Rate Of Major Surgery Research Articles

Perioperative Risk: Short Review of Current Approach in Non Cardiac Surgery

The rate of major surgery is constantly increasing worldwide, and approximately 85% are non-cardiac surgery. More than half of patients over 45 years presenting for non-cardiac surgical interventions have cardiovascular risk factors, and the most common: chronic coronary syndrome and history of stroke. The preoperative cardiovascular risk is determined by the comorbidities, the clinical condition before the intervention, the urgency, duration or type. Cardiovascular risk scores are necessary tools to prevent perioperative cardiovascular morbidity and mortality and the most frequently used are Lee/RCRI (Revised Cardiac Risk Index), APACHE II (Acute Physiology and Chronic Health Evaluation), POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity), The American University of Beirut (AUB)-HAS2. To reduce the perioperative risk, there is a need for an appropriate preoperative risk assessment, as well as the choice of the type and timing of surgical intervention. Quantification of surgical risk as low, intermediate, and high is useful in identifying the group of patients who are at risk of complications such as myocardial infarction, thrombosis, arrhythmias, heart failure, stroke or even death. Currently there are not enough studies that can differentiate the risk according to gender, race, elective versus emergency procedure, the value of cardiac biomarkers.

The novel use and feasibility of hemostatic oxidized regenerated cellulose agent (SurgiGuard®): multicenter retrospective study.

SurgiGuard® is an absorbent hemostatic agent based on oxidized regenerated cellulose. The efficacy, effects and safety of SurgiGuard® are equivalent to existing hemostatic agents in animal experiments. This study was designed to confirm that the use of SurgiGuard® alone is effective, safe and feasible compared to combination with other hemostatic methods. We retrospectively reviewed clinical data from 12 surgery departments in seven tertiary centers in South Korea nationwide. All surgeries were performed between January and December 2018. A total of 807 patients were enrolled; 447 patients (55.4%) had comorbidities. The rate of major surgery (operative time ≥4 hours) was 44% (n=355 patients). Regarding the type of SurgiGuard® used in surgery, more than 70% of minor surgeries used non-woven types. In major surgery, more than five SurgiGuards® were used in 7.3% (26 patients), and the proportion of co-usage (with four other hemostatic products) was 19.7% (70 patients). The effectiveness score was higher when SurgiGuard® was used alone in both major (5.3±0.5 vs. 5.1±0.6, P=0.048) and minor surgery (5.4±0.6 vs. 5.2±0.4, P<0.001). Seven patients had immediate re-bleeding, and all of them used SurgiGuard® and other products together. Nine patients reported adverse effects, such as abscess, bleeding, or leg swelling, but we found no direct correlation with SurgiGuard®. SurgiGuard® exhibited greater effectiveness when used alone. No direct adverse effects associated with SurgiGuard® use were reported, and SurgiGuard® had stable feasibility. Prospective comparative studies are needed in the future.

Effect of the postpartum hemorrhage intervention package implementation in a fourth-level hospital in Latin America.

To evaluate the effectiveness of the implementation of intervention packages for postpartum hemorrhage (PPH) management in pregnant women hospitalized in a High Obstetric Complexity Unit in a Latin American country. Retrospective cohort study including pregnant women with PPH attended between January 2011 to December 2019. Three periods of time were defined according to management strategies We performed univariate and multivariate robust Poisson regression logistic models for each of the outcomes derived from each period. We included 602 patients. There was a reduction in period 3 of the incidence of massive PPH (16% versus 12% P < 0.001, relative risk [RR] 0.61, 95% confidence interval [CI] 0.44-0.85; P = 0.003), major surgery (24%, 13%, 11%, P = 0.002, RR 0.54, 95% CI 0.33-0.883; P = 0.014), and admission to the intensive care unit (ICU) (14%, 7%, 6.1%, P = 0.0, RR 0.40, 95% CI 0.17-0.96 P = 0.00). The implementation of PPH intervention packages in a hospital in a middle-income country from Latin America, led to a significant decrease in the incidence of massive bleeding, the rate of major surgery, and the ICU stay of pregnant women affected by this condition.

Prenatal diagnosis of isolated clubfoot: Diagnostic accuracy and long-term postnatal outcomes

ObjectiveTo evaluate concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery and postnatal outcomes in relation to the prenatal classification of severity. Study designThis is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV between 2004 and 2018. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed-up postnatally for at least two years, with a specific focus on neurodevelopmental outcome. ResultsThe cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases. Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity (k = 0.61 and 0.66, respectively). The average Pirani score, number of casts and rates of Achilles tendon tenotomy were higher for III degree cTEV (p < 0.001). Within this group only, the rate of relapse was 11% and the rates of major surgery was 6%. The postnatal outcome was normal in 68.6% newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development. None of the outcome was statistically correlated to the prenatal assessment of laterality or degree. ConclusionsThe accuracy of prenatal ultrasound for isolated cTEV is 86% with a false positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of number of casts and need of surgery. The assessment of the correlation between cTEV and neurological impairment requires further prospective studies on larger cohorts.

