Surgical Discharge Research Articles

PREDICTION OF SURGICAL OUTCOME OF EMERGENCY ABDOMINAL SURGERIES USING PREOPERATIVE LACTATE LEVELS AS A DIAGNOSTIC TOOL

Introduction: Acute abdominal conditions are those which presents with sudden abdominal pain and are coupled with those symptoms which are focussed to abdominal causes. To operate or not during acute abdominal conditions, still remains a challenge for a surgeon. Aim: To access the predictive value of preoperative blood lactate levels in evaluating the surgical outcomes of the patients of with acute abdominal conditions. Material And Methods: Sixty patients (including both genders) above 15 years of age, presenting with acute abdominal problems in Emergency department were included in the study. Preoperative Lactate levels were measured for all the patients. The study sample was divided into group 1 with 30 Patients who had Preoperative lactate levels 2.5 mmol/l. Different parameters were assessed further which were Mortality, Surgical site discharge and dehiscence and Respiratory complications and anastomotic leak and prolonged illeus. Results: Total of 60 patients were included. When both study groups were compared it was observed that group 1 had mortality of 4 patients while group 2 of 10 patients (p0.05), respiratory complications were among 5 patients of group 1 and 12 patients of group 2 (p0.05), anastomotic leak was found in only 1 patient of group 1 while prolonged ileus found in only 2 patients of group 1. (p>0.05). Conclusion: Thus we conclude that we observed high mortality and more respiratory complications among patients with Preoperative lactate levels of > 2.5 mmol/l. we did not find any correlation of Preoperative lactate levels with wound complications, anastomotic leak and prolonged ileus.

Outcomes, Microbiology and Antimicrobial Usage in Pressure Ulcer-Related Pelvic Osteomyelitis: Messages for Clinical Practice.

Introduction: Pressure ulcer-related pelvic osteomyelitis is a relatively under-studied entity in the field of bone infection. We sought to add to the limited evidence base for managing this challenging syndrome.Methods: Cases were identified retrospectively from a surgical database and hospital discharge codes at a U.K. tertiary centre (2009-2018). Risk factors associated with outcomes were analysed by logistic regression.Results: We identified 35 patients (mean age 57.4 years), 69% managed with a combined medical and surgical approach, with mean follow-up of 3.7 years from index admission. Treatment failure (requiring further surgery or intravenous antimicrobials) occurred in 71% and eventual ulcer healing in 36%. One-year mortality was 23%. Lack of formal care support on discharge, post-traumatic (asensate) neurological deficit and index CRP (>184mg/L) were associated with treatment failure (p=0.001). Age (>59.5 years), lack of attempted soft tissue coverage, haemoglobin (<111g/L) and albumin (<25g/L) were associated with non-healing ulcers (p=0.003). Superficial wound swabs had low sensitivity and specificity compared to deep bone microbiology. Infection (based on deep bone microbiology from 46 infection episodes) was usually polymicrobial (87%), commonly involving S. aureus, Enterococci, GNB and anaerobes. Antimicrobial duration ranged from 0-103 days (mean 54) and was not associated with subsequent treatment failure.Conclusions: Attempted soft tissue coverage after surgical debridement, ensuring appropriate support for personal care after discharge and nutritional optimisation could improve outcomes. Superficial wound swabs are uninformative and deep bone sampling should be pursued. Long antimicrobial courses do not improve outcomes. Clinicians should engage patients in anticipatory care planning.

Do Patient Point of Entry and Medicaid Status Affect Quality Outcomes Following Total Knee Arthroplasty?

