Mortality Of Surgical Treatment Research Articles

Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children.

Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial. The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis. Retrospective single-center cohort study. A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information. There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493). The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.

Hybrid stepwise external wrapping for type a acute aortic dissection with cerebral Malperfusion

BackgroundAcute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion.Case presentationThe ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications.ConclusionsHybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.

Invasive monitoring and dosing strategy to mitigate risks of general anaesthesia in a patient with connective tissue disease and pulmonary arterial hypertension.

Patients with mixed connective tissue disease (MCTD) can have concomitant pulmonary arterial hypertension (PAH), a major cause of mortality. In particular, PAH is associated with significant perioperative mortality in surgical treatment under general anaesthesia. In this case report, we present a patient with MCTD and PAH who needed hip replacement surgery and illustrate how an invasive monitoring and dosing strategy enabled a successful outcome. Invasive monitoring was conducted before and after optimizing the PAH treatment to ensure that the patient was adequately treated prior to surgery. Subsequent management of the patient with a multi-disciplinary team ensured a good outcome post-surgery.

Stepwise external wrapping procedure for Stanford type A aortic dissection in extremely high-risk patients: case reports

BackgroundAcute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial.Case presentationA new surgical approach which entails “stepwise external wrapping (SEW)” using a zero-porosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done.ConclusionsOur SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words).

Mortality Predictors in the Surgical Treatment of Active Infective Endocarditis.

IntroductionActive infective endocarditis is associated with high morbidity and mortality. Surgery is indicated in high-risk conditions, and the main determinants of mortality in surgical treatment should be evaluated.ObjectiveTo identify mortality predictors in the surgical treatment of active infective endocarditis in a long-term follow-up.MethodsThis prospective observational study involved 88 consecutive patients diagnosed with active infective endocarditis, who underwent surgery between January 2005 and December 2015. Fifty-eight (65.9%) patients were male, the mean age was 50.87±16.15 years. A total of 31 (35.2%) patients had a history of rheumatic fever; 48 (54.5%) had had heart surgery with prosthetic valve implantation; 45 (93.8%) had biological prosthetic valve endocarditis and 3 (6.3%) mechanical prosthetic valve; 40 (45.5%) patients had the disease in their native valve. The mean EuroSCORE II was 8.9±6.5%, and the main surgical indication was refractory heart failure in 38 (43.2%) patients. A total of 68 bioprosthesis (36 aortic, 32 mitral) and 29 mechanical prostheses (12 aortic, 17 mitral) were implanted and three mitral valve plasties performed. A total of 25 (28.4%) patients underwent double or triple valve procedures. Aortic annulus reconstruction by abscess was performed in 18 (20.5%) and six (6.81%) patients had combined procedure. The mean surgery time was 359±97.6 minutes.ResultsThe overall survival in up to a 10-year follow-up period was 79.5%. In the univariate analysis, the main mortality predictors were positive blood cultures (P=0.003), presence of typical microorganisms (P=0.008), most frequently Streptococcus viridans (12 cases; 25%); C-reactive protein (hazard ratio [HR] 1.034, 95% confidence interval [CI] 1.000 to 1.070, P=0.04); creatinine clearance (HR 0.977, 95% CI 0.962 to 0.993, P=0.005); length of surgery: every five minutes multiplies the chance of death 1.005-fold (HR 1.005, 95% CI 1.001 to 1.009, P=0.0307); age (HR 1.060, 95% CI 1.026 to 1.096, P=0.001); and EuroSCORE II (HR 1.089, 95% CI 1.030 to 1.151, P=0.003).ConclusionA positive blood culture with typical microorganism, C-reactive protein, age, EuroSCORE II, total surgical time and the presence of postoperative complications were the major predictors of mortality and significantly impacted survival in up to a 10-year follow-up period.

Mo1625 Outcomes and Predictors of Mortality in Surgical Treatment for Clostridium difficile Colitis in a High Volume Center

Mo1625 Outcomes and Predictors of Mortality in Surgical Treatment for Clostridium difficile Colitis in a High Volume Center

Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China

To establish a systematic registry of aortic dissection in China, assess the clinical features of Chinese patients with acute aortic dissection (AAD), and compare our results with the data published by the International Registry of Acute Aortic Dissection (IRAD). We established the first Registry of Aortic Dissection in China (Sino-RAD) in 2011. Then we evaluated 1003 patients with AAD in Sino-RAD and compared our results with those reported by IRAD. Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger. Also, the ratio of male patients in Sino-RAD was significantly greater for the total cohort and the type A and B cohorts. The overall in-hospital mortality was 10.3% in Sino-RAD. For type A dissection, more patients in Sino-RAD received medical treatment and fewer received surgical treatment. The overall mortality, mortality of medical treatment, and mortality of surgical treatment was lower in Sino-RAD. In type B dissection, fewer patients in Sino-RAD received medical and surgical treatment and more received endovascular treatment. The first Sino-RAD, including 15 large cardiovascular centers throughout China, was established. Our data were compared with those reported by IRAD. We found that, compared with Western populations, Chinese patients with AAD showed 6 differences, including earlier onset, more male patients, a low incidence of hypertension, a low incidence of chest pain, a high incidence of back pain, great differences in the choice of therapeutic strategies, and relatively low in-hospital mortality.

