Postponement Of Surgery Research Articles

Delay in anesthesia assessment time – A cause of postponement in orthopedic trauma surgery

Background: Postponement of surgery increases the length of hospitalization and medical expenses, the mortality rate, and the prevalence of major medical complications. There is a limited study about the role of anesthesia assessment in developing these complications. Thus, the aim of the present study was to examine the anesthesia assessment time for traumatic patients aged over 50 years and also to investigate the role of anesthesia service in surgery postponement. Materials and Methods: This descriptive retrospective study was performed on 110 patients with traumatic injuries referred to Imam Khomeini Hospital Complex (Tehran, Iran) from March to September 2017. The information was extracted retrospectively from the hospital information system. The standard definitions in the International Classification of Diseases 10 code S00-T88 were used to identify traumatic injuries and fractures. Results: The results of the present study showed that the mean of anesthesia assessment time was significantly different in terms of the type of trauma, and femoral fractures had a higher anesthesia assessment time (P = 0.009). Furthermore, the anesthesia assessment time in patients who underwent echocardiography was significantly higher than those with no echocardiography (P

Health system strengthening during COVID-19 pandemic through virtual out-patient clinics: An experience from India

Whenever any pandemic accelerates, e.g., the corona virus disease 2019 (COVID-19), it is commonly observed that health care systems face tremendous workload in terms of infectious patients seeking testing and care. During such public health emergencies, besides logistics, there is shortage of trained personnel. In this COVID-19 pandemic Government of India is doing its level best for minimizing the impact of COVID-19. Multiple stringent measures are already taken like nationwide lockdown, social distancing, in hospitals-closing of out-patient services, postponement of elective surgeries, creating dedicated COVID-19 treatment hospital, one third of health staff is working on rotation basis and many more, for prevention of COVID-19 and minimizing the impact. Despite of this, the looming communication gap between people living in remote areas and the specialist doctors has always been in the picture. Due to COVID-19, as most of the routine OPDs are closed it is it has become very tough for people specially who have chronic diseases to consult their doctor. In this scenario artificial intelligence enabled Virtual OPD (VOPD) can be boon to the Indian population. The existing problems related to lack of access to OPD care for a major proportion of population can be solved by some extent by virtual OPD care services, in which patients consult with doctors in a virtual platform via mobile phone, computer and other e-devices. It is supposed to offer a number of advantages over traditional medical consultations in terms of convenience and cost. First and foremost, leverage of video consultation is “Therapeutic presence” that it is reassuring for the patients when they see doctor on video. The second advantage is that it helps in diagnostic assessment of the patients. Not only virtual OPDs solve the issues of delays and self-medication. This not only give benefit of availing the service as per the convenience but also provides the utmost medical consultation directly from the expertise. Alongside, the waiting period of minimum 3-4 hours can be reduced by simply audio-video consultations. It becomes easy to generate electronic prescription and can be emailed. However, evidence of clinical outcomes of VOPD is limited in Indian context. Furthermore, if integrated smartly into existing health care systems, VOPD care have the potential to manage the problem caused by the COVID-19 pandemic.

Analgesic Medication Shortages: Inform Our Patients via a Shared Decision-Making Process.

Analgesic Medication Shortages: Inform Our Patients via a Shared Decision-Making Process.

Impact of COVID-19 on orthopaedic care: a call for nonoperative management.

Background:Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions.Methods:A systematic search was conducted, and included guidance were categorized as either “Selective Postponement” or “Complete Postponement” of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports.Results:A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown.Conclusion:Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.

Pattern of utilization of facilities in the intensive care unit by elective surgical patients in a tertiary care institution: Can the services be provided by high dependency units in surgical wards?

