Major Cause Of Perioperative Mortality Research Articles

Semi-automated computed tomography Volumetry can predict hemihepatectomy specimens\u2019 volumes in patients with hepatic malignancy

BackgroundOne of the major causes of perioperative mortality of patients undergoing major hepatic resections is post-hepatectomy liver failure (PHLF). For preoperative appraisal of the risk of PHLF it is important to accurately predict resectate volume and future liver remnant volume (FLRV). The objective of our study is to prospectively evaluate the accuracy of hemihepatectomy resectate volumes that are determined by computed tomography volumetry (CTV) when compared with intraoperatively measured volumes and weights as gold standard in patients undergoing hemihepatectomy.MethodsTwenty four patients (13 women, 11 men) scheduled for hemihepatectomy due to histologically proven primary or secondary hepatic malignancies were included in our study. CTV was performed using a semi-automated module (S, hereinafter) (syngo.CT Liver Analysis VA30, Siemens Healthcare, Germany). Conversion factors between CT volumes on the one side and intraoperative volumes and weights on the other side were calculated using the method of least squares. Absolute and relative disagreements between CT volumes and intraoperative volumes were determined.ResultsA conversion factor of c = 0.906 most precisely predicted intraoperative volumes of exsanguinated hemihepatectomy specimens from CT volumes in all patients with mean absolute and relative disagreements between CT volumes and intraoperative volumes of 57 ml and 6.3%. The use of operation-specific conversion factors yielded even better results.ConclusionsCTV performed with S accurately predicts intraoperative volumes of hemihepatectomy specimens when applying conversion factors which compensate for exsanguination. This allows to precisely estimate the FLRV and thus minimize the risk of PHLF in patients undergoing major hepatic resections.

Preoperatiove Airway Bacterial Colonization: the Missing Link between Non-small Cell Lung Cancer Following Lobectomy and Postoperative Pneumonia?

背景与目的外科手术是目前治疗肺癌的主要手段，肺癌患者围术期死亡的主要原因仍是术后肺炎。已有的研究结果显示致病性气道定植菌被认为是术后肺部并发症的一个独立危险因素，本研究旨在探讨术前致病性气道定植菌的存在与术后发生肺炎的关系及其危险因素。方法横断面调查2014年5月至2015年1月连续收治于成都市6家三级甲等医院胸外科行手术治疗的125例非小细胞肺癌患者，术前经纤维支气管镜取气管及支气管内液细菌学标本，并检测术前血清肺表面活性蛋白D（surfactant protein D, SP-D）水平，术后肺部相关并发症进行分析。结果肺癌患者术前合并致病性气道定植菌的发生率为15.2%（19/125），以革兰氏阴性菌为主（19/22, 86.36%）；肺癌患者术前合并致病性气道定植菌的高危因素为：高龄（≥75岁）和长期吸烟史（吸烟指数≥400支/年）；术后肺部相关并发症和术后肺炎发生率在肺癌合并致病性气道定植菌组（42.11%, 26.32%）均显著高于非合并组（16.04%, 6.60%）（P=0.021, P=0.019）。术前血清SP-D浓度在肺癌合并致病性气道定植菌（31.25±6.09）显著高于非合并组（28.17±5.23）（P=0.023）。并发术后肺炎患者中气道致病性定值菌发生率为41.67%（5/12），其发生率是无手术后肺炎患者的3.4倍（OR=3.363, 95%CI: 1.467-7.711）。结论肺癌患者合并致病性气道定植菌与术后肺炎发生密切相关，且高危险因素是高龄和长期吸烟史。

IS PREOPERATIVE STRESS TESTING ASSOCIATED WITH 30-DAY POSTOPERATIVE MORTALITY IN PATIENTS PRIOR PCI UNDERGOING NONCARDIAC SURGERY: INSIGHTS FROM THE VETERANS AFFAIRS HEALTH CARE SYSTEM

Adverse cardiac events in patients with prior PCI undergoing noncardiac surgery are a major cause of perioperative mortality. Preoperative stress testing is often used to estimate the risk of these events, however there is limited data on patterns of this practice and their relationship with

Perioperative bleeding in patients undergoing liver transplantation.

Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years or so, significant progress in surgical techniques and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during LT have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.

Acute pulmonary embolism following gynaecological surgery

Venous thromboembolism (VTE) and pulmonary embolism (PE) are two of the major causes of perioperative mortality and morbidity. In the past, thromboembolism has been considered as a rare disease in ...