BackgroundThe effect of surgeon practice and patient care setting have not been studied in the Medicaid population undergoing total knee arthroplasty (TKA). This study aims to evaluate whether point of entry and Medicaid status affect outcomes following TKA. MethodsThe electronic medical record at our urban, academic, tertiary care hospital system was retrospectively reviewed for all primary, unilateral TKA during January 2016 and January 2018. Outpatient visits within the 6-month preoperative period categorized TKA recipients as either Hospital Ambulatory Clinic Centers patients with Medicaid insurance or private office patients with non-Medicaid insurers. ResultsThere were 174 Medicaid patients and 317 non-Medicaid patients for 491 total patients. Medicaid patients were significantly younger (62.6 ± 1.6 vs 65.4 ± 1.1 years, P < .01), of “other’ ethnicity (43.1% vs 25.6%, P < .01), and to be a current smoker (9.3% vs 6.6%, P = .02). There was no difference in gender, body mass index, and American Society of Anesthesiologists score. After controlling for patient factors, the Medicaid effect was insignificant for surgical time (exponentiated β 0.93, 95% confidence interval [CI] 0.86-1.01, P = .076) and facility discharge (odds ratio 1.58, 95% CI 0.71-3.51, P = .262). Medicaid status had a significant effect on length of stay (LOS) (rate ratio 1.21, 95% CI 1.02-1.43, P = .026). ConclusionMultivariable analysis controlling for patient factors demonstrated that Medicaid coverage had minimal effect on surgical time and facility discharge. Medicaid patients had significantly longer LOS by one-half day. These results indicate that comparable outcomes can be achieved for Medicaid patients following TKA provided that the surgeon and care setting are similar. However, increased care coordination and preoperative education may be necessary to normalize disparities in hospital LOS. Level of EvidenceIII, retrospective observational analysis;

Age and postoperative opioid prescriptions: a population-based cohort study of opioid-naïve adults.

Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures. This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure. For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends. The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.

Patient frailty as a risk assessment tool in surgical management of long bone fractures

BackgroundFrailty is an important predictor of surgical outcomes and has been quantified by several models. The modified frailty index (mFI) has recently been adapted from an 11-item index to a 5-item index and has promise to be a valuable risk assessment tool in orthopedic trauma patients. We perform a retrospective analysis of the 5-item mFI and evaluate its effectiveness in predicting outcomes in patients with long bone fractures. MethodsThe National Surgery Quality Improvement Program (NSQIP) 2006–2016 database was queried for surgical procedures in the treatment of long bone fractures by current procedural terminology (CPT) codes, excluding those performed on metacarpals and metatarsals. Cases were excluded if they were missing demographic, frailty, and variable data. The 5-item frailty index was calculated based on the sum of presence of 5 conditions: COPD/pneumonia, congestive heart failure, diabetes, hypertension, and impaired functional status. Chi square was used to determine variables significantly associated with each outcome. The significant variables were included in multivariate logistic regression along with the mFI. Significance was defined as p < 0.05. ResultsOf the 140,249 fixation procedures performed on long bone fractures in NSQIP, 109,423 cases remained after exclusion criteria were applied. The majority of patients were between the ages of 61 and 80 (34.0%), were female (65.6%) and Caucasian (86.3%). Multivariate analysis revealed that mFI scores ≥3 were predictive of unplanned reoperation (OR = 1.57), wound disruption (OR = 2.83), unplanned readmission (OR = 2.12), surgical site infection (OR = 1.90), major complications (OR = 3.04), and discharge destination (OR = 3.06). ConclusionsOur study analyzed the relationship of frailty and postoperative complications in patients with long bone fractures. Patients had increased likelihood of morbidity, independent of other comorbidities and demographic factors. The mFI may have a role as a simple, easy to use risk assessment tool in cases of orthopedic trauma.

Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis

IntroductionExcessive prescribing after surgery has contributed to a public health crisis of opioid addiction and overdose in North America. However, the value of prescribing opioids to manage postoperative pain after...