Introduction Intensive care is indicated for patients requiring intensive monitoring and/or organ support. It is a costly and time limited resource utilized by those with reversible pathologies and reasonable likelihood of survival. Patients awaiting elective surgery with preoperative intensive care unit (ICU) bookings need to compete with emergency and unanticipated admissions leading to cancellation and postponement of elective surgery, a disadvantage to both the patient and the institution. Hence this study is aimed at evaluating the extent of ICU care utilized by elective surgical patients and to analyse the indications vs. utilization of ICU care by them. Methods This was a retrospective cross-sectional study carried out in the surgical ICU of Colombo South Teaching Hospital, enrolling 47 elective surgical patients admitted to the ICU over a period of 3 months. Data was collected using a pre structured data collection form. Results Majority of the patients were middle aged, belonged to the American Society of Anaesthesiologists Physical Status 2 (68.1%) and underwent colorectal (26%), upper gastrointestinal (GI) (15%) or hepatobiliary (13%) surgeries. Main comorbidities amongst the study population were diabetes and hypertension. Mean duration of ICU stay was 2 days. Most patients were monitored non-invasively within the ICU (68%). Organ support was required by only 17% of patients. Most frequent indication for preoperative ICU booking was the surgical/anaesthetic complexity determined by British United Provident Association (BUPA) schedule of procedures (83%). However, ICU resources were mainly utilized for provision of analgesia particularly in the form of epidural infusions (52%). Recommendations We recommend the development of level 2 care/high dependency units to reduce the burden on the ICU and a unit-based policy for ICU resource allocation for surgical patients.

Tumor Response After Neoadjuvant Magnetic Resonance Guided Single Ablative Dose Partial Breast Irradiation

To assess the pathologic and radiologic response in patients with low-risk breast cancer treated with magnetic resonance (MR) guided neoadjuvant partial breast irradiation (NA-PBI) and to evaluate toxicity and patient-reported outcomes (PROs). For this single-arm prospective trial, women with unifocal, non-lobular tumors with a maximum diameter of 20 mm (age, 50-70 years) or 30 mm (age, ≥70 years) and tumor-negative sentinel node(s) were eligible. Patients were treated with a single ablative dose of NA-PBI followed by breast-conserving surgery after an interval of 6 to 8 months. Target volumes were defined on radiation therapy planning computed tomography scan and additional magnetic resonance imaging. Prescribed doses to gross tumor volume and clinical target volume (gross tumor volume plus 20 mm margin) were 20 Gy and 15 Gy, respectively. Primary outcome was pathologic complete response (pCR). Secondary outcomes were radiologic response (on magnetic resonance imaging), toxicity (Common Terminology Criteria for Adverse Events), PROs (European Organisation for Research and Treatment of Cancer QLQ-BR23, Hospital Anxiety and Depression Scale), and cosmesis (assessed by patient, radiation oncologist, and BCCT.core software). Thirty-six patients were treated with NA-PBI, and pCR was reported in 15 patients (42%; 95% confidence interval, 26%-59%). Radiologic complete response was observed in 15 patients, 10 of whom had pCR (positive predictive value, 67%; 95% confidence interval, 39%-87%). After a median follow-up of 21 months (range, 12-41), all patients experienced grade 1 fibrosis in the treated breast volume. Transient grade 2 and 3 toxicity was observed in 31% and 3% of patients, respectively. Local recurrences were absent. No deterioration in PROs or cosmetic results was observed. NA-PBI has the potential to induce pCR in a substantial proportion of patients, with acceptable toxicity. This treatment seems a feasible alternative to standard postoperative irradiation and could even result in postponement or omission of surgery if pCR can be accurately predicted in selected low-risk patients.

No-shows in ambulatory clinics and non-utilized appointments for elective operations in selected surgical departments at a tertiary hospital in Israel