Comparison of In-hospital Morbidity and Mortality Rates Between Anterior and Nonanterior Approach Procedures for Thoracic Disc Herniation

Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample. To compare in-hospital morbidity and mortality rates between anterior and nonanterior approach procedures for thoracic disc herniation at national level. Surgical treatment for thoracic disc herniation can be largely divided into anterior and nonanterior approach procedures. An anterior approach necessitates invasion of the thoracic cavity, which may subject the patient to increased risk of certain complications. Large sample studies comparing anterior and nonanterior procedures in terms of morbidity and mortality are lacking. The Nationwide Inpatient Sample was used to identify patients who underwent surgical treatment for thoracic disc herniation from 2000 to 2009 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes. Patients were then divided into those who underwent anterior approach procedures and those who received nonanterior approach procedures using the appropriate ICD-9 codes. Patient- and health care system-related demographic data were retrieved and analyzed. There were 25,413 patients included in this study. Anterior approach procedures were associated with a significantly higher overall in-hospital complication rate (26.8% vs. 9.6%) and mortality rate (0.7% vs. 0.2%), as well as a longer hospital stay (7.6 vs. 4.8 d) and increased hospital charges ($84,199 vs. $46,837) compared with nonanterior approach procedures. Risk factors for mortality in surgical treatment for thoracic disc herniation included age 85 years or more, female sex, and the presence of complications (respiratory, cardiac, and urinary and renal). Anterior approach procedures for thoracic disc herniation were associated with increased in-hospital morbidity and mortality rates, as well as increased health care burden, compared with nonanterior approach procedures. If thoracic disc herniation can be adequately excised by either approach, a nonanterior approach procedure may be a better option.

Evaluation of the POSSUM, P-POSSUM and E-PASS scores in the surgical treatment of hilar cholangiocarcinoma.

BackgroundThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model, its Portsmouth (P-POSSUM) modification and the Estimation of physiologic ability and surgical stress (E-PASS) are three surgical risk scoring systems used extensively to predict postoperative morbidity and mortality in general surgery. The aim was to undertake the first study of the predictive value of these models in patients undergoing surgical treatment of hilar cholangiocarcinoma.MethodsA retrospective analysis was performed on data collected prospectively over a 10-year interval from January 2003 to December 2012. The morbidity and mortality risks were calculated using the POSSUM, P-POSSUM and E-PASS equations.ResultsOne hundred patients underwent surgical treatment of hilar cholangiocarcinoma. Complications were seen in 52 of 100 patients (52.0%). There were 10 postoperative in-hospital deaths (10.0%). Of 31 preoperative and intraoperative variables studied, operative type (P = 0.000), preoperative serum albumin (P = 0.003) and aspartate aminotransferase (P = 0.029) were found to be factors multivariate associated with postoperative complications. Intraoperative blood loss (P = 0.015), Bismuth-Corlette classification (P = 0.033) and preoperative hemoglobin (P = 0.041) were independent factors multivariate associated with in-hospital death. The POSSUM system predicted morbidity risk effectively with no significant lack of fit (P = 0.488) and an area under the ROC curve (AUC) of 0.843. POSSUM, P-POSSUM and E-PASS scores showed no significant lack of fit in calculating the mortality risk (P >0.05) and all yielded an AUC value exceeding 0.8. POSSUM had significantly more accuracy in predicting morbidity after major and major plus operations (O:E (observed/expected) ratio 0.98 and AUC 0.901) than after minor and moderate operations (O:E ratio 1.13 and AUC 0.759).ConclusionsPOSSUM, P-POSSUM and E-PASS scores effectively predict morbidity and mortality in surgical treatment of hilar cholangiocarcinoma. However, improvements are still needed in the future because none of these scoring systems yielded an AUC value exceeding 0.9 for operations with all different levels of severity. Only POSSUM had more accuracy in predicting postoperative morbidity after operations with higher severity.Trial registrationThis study was undertaken after obtaining approval from the ethics committee of School of Medicine, Shanghai Jiao Tong University with a trial registration number of http://09411960800.