A study of pattern of pathogen and their sensitivity isolated from surgical site infections in abdominal surgeries

Background: Surgical site infection (SSI) is defined as those infections presenting up to 30 days after a surgical procedure if no prosthetic is placed and up to 1 year if prosthesis is implanted in the patient. SSI contributes to increasing morbidity, mortality and cost related to surgeries and continues to be a major problem even in tertiary care modern hospitals following standard protocols of peri operative preparation and antibiotics prophylaxis. Objective of this study was to study and analyse the pattern of pathogen causing SSI in abdominal surgeries in a tertiary care hospital.Methods: Descriptive study on patients undergoing abdominal surgery in the department of surgery. Patients satisfying inclusion criteria will be assessed on 2nd postoperative day and then daily for surgical site pain, redness, warmth, discharge and swelling of surgical site till the patient gets discharged and followed up after discharge every 7 days up to 1 month. If SSI is detected, swab will be taken and sent for culture and sensitivity.Results: At the end of the study, after analysing the pattern of pathogens and antibiotic susceptibility, we intend to conclude the safe usage of empirical antibiotic prophylaxis to prevent the incidence of SSI’s in our hospital.Conclusions: Appropriate prophylactic therapy for any open abdomen surgeries reduces incidence of surgical site infection thereby reducing morbidity, mortality and cost burden in patients undergoing abdominal surgeries.

A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription.

This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP. The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term. The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year. Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.

Skin closure with 2-octyl cyanoacrylate and polyester mesh after primary total knee arthroplasty offers superior cosmetic outcomes and patient satisfaction compared to staples: a prospective trial

The goals of this study were to compare patient satisfaction and wound-related complications in patients receiving 2-octyl cyanoacrylate (glue) and polyester mesh for skin closure after primary total knee arthroplasty (TKA) versus staples. A total of 60 knees in 54 patients undergoing TKA were enrolled in a prospective trial and randomized to receive either skin closure with glue and polyester mesh (n = 30) or a control group closed with staples (n = 30). Hollander wound cosmesis score (measured on a scale of 0-5, with 0 being the best) and visual analog scale (VAS) scores (range 0-100mm) for patient satisfaction with wound cosmesis, as well as wound-related readmission, reoperation, and complications, including superficial surgical site infection, wound dehiscence, wound hematoma, stitch abscess, and wound discharge, were assessed at 6weeks and 90days after TKA. Baseline characteristics were not statistically significantly different between the groups (p > 0.05). At 6weeks and 90days, the Hollander wound cosmesis score was significantly lower (p < 0.01) in the glue and polyester mesh groups. Similarly, at 6weeks and 90days, the VAS for patient satisfaction with wound cosmesis was significantly higher (p < 0.01) in the glue and polyester mesh groups. The rate of superficial surgical site infection was 1/30 (3%) in glue and polyester mesh groups versus zero in the control group (p = 1.00). The rate of wound dehiscence was 1/30 (3%) in glue and polyester mesh groups versus zero in the control group (p = 1.00). These results suggest that glue and polyester mesh closure may offer superior cosmetic outcomes to staples for skin closure in TKA.

Rate of drop in serum calcium as a predictor of hypocalcemic symptoms post total thyroidectomy.

Test the hypothesis that rate of drop in calcium is a significant and independent predictor of post-operative hypocalcemic symptoms post total thyroidectomy. A retrospective chart review (electronic and hard copy) for 429 patients who underwent total thyroidectomy from January 2011 to December 2016. We collected information on demographics, clinical characteristics, information on surgical intervention, histopathology reports, clinical course, biochemistries, treatments and discharge instructions. Sixty-one patients (14%) developed post-operative hypocalcemic symptoms. The rate of calcium drop, younger age, female gender, and lower body mass index, and the presence of parathyroid tissue in resected specimen all correlated significantly with the development of symptoms. The rate of drop in serum calcium and the post-operative serum calcium level remained the only significant predictors of symptom development, after adjustment for other significant co-variates. Using a receiver operating characteristics curve, a cutoff rate of calcium drop > 0.083mg/dl/h, that is 1mg/dl over 12h, has a sensitivity of 71% and specificity of 73% for detecting hypocalcemic symptoms. The rate of drop of serum calcium post total thyroidectomy significantly and independently correlated with the development of hypocalcemic symptoms. Patients with a rate of drop < 1mg/dl/12h may be considered for earlier discharge and less aggressive management peri-operatively.