BackgroundThe phenomenon of a patient missing a medical appointment without notification is called a “no-show”. In contrast, “non-utilized appointments” are a broader phenomenon including all appointments that didn’t occur as registered – whether due to actions taken by providers or patients. Both no-shows and non-utilized appointments can lead to reduced quality of care, loss in productivity, financial losses and impaired patient outcomes.MethodsThe study was carried out between August 2016 and January 2017 in the ENT, Orthopedics and General Surgery Departments of the Jerusalem-based Shaare Zedek Medical Center. The study team sought to examine the reasons for non-utilized appointments in elective operations. The study team also interviewed no-show ambulatory care patients regarding the causes of the no-show and reviewed medical records of no-show patients to determine the nature of the missed appointments.ResultsThe rate of non-utilization of appointments for elective operations was 6%. The leading reasons for non-utilization of these appointments were: patient health issues, patient surgery postponement and surgery schedule overload (together accounting for 52% of cases and 72% of known reasons). The no-show rate for ambulatory clinic appointments was approximately 15%. The leading reasons for ambulatory clinic no-shows were: administrative issues, illness and forgetfulness (together accounting for 58% of all reasons). The leading types of appointments missed were:post-operation follow-ups and chronic illness follow-up (together accounting for 46% of cases and 63% of known reasons).ConclusionsIn this study, the non-utilized appointment rate for elective operations was found to be lower than those noted in the medical literature, while the no-show rate for ambulatory visits was found to be similar to that found in the literature. There is room to question the necessity of certain types of postoperative follow-up appointments since they are at “high risk” for no-show. One promising way to reduce the no-show rate would involve improving the hospital’s information and computing systems in order to identify patients who are susceptible to a no-show incident.

Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units

IntroductionThe development of outpatient surgery, cost-reduction pressures and instrumentation storage limitations have led to their use “just-in-time”. A recent study showed that stoppage of surgical procedures immediately before the incision (No-Go) was often due to the management of supplies and implantable medical devices. To our knowledge, since the development of outpatient surgery and the shortening of hospital stays, managing the flow of instrumentation has not been optimized. At our hospital, we used a two-prong approach consisting of a tool to manage instrumentation and working group from the sterilization and orthopedic surgery units. The aims of this study were to: 1) evaluate whether this approach led to better notification of the risk of supply shortage for instrumentation and 2) determine whether it could reduce by at least half operating room disruptions such as delays or cancellation of surgical procedures. HypothesisThis approach results in better notification of the risk of supply shortage for instrumentation and reduces by at least half operating room disruptions such as delays or cancellation of surgical procedures. Material and methodsA tool was developed to manage instrumentation flow based on a retrospective analysis of data from 2015. This tool consisted of: (1) a list of instrumentation needed for each surgical procedure from an analysis of the surgical schedule and verification of traceability labels of the instrumentation actually used, (2) a list of reasons for supply shortage identified from an analysis of non-conformities occurring in the sterilization process of instrumentation kits. These analyses resulted in the development of checklists for instrument sets for each procedure, while identifying those with a high risk of shortage. In 2017, a working group focused on instrumentation was set up with personnel from the sterilization unit and the orthopedic surgery unit. Based on the check-lists and the schedule 24hours before the surgery, the sterilization unit alerted the surgery unit by email of the risk of material shortage; the surgery ward replied with potential changes to the material or the surgery planning. This approach (instrumentation management tool and working group) was named just-in-time (JIT). The main outcome was the number of notifications of potential supply shortage with and without JIT over a 10-week period. The secondary outcomes were the number of notifications resolved in time and the occurrence of operating room disruptions (delay>30min or postponement of surgery) related to unavailable instrumentation. ResultsNine reasons for potential supply shortage were identified such as instrumentation kits used for several types of procedures, those with fast rotation and low stock, or in double pathways (on loan and on deposit). The working group reported 163 potential shortages with JIT versus 41 without (p<10−5), of which 150 (92.5%) were resolved. Thirteen operating room disruptions occurred; only one was not detected by the JIT approach. ConclusionOur JIT approach (instrumentation management tool and working group) is effective at preventing instrumentation supply shortages. Level of evidenceIII, prospective comparative study.

Safety of urgent hip fracture surgery protocol under influence of direct oral anticoagulation medications

