor in clinical medicine associated with frailty, mortality, and worse...
BACKGROUND
Sarcopenia, defined as a decrease in skeletal muscle mass and strength, is an important risk factor in clinical medicine associated with frailty, mortality, and worse surgical and nonsurgical outcomes. Conventional measures of sarcopenia rely on the subjective "eyeball test" and do not adequately describe risk. Computed tomography (CT) imaging studies may be used to objectively measure sarcopenia and may be used for surgical risk stratification and identification of patients for inclusion in a novel clinical remediation program.
METHODS
We describe results observed in the general, vascular, and liver transplant surgery populations determined by analytic morphomics--an analysis of CT scans in a semiautomated process using MATLAB v13.0. A perioperative optimization program has been implemented with the objective of remediating sarcopenia through improvement of patient mental and physical status prior to surgery.
RESULTS
Using analytic morphomics, we have noted significantly higher cost and increased rates of mortality and surgical complications among sarcopenic patients. The training program shows initial success, and among participating patients, we have observed reductions in payer and hospital costs and a decrease in length of hospital stay for patients following surgery.
CONCLUSIONS
Through analytic morphomics, we are able to quantify markers of sarcopenia and identify patients at risk for increased mortality and poor surgical outcomes. Early identification of patients offers us the opportunity to remediate sarcopenia through perioperative training and support. Participating patients spend less time in the hospital and have lower healthcare costs. This program has the potential to improve the perioperative patient experience and ease financial burdens.
Topics: Adult; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Preoperative Care; Risk Factors; Sarcopenia; Surgical Procedures, Operative; Tomography, X-Ray Computed
PubMed: 25681482
DOI: 10.1177/0884533615569888 -
International Dental Journal Dec 2022The effect of perioperative oral management on the prevention of postoperative complications remains unclear in cardiac surgery. Exploratory factor analysis was...
OBJECTIVES
The effect of perioperative oral management on the prevention of postoperative complications remains unclear in cardiac surgery. Exploratory factor analysis was performed to examine whether a lack of perioperative oral management was associated with postoperative complications of heart valve surgery.
MATERIALS AND METHODS
We retrospectively enrolled 365 patients who underwent heart valve surgery between April 2010 and March 2019. We extracted data on patient characteristics and set postoperative pneumonia and postoperative bloodstream infection as outcomes. A logistic regression analyses were performed to examine the effect of factors on the incidence of postoperative complications.
RESULTS
Significant risk factors for postoperative pneumonia included dialysis, long operative time, and long-term intubation. Similarly, risk factors for postoperative bloodstream infection were long-term intubation and lack of perioperative oral management. Subsequently, we identified the risk factors for long-term intubation, which were common to both complications, and found they were emergency status, combined valvular disease, long operative time, and lack of perioperative oral management.
CONCLUSIONS
We demonstrated that a lack of perioperative oral management could be a risk factor for postoperative bloodstream infection and long-term intubation in heart valve surgery. The results suggest that perioperative oral management is effective in preventing postoperative complications of heart valve surgery.
Topics: Humans; Cardiac Surgical Procedures; Heart Valves; Pneumonia; Postoperative Complications; Retrospective Studies; Risk Factors; Sepsis; Treatment Outcome; Perioperative Care
PubMed: 35525805
DOI: 10.1016/j.identj.2022.04.002 -
Gaceta Medica de Mexico 2019Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of... (Review)
Review
Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of risk. Preoperative assessment should not be restricted to cardiovascular aspects, but it should focus on all organs and systems and include medication reconciliation. The purpose of this article is to approach the performance of a preoperative assessment in non-cardiac surgery from the perspective of the internist, with the purpose to help prevent adverse events and improve the overall outcome.
Topics: Cardiovascular Diseases; Humans; Postoperative Complications; Preoperative Care; Surgical Procedures, Operative
PubMed: 31219462
DOI: 10.24875/GMM.18004492 -
Tidsskrift For Den Norske Laegeforening... Feb 2010All types of anaesthesia should ensure absence of pain, inhibit autonomic responses and provide optimal conditions for surgery. Choice of anaesthetic approach (local,... (Review)
Review
BACKGROUND
All types of anaesthesia should ensure absence of pain, inhibit autonomic responses and provide optimal conditions for surgery. Choice of anaesthetic approach (local, regional or general anaesthesia or a combination of methods) depends on type of surgery and the patients' health and preferences.
MATERIAL AND METHODS
The review is based on literature identified through non-systematic searches in PubMed and own research and experience.
RESULTS
When selecting anaesthetic approach and anaesthetic drugs one has to consider not only the perioperative period, but also postoperative aspects such as pain relief, awakeness, functional ability and absence of nausea. After major surgery, regional anaesthesia (especially epidural anaesthesia) and postoperative analgesia have been shown to reduce pulmonary complications and chronic pain. General anaesthesia can be administered either by volatile agents for inhalation, intravenous hypnotics, potent opioids or a combination (often used). Volatile agents, shown to be cardioprotective during cardiac surgery, are recommended for major non-cardiac surgery in patients with heart disease (even though clinical documentation is limited).
INTERPRETATION
An appropriate anaesthetic approach, taking into account patient characteristics and type of surgery, is important for safety and potential complications. In some situations, the anaesthetic approach and anaesthetic drugs may have an impact on outcome.
Topics: Analgesics; Anesthesia; Anesthesia, Conduction; Anesthesia, General; Anesthesia, Local; Anesthetics; Humans; Hypnotics and Sedatives; Nociceptors; Pain, Postoperative; Preanesthetic Medication; Surgical Procedures, Operative
PubMed: 20220866
DOI: 10.4045/tidsskr.08.0370 -
Current Problems in Surgery Sep 2020
Review
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Disease Transmission, Infectious; General Surgery; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2; State Medicine; Surgical Procedures, Operative; United Kingdom
PubMed: 32948255
DOI: 10.1016/j.cpsurg.2020.100856 -
Annals of Surgery Dec 2020
Topics: Black or African American; General Surgery; Homicide; Humans; Racism; Societies, Medical; United States; Violence
PubMed: 32976286
DOI: 10.1097/SLA.0000000000004430 -
Arquivos de Neuro-psiquiatria Aug 2015Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made... (Review)
Review
Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.
Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Loss, Surgical; Female; Humans; Intraoperative Complications; Male; Risk Assessment; Risk Factors; Surgical Procedures, Operative; Venous Thromboembolism; Withholding Treatment
PubMed: 26222364
DOI: 10.1590/0004-282X20150085