The impact of preoperative opioid use on outcomes after elective colorectal surgery: A propensity-matched comparison study

BackgroundThe impact of recent preoperative opioid exposure on outcomes of colorectal surgery is unclear. Our aim was to evaluate the impact of preoperative opioid use on outcomes and opioid prescribing patterns after colorectal surgery. MethodsWe performed a retrospective review of all patients undergoing elective resection at a single institution from 2015 to 2017. Primary outcomes included in-hospital narcotic use and cost. Secondary outcomes included postoperative surgical outcomes and discharge prescribing patterns. ResultsA total of 390 patients underwent elective colorectal surgery, of whom 63 (16%) had a recent history of preoperative opioid use. Opioid users had similar age, sex, American Society of Anesthesiologists score, and operative indication compared with opioid-naïve patients (P > .05 for each). Postoperatively, the 30-day readmission rate was greater among opioid users (18% vs 9%, P = .03). Opioid users had greater total narcotic use (218 morphine milligram equivalents vs 111 morphine milligram equivalents, P = .04) and direct costs ($11,165 vs $8,911, P < .01). These patients were also more likely to require an opioid prescription on discharge (90% vs 68%, P < .01) and an opioid refill within 30 days (54% vs 21%, P < .01). ConclusionRecent preoperative opioid exposure among colorectal surgery patients was associated with increased opioid consumption and costs. Moreover, unadjusted analysis was pertinent for more readmissions after surgery among preoperative opioid users. This work underscores the negative impact of preoperative, chronic opioid use on surgical outcomes and highlights the need for developing protocols to minimize perioperative narcotics.

52. Pre-emptive opioid-sparing medication protocol decreases pain and length of hospital stay in children undergoing posterior spinal instrumented fusion for scoliosis

BACKGROUND CONTEXT Poorly controlled postoperative pain following posterior spinal instrumented fusion (PSIF) for scoliosis may be associated with delayed ambulation and longer hospital stays. Multimodal analgesia use has been shown to provide superior analgesia with improved recovery in other orthopedic subspecialities, but has not been described with pediatric patients undergoing spinal surgery. We describe a novel, pre-emptive, opioid-sparing pain medication protocol that is started 2 days prior to surgery, in accordance with first-order pharmacokinetics, and continued postoperatively until discharge with the goal of decreasing postoperative pain, improving mobilization, and decreasing the patient's length of hospital stay. PURPOSE The purpose of this study was to determine if adequate blood concentrations of non-opioid analgesia prior to surgery can decrease the total amount and duration of opioids used postoperatively, while providing optimal pain control. STUDY DESIGN/SETTING Single institution retrospective chart review. PATIENT SAMPLE Patients who had undergone PSIF from March 2014 to November 2017. OUTCOME MEASURES Variables analyzed between both groups were length of hospital stay, total opioid consumption and maximum pain scores per day from surgical discharge date. METHODS We retrospectively reviewed 116 PSIF cases from March 2014 to November 2017. Fifty-two patients received standard analgesia, and 64 patients received the pre-emptive protocol consisting of a standardized combination of acetaminophen, celecoxib, and gabapentin 2 days prior to surgery and continued during their inpatient stay. Scheduled oxycodone and intravenous hydromorphone via patient controlled analgesia (PCA) were given to both groups equally during their hosptial stays. We analyzed legth of stay, total opioid consumption, and maximum pain scores per day from surgical to discharge date. RESULTS Length of hospital stay significantly differed, with means of 3.9 days in the pre-emptive group and 4.5 days in the standard analgesia group (p CONCLUSIONS This is a preliminary report demonstrating a significant decrease in maximal pain score and length of stay following PSIF on a cohort of patients receiving a novel pre-emptive opioid-sparing pain medication protocol. Future studies should investigate degrees of mobilization and opioid consumption and pain levels after discharge from the hospital. FDA DEVICE/DRUG STATUS Univailable from authors at time of publication.

Race and socioeconomic disparity in treatment and outcome of traumatic cervical spinal cord injury with fracture: Nationwide Inpatient Sample database, 1998-2009.