IntroductionDirect oral anticoagulation agents (DOACs) are increasingly prescribed to older adults. Concerns for perioperative blood loss dictate cessation of anticoagulation treatment and postponement of surgery until the coagulation system returns to normal state. The goal of this study is to compare the estimates of perioperative blood loss and mortality between patients using DOACs and patients receiving no anticoagultaion, in order to challenge the existing policy and question the need for surgery deferral. Materials and methodsThis is a retrospective cohort of patients (age > 65) with proximal hip fractures treated with either closed reduction internal fixation (CRIF, n = 1143; DOAC use n = 60) or hemiarthroplasty (HA, n = 571; DOAC use n = 29). Baseline patient characteristics included age, gender, ASA score, socioeconomic level, type of surgica#1: In general a l treatment, duration of surgery and time from admission to surgery. The effect of anticoagulant prescription on percentage of hemoglobin change, odds of receiving blood transfusions and one-month and one-year mortality was evaluated separately for CRIF and HA patients. ResultsPatients receiving DOACs had similar perioperative hemoglobin change, transfusion rates and mortality, compared to subjects without anticoagulants in both CRIF and HA cohorts. DOAC patients undergoing CRIF had a longer delay to surgery (40.2 ± 26.9 vs 31.2 ± 22.2, p = 0.003) and higher mortality rates at one year postoperatively (26.7% vs 16.1%, p = 0.015). ConclusionsDOAC use was not associated with an increased perioperative blood loss or mortality compared to controls. However, they had to wait longer for surgery, which itself was an independent predictor of mortality. It may be safe to shorten waiting time for surgery in patients using anticoagulation, with the goal to minimize surgery delay.

Intersexual Births: The Epistemology of Sex and Ethics of Sex Assignment.

This article aims to analyse a possible manner of approaching the birth of intersexual children. We start out by summing up what intersexuality is and how it is faced in the dominant clinical practice (the "treatment paradigm"). We then argue against this paradigm, in favour of a postponement of genital surgery. In the second part of this paper, we take into consideration the general question of whether only two existing sexes are to be recognized, arguing in favour of an expansion of sex categories. In the third part, we illustrate the reasons supporting provisional sex attribution: the child's best interest and respect for their developing moral autonomy. This position aims to increase the child's well-being and self-determination, limiting parents' freedom to take decisions on behalf of others, in particular, those decisions concerning basic aspects of their children's personal identity.

PS02.064: ACCURACY OF F-18-FDG-PET/CT IN MONITORING TUMOUR RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH OESOPHAGEAL CANCER

Abstract Background Neoadjuvant chemoradiotherapy (nCRT) induces a pathologically complete response in approximately 30% of patients with oesophageal cancer. To explore the possibility of safe postponement of surgery, accurate clinical response evaluations are needed to exclude residual disease. The present study aims to assess the value of F-18-FDG-PET/CT for the detection of residual tumour (&gt; 10% tumour cells = TRG3–4 vs. no vital cells = TRG1) or metastases after nCRT. Methods FDG-PET/CT at baseline and 12 weeks after nCRT was performed according to the European Association of Nuclear Medicine guidelines 1.0 (2.3MBq/kg F-18-FDG; scanning 60 ± 5min.) and the protocol of the preSANO study. Qualitative analysis included sensitive reading of presence of residual tumour and/or metastases. A lesion was considered FDG-positive, when any uptake in the lesion itself was above the adjacent oesophageal background uptake. Quantitatively, SUV/lean body mass (SUL) measurements at tumour, lymph nodes, oesophagus, liver and bloodpool were recorded and compared with pathology (resection specimen: gold standard). Results Some 129 of 207 patients with FDG-avid tumours at baseline proceeded to FDG-PET/CT at around 12 weeks after nCRT just before surgery. Forty-one of 129 patients had TRG3–4, of whom 6 were missed on FDG-PET/CT (15% false negative) with SULmax 2.07 ± 0.25, SUL-ratio tumour/oesophagus (SULR) 1.35 ± 0.14. Sensitivity for TRG2–3-4 vs. TRG1 was 57/71 (80%). SULmax and SULR of FDG-positives were 3.76 ± 1.33 and 1.82 ± 0.69 respectively, compared to SULmax 2.21 ± 0.42 and SULR 1.31 ± 0.22 in FDG-negatives. Distant metastases were detected in 18 of 190 (10%) patients. Of all patients with postponed surgery, 12 had ≥ 1 additional FDG-PET/CT during follow-up (25–49.7 weeks after nCRT). Eventually, 4 patients underwent surgery. Three of 4 had increased FDG-signal and TRG3–4; 1 patient had decreased FDG-signal and no tumour left (TRG1). Conclusion FDG-PET/CT at around 12 weeks after nCRT misses TRG3–4 tumours in 15% and detects residual TRG2–3-4 in 80%. Furthermore, PET-CT detects distant metastases in 10% of patients after nCRT. These data indicate that serial FDG-PET may become valuable in an active surveillance approach. Disclosure All authors have declared no conflicts of interest.