Post-Operative Pulmonary Function : A Comparison between Upper Abdominal Open Cholecystectomy and Laparoscopic Cholecystectomy

Postoperative Pulmonary Complications (PPCs) is one of the major cause of perioperative mortality and morbidity in thoracic and upper abdominal surgery. Preoperative risk assessment enables clinicians to reduce perioperative risk in high risk patients.. In upper abdominal surgery, there is a larger alteration in pulmonary functions. This study was performed in 30 patients scheduled for laparoscopic cholecystectomy and for upper abdominal open cholecystectomy. The study revealed that after both laparoscopic & open upper abdominal cholecystectomy there was significant alteration of pulmonary function. There was significant alteration at six hours and after operation which then gradually improved, but it took about 24 hours for its complete recovery. The alteration was more evident in open cholycystectomy. Nevertheless these alterations did not cause any clinical derangement as expressed by SpO2, HR, & BP. The study also showed a significant dose reduction of opioid in case of laparoscopic cholecystomy. The lung function at postoperative ward correlated well with the level of analgesia. But persistent alteration of pulmonary function indicated presence of other mechanical factors. Key Words: Surgery-Lap.Cholecystectomy, Surgery- Upper abdominal, Complication-post- Operative, complication-pulmonary, Patient control analgesia Journal of BSA, Vol. 17, No. 1 & 2, 2004 p.12-16DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4045

Combined intra-abdominal pelvic packing during cytoreductive surgery in advanced epithelial ovarian cancer: a case series

Uncontrollable hemorrhage during cytoreductive surgery for advanced carcinoma ovary is a major cause of peri-operative mortality. This case series presents a novel technique of "combined intra pelvic and intra-abdominal packing," a life saving approach for such situations. This case series describes the retrospectively analyzed outcome of 16 non-consecutive patients with advanced epithelial ovarian cancer who underwent this 'packing' procedure in view of diffuse oozing and deteriorating patient condition. Three to six povidone-iodine soaked roller gauges were used and removal was done through exit sites on abdomen, 48 h after packing at bedside in 14 cases. 43 patients of carcinoma ovary who underwent debulking surgery during the same period but did not need packing were analyzed to compare underlying patient- and disease-related factors and complication rates. Operative mortality due to excessive primary hemorrhage was avoided in 14 out of 16 packed patients (87.5%). There was no notable increase in morbidity in cases compared with controls. Post-operative complication rates were more or less acceptable. This method can achieve acceptable survival rates in patients with advanced ovarian malignancy having severe primary hemorrhage.

Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

Posthepatectomy liver failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy liver failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy liver failure. A literature search on posthepatectomy liver failure after hepatic resection was conducted. Based on the normal course of biochemical liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy liver failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. No uniform definition of posthepatectomy liver failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy liver failure as the impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy liver failure should be graded based on its impact on clinical management. Grade A posthepatectomy liver failure requires no change of the patient's clinical management. The clinical management of patients with grade B posthepatectomy liver failure deviates from the regular course but does not require invasive therapy. The need for invasive treatment defines grade C posthepatectomy liver failure. The current definition of posthepatectomy liver failure is simple and easily applicable in clinical routine. This definition can be used in future studies to allow objective and accurate comparisons of operative interventions in the field of hepatic surgery.

Combined Abdominal Aortic Aneurysm Repair and Coronary Artery Bypass: Presentation of 13 Cases and Review of the Literature

Coronary artery disease remains the major cause of perioperative mortality after abdominal aortic aneurysm (AAA) repair. The beneficial effect of coronary artery bypass (CAB) before AAA repair in patients with severe coronary artery disease has been proven. The coexistence of a very large or symptomatic AAA and coronary artery disease remains a therapeutic challenge since there is the risk of AAA rupture in the interval between CAB and AAA repair. Combined CAB and aortic aneurysm repair has been suggested for these cases, and results on several series of patients have been published. However, the exact indication for the combined operation remains to be clarified. We present a series of 13 patients who underwent CAB on cardiopulmonary bypass and aortic aneurysm repair as a one-stage procedure. The indication was a large AAA in seven patients and a symptomatic AAA in six patients. In four patients, the aortic reconstruction was performed without the use of cardiopulmonary bypass; in nine patients, the aortic reconstruction was performed under partial cardiopulmonary bypass. Thirty-day mortality was 15%. Major morbidity was 31%. All major complications were due to excessive bleeding and occurred in patients who had AAA repair performed with partial cardiopulmonary bypass, suggesting that prolonged bypass time represents a major source of morbidity. A detailed review of the literature is presented. From the evidence available we suggest that the combined procedure can be recommended only for patients with very high rupture risk, such as in symptomatic AAA. In all other cases, the staged approach--CAB followed by AAA repair 2-4 weeks later--is preferable. During the combined procedure, cardiopulmonary bypass support during AAA repair should be used only in patients with clear evidence of hemodynamic instability.

Internal mammary artery bypass graft for impaired coronary perfusion after neonatal arterial switch operation

Myocardial ischaemia caused by perfusion impairment of translocated coronary arteries is the major cause of perioperative mortality after neonatal arterial switch operation for transposition of the great arteries. We report the successful use of the right internal mammary artery as a bypass graft to a dominant right coronary artery to treat insufficient perfusion of this artery in a newborn. Eight months later, coronary angiography showed a full blood supply of the right coronary artery across the internal mammary anastomosis. After a follow-up period of more than 30 months, somatic development, electrocardiogram and echocardiographically determined contractility of both ventricles are practically normal indicating regular function of the bypass graft.