Sa1171 Diagnostic Delay Is Associated With Higher Rate of Major Surgery in a French Prospective Cohort of Patients With Crohn's Disease

Sa1171 Diagnostic Delay Is Associated With Higher Rate of Major Surgery in a French Prospective Cohort of Patients With Crohn's Disease

P231. Diagnostic delay is associated with higher rate of major surgery in a French prospective cohort of patients with Crohn's Disease

P231. Diagnostic delay is associated with higher rate of major surgery in a French prospective cohort of patients with Crohn's Disease

Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease: a systematic review and meta-analysis.

We systematically reviewed infliximab benefit in reducing hospitalizations and/or major surgery rates in patients with inflammatory bowel disease (IBD). A literature search to May 2012 was performed to identify all studies (experimental and observational) evaluating patients with IBD treated with infliximab and providing data on hospitalizations and/or major surgery rates. Three reviewers independently performed studies' selection, quality assessment, and data extraction. Analyses were carried according to study design (randomized clinical trials [RCTs] and observational studies) and IBD type (Crohn's disease [CD] and ulcerative colitis [UC]). Random-effects meta-analysis was used to derive pooled and 95% confidence intervals (CIs) estimates of odds ratios (OR). Heterogeneity was assessed with I test. Twenty-seven eligible studies were included (9 RCTs and 18 observational studies). Infliximab reduced hospitalization risk, both in pooled RCTs (OR, 0.51; 95% CI 0.40-0.65; I = 0%) and results of observational studies (OR, 0.29, 95% CI, 0.19-0.43; I = 87%), without differences between CD and UC. Infliximab reduced surgery risk in pooled RCTs results, both in CD (OR, 0.31; 95% CI, 0.15-0.64; I = 0%) and UC (OR, 0.57; 95% CI, 0.37-0.88; I = 0%). Pooled estimate from observational studies favored infliximab for patients with CD (OR, 0.32; 95% CI, 0.21-0.49; I = 77%), but not for patients with UC. The best evidence available points toward a reduction of the risk of hospitalization and major surgery requirement in patients with IBD treated with infliximab. This impact is clinically and economically relevant because hospitalization and surgery are considered to be markers of disease severity and significantly contribute to the total direct costs associated with IBD.

Guías de práctica clínica de la Sociedad Española de Cardiología en la valoración del riesgo quirúrgico del paciente cardiópata sometido a cirugía no cardíaca

All patients undergoing a surgical intervention require a cardiovascular evaluation that establishes the surgical risk. On the other hand, an important proportion of the deaths that happened during the surgery are due to cardiovascular complications, many of them could be avoided with a cardiac risk screening. The surgery and the anesthesia subject the patient to stress situations during the perioperative period that forces the check upon capacity of the patient to respond to those demands, dissuading surgery if it considered that the risk is very high. The rate of major surgery in elderly patients is growing, with the increase in cardiovascular complications, mainly myocardial infarction, unstable angina and perioperative heart failure. Following we establish some recommendations for the cardiovascular assessment of the cardiac patient that will undergo noncardiac surgery.

Rates of major surgery by age and sex in a rural district in Kenya

All major surgical operations performed during 1 year in Meru district, Kenya, were recorded. The district, with a population of 1.3 million, had five hospitals and two nursing homes where major surgery was performed. Over 3400 major operations were recorded: Caesarean section (129.0 operations/100,000 population), tubal ligation (39.4), laparotomy (14.0), hysterectomy (5.0), open reduction of fracture (4.3) and hernia repair (6.3). The total major surgery rate was 263/100,000 year: 88/100,000 males and 434/100,000 females. Of all major operations, 83.5% were performed on females, the most common being Caesarean section, tubal ligation, laparotomy, eye or lens removal and hysterectomy. Most frequent major operations on males were laparotomy, eye or lens removal, hernia repair, gastro-intestinal surgery and prostatectomy. Most major surgery (68.1%) was on young and middle-aged adults; only 7.7% was performed on children aged < 15 years even though these made up half of the population. Rates increased with age, and there were modest male/female differences except for very high rates of obstetrical surgery on young women. There is need to expand the district's capacity for major surgery and also to prevent more conditions requiring surgery, for example by improving sexual- and reproductive-health education, making family planning services more easily available among sexually active adolescents, and by initiating more aggressive prevention programmes against injuries. Although population-based operation rates, totally and by sex and age-group, are useful indicators for monitoring service output, current reporting is inadequate. One step towards improvement would be to require that every hospital reports, annually to the district level, all major operations by kind and by age and sex of the patient.