Causes for Postponement of Cataract Surgery in a Peripheral Eye Hospital

Objective: To study the common causes leading to postponement of cataract surgery in a peripheral eye hospital. Design: Retrospective secondary data analysis of patients who underwent cataract surgery from 1 January 2015 to 31 December 2017. Method: All adult patients diagnosed with cataract and posted for cataract surgery from 1 January 2015 to 31 December 2017 and were cancelled on the day or 24 hours before the intended procedure were included in the study. The causes for cancellation were retrieved from the patient files. Pareto analysis was done to find out the most common causes for the cancellation. Results: 14113 patients were posted for cataract surgery from 1st January 2015 to 31st December 2017, of which 13265 patient underwent cataract surgery while 848 patients were cancelled within 24 hours of scheduled start time due to different causes. The cancellation rate for on the day cancellation of cataract surgery for a peripheral eye hospital is found to be 6%. Conclusion: Systemic illnesses especially uncontrolled diabetes and hypertension are the most common causes for on the day cancellation of cataract surgery in a peripheral eye hospital.

The fate of a thoracoabdominal aortic bypass graft 10 years after surgery in a child with the middle aortic syndrome

A 13-year-old boy who underwent thoracoabdominal aortic bypass when he was three years old for middle aortic syndrome was admitted with fatigue and need for an increased dose of antihypertensive mediations. The graft was patent, but there were stenoses at the juxta-proximal and juxta-distal anastomosis sites. A partial benefit was gained with endovascular stenting. Although postponement of surgery, until the child reaches full growth is preferred, surgery remains the inevitable treatment of choice in patients with middle aortic syndrome. In contrary, it is important to use the graft as large as possible during the initial operation to avoid patient-graft mismatch in the future.

Frequency of abnormal findings on routine chest radiography before cardiac surgery

ObjectivePreoperative chest radiograph screening is widely used before cardiac surgery. The objective of this study was to investigate the frequency of abnormal findings on a routine chest radiograph before cardiac surgery. MethodsIn this retrospective cohort study, 1136 patients were included. Patients were scheduled for cardiac surgery and underwent a preoperative chest radiograph. The primary outcome was the frequency of abnormalities on the chest radiograph. Secondary outcome was the effect of those abnormalities on surgery. ResultsOne half of the patients (570/1136; 50%) had 1 or more abnormalities on the chest radiograph. Most frequent abnormalities were cardiomegaly, aortic elongation, signs of chronic obstructive pulmonary disease, vertebral fractures or height loss, possible pulmonary or mediastinal mass, pleural effusion, and atelectasis. In 2 patients (2/1136; 0.2%), the chest radiograph led to postponement of surgery, whereas in none of the patients the surgery was cancelled. In 1 patient (1/1136; 0.1%) the surgical approach was altered and in 15 patients (15/1136; 1.3%) further analysis was performed without having an impact on the planned surgical approach. ConclusionsAlthough abnormalities are frequently found on preoperative chest radiographs before cardiac surgery, change in clinical management with regard to planned surgery or surgical approach occurs infrequently.

Quoi de neuf en dermatologie instrumentale ?