A retrospective national administrative database study. Advances in treatment of traumatic cervical spinal cord injury with fracture (TCSCIF) have led to significant improvements in clinical outcomes; however, progress in healthcare is seldom ubiquitous across demographic groups. Therefore, we explored if disparities in treatment and outcome after TCSCIF exist across race and socioeconomic status. USA. We queried the Nationwide Inpatient Sample database from 1998 to 2009 for TCSCIF hospitalizations. Multivariate analysis was used to identify the correlation between socioeconomic status and race to injury, treatment type, and outcome. There were 21,985 admissions for TCSCIF, 66.9% of whom had a favorable discharge disposition. In-hospital mortality rate was 12.5%. A total of 43.7% underwent surgery. Overall, surgery was associated with lower in-hospital mortality (OR 0.30, 95% CI 0.27-0.34, p < 0.01) and better discharge disposition (OR 0.68, 95% CI 0.62-0.74, p < 0.01) versus nonsurgical or no intervention. African-American (AA) race and low socioeconomic status (LSES) were significant predictors of lower odds to undergo surgery and unfavorable discharge disposition, respectively; potentially explained by a higher odds of increased New Injury Severity Score classification at presentation. Surgical and favorable discharge rates for LSES and non-Caucasian races, however, have been steadily improving over the study period. Despite trending improved outcomes after TCSCIF, LSES, or AA race were more likely to have worse outcomes compared to their counterparts. In addition, LSES, AA, and Hispanic groups were less likely to undergo surgical treatment, suggesting disparities in management and outcome effect.

Hospital Teaching Status Impacts Surgical Discharge Efficiency

There is a paucity of data regarding the efficiency of care provided by teaching hospitals. Yet, instruction on transitions in care and an understanding of systems-based practice are key components of modern graduate medical education. We aimed to determine the relationship between hospital teaching status and the discharge efficiency from a surgical service. Patients who were cared for at teaching and nonteaching hospitals captured in the Healthcare Cost and Utilization Project National Inpatient Sample from 2012. A total of 272,090 patients who underwent one of 44 predefined general surgery procedure types. Patients were stratified based on treating hospital teaching status (TH vs. NTH). Procedure-specific early discharge (PSED) was defined for each operation type as a discharge that occurred within the lowest 25th percentile for overall length of stay. PSED was used as the discharge efficiency metric. To adjust for cofounders and hospital level clustering, multivariable mixed-effects logistic regression was used to examine the association between teaching status and PSED. Subgroup analysis was performed by operation type. Models were constructed with and without adjustment for inpatient complications. There were 140,878 (51.8%) patients who received care at a TH. TH status was significantly associated with lower PSED (TH: 10.7% vs. NTH: 11.4%; p < 0.001) and longer length of stay (TH: 5.5 days vs. NTH: 4.5 days; p < 0.001). In the adjusted model of the overall cohort, patients treated at a TH were 8% less likely to receive a PSED compared to those treated at NTH (odds ratio 0.92, 95% confidence interval (0.88, 0.97); p < 0.002). Differences in the rates and odds of PSED were noted across the subgroups. Teaching hospital status is associated with a reduced likelihood of PSED. The effect of TH on PSED varied by procedure subgroup. Examining the recovery pathways and discharge practices at NTH may allow for the identification of more efficient methods of care that can be applied to the broader healthcare system.

Evaluating the ACS NSQIP Risk Calculator in Primary Pancreatic Neuroendocrine Tumor: Results from the US Neuroendocrine Tumor Study Group

