Quality Of Surgical Result Research Articles

Interaction concept and system architecture for the sterile information system OR-Pad in the perioperative area

Abstract Access to clinical information during interventions is an important aspect to support the surgeon and his team in the OR. The OR-Pad research project aims at displaying clinically relevant information close to the patient during surgery. With the OR-Pad system, the surgeon shall be able to access case-specific information, displayed on a sterilepackaged, portable display device. Therefore, information shall be prepared before surgery and also be available afterwards. The project follows an user-centered design process. Within the third iteration, the interaction concept was finalized, resulting in an application that can be used in two modes, mobile and intraoperative, to support the surgeon before/after and during surgery, respectively. By supporting the surgeon perioperatively, it is expected to improve the information situation in the OR and thereby the quality of surgical results. Based on this concept, the system architecture was designed in detail, using a client-server architecture. Components, communication interfaces, exchanged data, and intended standards for data exchange of the OR-Pad system including connecting systems were conceived. Expert interviews by using a clickable prototype were conducted to evaluate the concepts.

PERITONEAL ADHESIONS TYPE I, III AND TOTAL COLLAGEN ON POLYPROPYLENE AND COATED POLYPROPYLENE MESHES: EXPERIMENTAL STUDY IN RATS

ABSTRACTBackground: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. Aim: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. Methods: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. Results: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). Conclusion: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

Graft Quality Control with the Traditional Roller Pump Flow Measurement in Comparison to the Transit-Time Flow Measurement

Objective: Vein graft quality control had been traditionally done for more than 20 years with a roller-pump flow measurement (RPFM) in our institute until off-pump coronary artery bypass grafting was introduced as the standard technique of myocardial revascularization in the year 2009 in our institute. In this study, the RPFM method was compared with the Transit-time flow measurement (TTFM). Patients and Methods: From February to September 2005, 31 patients (5 females) undergoing CABG in our institute were included into the study. All the patients were operated with cardiopulmonary bypass. In those patients, 27 distal anastomoses were done with the left internal thoracic artery and 99 anastomoses were done with vein grafts. Those 99 vein graft were assessed both, with the RPFM method and TTFM method. Results: CABG could be safely performed in all cases. In all target vessels, the RPFM method overestimated bypass flow compared to the TTFM method, and simple linear regression revealed no correlation between the TTFM measurement and the RPFM measurement (r = 0.08, p = 0.21). There were two cases in which a graft problem could be detected only with TTFM method, even in our small patient cohort. Conclusion: The present study suggests that the TTFM method is clearly superior to the traditional RPFM method and we believe now that TTFM should be performed routinely in all CABG to improve patient care and quality of surgical results.

Factors Influencing Late Survival After Coronary Bypass Surgery

In order to determine which factors most influence late survival after the coronary bypass procedure, a review was made of the initial experience of one surgeon who performed 792 operations between 1968 and 1972. The initial 250 patients were compared with the subsequent 542 patients. The two groups were of similar age and sex and had a similar distribution of coronary disease and impaired left ventricular function. Perioperative mortality fell from an initial 6.8% (17/250) to 4.8% (26/542). The number of grafts per patient was initially 1.5 but later was 1.8. Graft patency beyond five years in 105 patients was 88.6% (148/167), 96.2% of patients had at least one patent graft. Initially, crude five year survival was 78.0% (195/250) but was 87.8% (476/542) in the later group. Patients who had no residual unbypassed lesions after operation had a 91.4% (287/314) survival while those with two residual lesions had a 66.7% (14/21) survival. Those patients with a preoperative end-diastolic pressure of less than 15 mmHg and no localized abnormality of contraction had a five year crude survival of 92.1% (316/343) whereas the patients with poor ventricular function had a survival of 81.8% (108/132). Our conclusion is that the most important factors determining late survival are the quality of surgical result achieved as shown by: perioperative mortality and graft patency; the degree of revascularization established; and the preoperative status of left ventricular function. The number of vessels diseased preoperatively had a minimal influence on late survival. These findings emphasize the primary importance of good surgical results in obtaining superior late survival rates.