This "What's new in instrumental dermatology" dedicated skin surgeryis based upon a 2015-2017 literature analysis. The excision of skin cancers is an important part of surgical dermatology. Will artificial intelligence and new drug be able to face the increasing need for therapy? Wrong-site surgery is due to multiple factors. Photographs of biopsy site and short time between biopsy and surgery decrease postponement of surgery and wrong-site surgery. Noninvasive imaging technologies are improving and help to delineate skin tumors and increase the probability of complete tumor removal. They are beginning to be an essential tool for skin surgery. The 2005 recommendations for the management of melanoma stages I to III have been updated in 2016. The Slow-Mohs technique is the better way to treat dermatofibrosarcoma protuberans whose sub-clinical invasion is often asymmetric and unpredictable. Wide local excision for the treatment of severe hidradenitis suppurativa improves the quality of life and decreases recurrence rate. Cutaneous surgery is considered as safe procedures with a low risk of complications. Postoperative bleedings are the most frequent. Anti-thrombotics enhance the risk, but must not be stopped or bridged, except the novel oral anticoagulants which can be interrupted 24h before surgery and started again a few hours after. The risk of surgical site infections is low in dermatologic surgery. Most recommended measures to prevent them have been extrapolated from other types of surgery and the level of evidence is low. The reconstruction of skin defect must be adapted on size and location. A birhombic transposition flap is reliable in case of a defect too large to be repaired by a single flap. Full-thickness skin graft is a safe option to repair defect on the external ear.

Acute abdomen and septic shock in young lady treated conservatively

Introduction Septic shock is a life-threatening condition that is accompanied by high mortality rates. It is defined as sepsis- induced hypotension that persists despite adequate fluid resuscitation and is associated with hypoperfusion abnormalities and organ dysfunction. Blood cultures are positive in only 40% to 60% of patients with clinical manifestations of septic shock. Aggressive treatment with broad-spectrum regimens and vasopressors is mandatory to increase survival. Case description A 37-year-old lady presented to the emergency unit with an intense, sudden onset periumbilical pain with fever (39oC) and rigor, the last five hours. On physical examination, she was haemodynamically stable with rebound tenderness at palpation of right iliac fossa and right lateral ventricle. Abnormal laboratory tests were leukocytosis (WBC=19.500/µL, neutrophils=96.5%), hypoalbuminemia (3.4gr/dL) and elevated LDH (579U/L). She underwent abdominal CT scan with edema and inflammation of terminal ileum loops, high turbidity of mesenteric fat and high amount of free fluid. She was surgically evaluated and admitted in internal medicine department with triple antibiotic therapy and hydration. Results and conclusions Just after admission, she had recurrent episodes of loss of consciousness and hypotension, refractory in administering fluids. She was treated, according to guidelines, as septic shock with vasopressors (noradrenaline) and broad-spectrum antibiotics (imipenem). She was informed of necessitation for urgent surgical intervention in case of response failure, however, she was gradually improved with postponement of surgery. Despite laboratory deterioration (WBC=44.000/µL, hypoalbuminemia=2.9gr/dL), she remained afebrile after the 2nd day with gradual symptoms' resolution and feeding the 5th day. She was discharged, free of symptoms, 7 days later. Blood cultures were negative. Abdominal MRI, upper and lower endoscopy were normal. Take-home message Early diagnosis and treatment of septic shock is mandatory for rapid and effective treatment of this potentially fatal situation. Aggressive administration of vasopressors and antibiotics are life-saving and may avoid complications or painful therapeutic interventions, such as surgery.

Lidocaine: A Key-Factor to Avoid the Postponement of an Oncologic Urgent Surgery

Background and objectives: On the perioperative period, cardiovascular disease represents one of the most important causes of morbidity and mortality. The prevalence of cardiovascular risk factors ischemic heart disease and heart failure is increasing alongside with life expectancy. Case report: We present a patient scheduled for laryngeal biopsies of a neoformation suspected of malignancy under general anesthesia. We describe the use of lidocaine in converting an atrial fibrillation with limited ventricular tachycardia episodes into sinus rhythm, in a patient with an Implantable Cardioverter Defibrillator. Discussion: Lidocaine is an anti-arrhythmic drug due to its effect on blockade sodium channel. In this case, it allowed the pharmacological cardioversion into sinus rhythm, avoiding the postponement of the surgery. Further investigation should be conducted to confirm the authors’ anesthetic approach in similar cases.