BackgroundIn a changing health care environment where patient outcomes will be more closely scrutinized, the ability to predict surgical complications is becoming increasingly important. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) online risk calculator is a popular tool to predict surgical risk. This paper aims to assess the applicability of the ACS NSQIP calculator to patients undergoing surgery for pancreatic neuroendocrine tumors (PNETs). MethodsUsing the US Neuroendocrine Tumor Study Group (USNET-SG), 890 patients who underwent pancreatic procedures between 1/1/2000–12/31/2016 were evaluated. Predicted and actual outcomes were compared using C-statistics and Brier scores. ResultsThe most commonly performed procedure was distal pancreatectomy, followed by standard and pylorus-preserving pancreaticoduodenectomy. For the entire group of patients studied, C-statistics were highest for discharge destination (0.79) and cardiac complications (0.71), and less than 0.7 for all other complications. The Brier scores for surgical site infection (0.1441) and discharge to nursing/rehabilitation facility (0.0279) were below the Brier score cut-off, while the rest were equal to or above and therefore not useful for interpretation. ConclusionThis work indicates that the ACS NSQIP risk calculator is a valuable tool that should be used with caution and in coordination with clinical assessment for PNET clinical decision-making.

Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol.

Gastrostomy tube placement is one of the most commonly performed pediatric surgical procedures and discharge is possible as early as the first postoperative day with early initiation of feeds postoperatively. We examined a national database to determine hospital length of stay (LOS) after elective laparoscopic gastrostomy in children. We queried the 2012-2013 National Surgical Quality Improvement Program Pediatric (NSQIP-P) database, including all patients who underwent elective laparoscopic gastrostomy tube placement for failure to thrive or feeding difficulties. Demographic data, admission status, disposition at discharge, surgical subspecialty data and hospital LOS were extracted. A total of 599 patients underwent gastrostomy tube placement for failure to thrive or feeding intolerance. The majority, 52%, was male and 69.3% were White. The median age was 2.2 years (IQR 0.9-6.3). Of the total, 28.7% were infants. The median total hospital LOS was 2 days (IQR 1-2), with only 39% discharged in a day or less. Pediatric patients undergoing elective laparoscopic gastrostomy have a median hospital length of stay of 2 days, despite evidence that early feeding and discharge within 24h is both feasible and safe. There is potential for the implementation of an enhanced recovery protocol as a quality metric for this procedure.

Twelve Tips for Preparing a Surgical Discharge Summary: Enabling a Safe Discharge.

This article was migrated. The article was marked as recommended. The surgical discharge summary allows the perioperative care team to summarize a recent hospitalization and relay important information to a variety of invested parties including other healthcare providers, outpatient caregivers, and the surgical patient. The inpatient care team can promote a smooth transition of care and empower outpatient providers and the patient to foster a confident progression through recovery. We describe twelve tips for a streamlined, successful discharge summary geared towards the surgical intern. A successful surgical discharge summary begins with patient and caregiver collaboration, communication and teamwork, and culminates with concise documentation. These tips reflect a review of the current literature and rely on the clinical expertise of an interdisciplinary surgical team. Our aim is to empower surgical educators and trainees to understand the complexity of discharge planning, and to improve the efficiency with which it can be completed and the quality of the discharge process at their training hospitals.

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction.

To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. A total of 116 patients presented with symptoms of FBO. Twenty-seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy-one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.

Surgical treatment 1of distal venous discharge in patients with venous form of erectile dysfunction

Статья посвящена диагностике и лечению дистального венозного сброса у пациентов с вено-окклюзивной форме ЭД. На базе андрологического виддлення ОКЦУН и Института общей и неотложной хирургии в отделении ангиографии и рентгенэндоваскулярной хирургии в период с 2015 по 2017 были обследованы и пролечены 64 пациента с вено-ок-люзивною форме ЭД (из них 17 пациентов с дистальной формой венозного сброса) и обследованы 18 пациентов с целью контроля. Выполнено эндоваскулярное оперативное лечение пациентов с дистальной формой венозного сброса. По итогам оперативного лечения было установлено, что субъективная оценка эректильной фунцкии (по шкале МИЭФ-5) через 1 мес. выросла на 8,3 балла. По объективной оценке качество эрекции у пациентов после операции выросла на 92% по сравнению с исходными данными. Эффективным лечением дистального венозного сброса полового члена является ограничение патологического сброса крови путем проведения рентгенэндоваскулярной окклюзии патоло-гических венозных шунтов.

Surveying the Literature

Surveying the Literature