Delay of Surgery does not Increase Transfusion Rates in Extracapsular Proximal Femur Fractures Stabilized with Intramedullary Implants

Scope: Aim of the study was to determine whether the delay of surgery increased transfusion requirements in extracapsular proximal femur fractures stabilized with intramedullary implants. Materials and Methods: We performed an internal audit (retrospective analysis of prospectively collected data) on blood transfusion requirements for hip fractures. Into this study were included 151 consecutive extracapsular proximal femur fractures in patients older than 55 years operated in our clinic over 9 months. Results: About the 126 patients operated using a short intramedullary implant, the time from admission to surgery did not correlate with transfusion needs (p=0.650). Patient’s age was positively correlated with the number of the received transfusions (p=0.125). Patient’s hemoglobin at admission was inversely correlated (p<0.001), whereas the duration of surgery was positively correlated with the number of transfusions (p=0.091). For 25 patients operated using a long intramedullary implant, the preoperative hemoglobin was the only significant influence for transfusion (p=0.005). Patients operated in the day of admission needed fewer transfusions compared to patients with delayed intervention: differences not statistically significant (p=0.222). Patients with sub trochanteric fractures required significantly more red blood cell mass (1.1 ± 1.1 versus 1.6 ± 1.0 units, p=0.024) and fresh frozen plasma (0.5 ± 1.3 versus 1.2 ± 1.4 units, p=0.014) spending nearly twice as long to operate (64.0 ± 21.8 versus 123.4 ± 45.7 minutes, p<0.001). Conclusions: The postponement of surgery did not increase the need of allogenic blood. Nonetheless, the older patients with lower baseline hemoglobin at admission undergoing to longer surgeries, did not require more perioperative transfusions.

Third Molar Complications in the Elderly—A Matched-Pairs Analysis

The aim of this study was to evaluate the perioperative morbidity of third molar (3M) removal in elderly patients in an attempt to estimate the long-term future burden of 3M-related morbidity resulting from the postponement of 3M surgery to old age. The study design was a retrospective matched-pair analysis comparing patients at least 65years old (group A) with a control group of 15- to 20-year-old patients (group B). Age group was the predictor variable in this study. Outcome variables were general health status as defined by the modified Charlson score (MCS) and the American Society of Anesthesiologists (ASA) score, general surgical risks from antithrombotic or antiresorptive medication, and specific local surgical risks and complications. Patients in group A showed substantially more comorbidities as reflected in significantly higher MCS and ASA scores (P < .001). Older patients more frequently used antithrombotic agents (P < .001), had higher rates of ankylosis (P < .001) and nerve proximity (P < .001), and showed significantly more in intra- and postoperative complications (P < .001), thus resulting in longer operations and a substantially longer hospital stay (P < .001). Within the limits of a non-epidemiologic approach, this study showed a substantially greater burden of morbidity and substantially worse outcome of 3M surgery in older adults compared with young adults. For the medical risks of an aging population, the present data suggest a veritable burst of 3M-associated morbidity when surgery is shifted to late adulthood.

Percutaneous aspiration and irrigation technique for the treatment of pediatric septic hip: effectiveness and predictive parameters.

Septic arthritis of the hip has been treated traditionally by surgical drainage. Recent reports have described repeated aspirations as an adequate and safe treatment. The aim of the present study was to assess the success of treatment of septic arthritis of the hip by repeated aspirations and to identify predictive factors for failure. Medical records were retrospectively reviewed for all patients treated by ultrasound-guided aspiration and intravenous antibiotics between 2002 and 2010. The demographic, clinical, laboratory, and outcome data were recorded. Findings were compared between patients who responded to this treatment and those who subsequently required surgery. A total of 42 patients fulfilled the inclusion criteria. Of the total 33 responded to repeated aspirations and nine required surgical drainage. The mean age of patients requiring surgery was 8.3 years compared with 2.6 years for those responding to aspirations. Age older than 10 years was associated with a 57% rate of failed conservative treatment compared with 14% for age younger than 10 years. There was no significant difference between the groups in any of the other parameters measured. Follow-up of the operated group after an average of 7.44 years showed no unfavorable results. In children with septic arthritis of the hip, hip decompression may be achieved with repeated aspirations and lavage combined with antibiotics, sparing patients the risks of anesthesia and surgery. Age older than 10 years at admission may serve as the cutoff for initial conservative treatment. The postponement of surgery did not cause any long-term morbidity. Level III; patients compared on the basis of outcome of conservative treatment of septic hip arthritis.