Influência da inversão do diâmetro veia porta/veia esplênica nos resultados do tratamento cirúrgico da hipertensão portal esquistossomótica

To evaluate the morbidity and mortality in surgical treatment of schistosomal portal hypertension in patients with inversion of the Portal/Splenic Vein diameter ratio. We conducted a retrospective cross-sectional study of patients undergoing surgical treatment of portal hypertension in the period between September 1993 and January 2004. The study population was divided into two groups: a) Inversion--splenic vein diameter greater than or equal to portal vein's--and b) control group (portal vein diameter greater than the splenic vein's). Statistical comparisons used the Student t test for averages difference, chi-square test for proportions difference and Fisher's exact test for small samples. 169 patients were analyzed, with follow-up averaging 23.6 months. Twenty-one patients (12.4%) had splenic vein caliber greater of equal than the portal vein's (Inversion--study group). The mean preoperative diameter of the portal and splenic veins were respectively 1.49 and 1.14 cm in the control group, and 0.98 versus 1.07 cm in the inversion group. The portal vein diameter was significantly higher in the control group when compared to the inversion group (p <0.05). Varices in the gastric fundus were found in 33.3% of the inversion group and in 38.5% of patients in the control group. Postoperative rebleeding occurred in 23.1% of patients in the inversion group and in 13.4% of the control group ones (p > 0.05). In the postoperative evaluation with Doppler ultrasonography of portal vessels, no cases of portal vein thrombosis were observed in the inversion group, whilst in the control group portal thrombosis was identified in 16.9% of the patients (p <0.05). Death occurred in one (4.8%) individual from the inversion group; mortality was 4.1% in the control group (p>0.05). The mean serum level of platelets was significantly lower (65,950/mm²) in the inversion group than in the controls (106,647/mm²) (p<0.05). The results suggest that the reversal of portal/splenic vein caliber ratio does not represent a contraindication to surgical treatment of schistosomal portal hypertension.

Endovascular Treatment of Unruptured Vertebro-basilar Aneurysms

We reviewed 201 unruptured vertebro-basilar aneurysms encountered at our institute and 35 affiliated hospitals over the past 8 years. Of these, 106 aneurysms in 103 patients were treated with surgical or endovascular approaches: 43 aneurysms, surgically with clipping or wrapping; and 63 endovascularly with embolization. Outcome was excellent or good in 87 patients (84.5%). Among 24 patients with 36 complications, 16 had unfavorable outcomes including five deaths. Twelve patients (27.9%) with surgical treatment and two (3.3%) with endovascular treatment had unfavorable results because of treatment-related complications. Two patients with surgical treatment had complications related to perioperative management. Vascular occlusive complications were likeliest to occur in surgically treated basilar artery aneurysms (41%). Among surgically treated aneurysms the vertebral artery site was relatively associated with cranial nerve injuries. Complications numbered 36, occurring in 24 patients and 54% of complications affected outcome. Overall morbidity and mortality of surgical treatment were 18.6% and 7.0%, respectively, while those of endovascular treatment were 5.0% and 3.3%. In conclusion, complications of surgery tend to be serious and affect outcome, and endovascular treatment is safer than surgical for vertebro-basilar aneurysms. Embolizations are particularly advantageous for patients who are poor surgical risks.

Risk factors for early and late mortality in surgical treatment of coronary artery disease

A total of 1025 patients who had coronary bypass surgery at the Surgical Department A, Rikshospitalet, Oslo, between 1982 and 1986, were analysed for factors associated with early mortality and long-term survival. The cumulative follow-up time accounted for 6553 patient-years; the median follow-up was 6.45 years and ranged from the day of admission to 10 years. In total, 31 patients (3%) died within 30 days of surgery. Some 30 possible risk factors were analysed. Univariate analysis followed by a multivariate analysis defined six independent risk factors for early mortality. These were lack of sinus rhythm, previous heart surgery, mitral regurgitation, left main stem stenosis, unstable angina, and an elevated left ventricular end-diastolic pressure. Estimation of attributable risk showed that these factors could identify all patients who died early. Independent risk factors for late death were: lack of sinus rhythm, resection of a left ventricular aneurysm, left main stem stenosis. New York Heart Association (NYHA) class IV on admission, an elevated end-diastolic pressure, and prolonged cross-clamping time. The attributable risk analysis showed that independent risk factors for total mortality explained only about half of the patients who died. This appeared to be because of the competing effect of non-cardiac mortality. Results of the study show that risk factors for early mortality are good indicators for the outcome of coronary artery bypass surgery, identifying all deaths, whereas long-term mortality cannot be predicted. Stratification of independent risk factors allows a better comparison of mortality in different centres, and also better quality control of bypass surgery.

Chylous Reflux Syndrome Involving the Pericardium and Lung

A ten-year-old boy with symptom-free pulmonary interstitial edema and pericardial effusion was found to have a chylous reflux syndrome involving the pericardium and lung. Evidence suggests that unlike patients with isolated primary chylopericardium in whom pericardial window and/or ligation of the thoracic duct is curative, those with chylous reflux should be managed medically since the morbidity and mortality of surgical treatment is high in this syndrome.

Late second cancers of the cervix after apparently successful initial radiation therapy.

LATE SECOND CANCERS OF THE CERVIX AFTER APPARENTLY SUCCESSFUL INITIAL RADIATION THERAPYJOSEPH R. BARRIE, M.D. and ALEXANDER BRUNSCHWIG, M.D.Audio Available | Share

Coarctation of the aorta in older patients.

Coarctation of the aorta has received increasing clinical attention since its surgical treatment has become possible (Crafoord and Nylin, 1945; Gross and Hufnagel, 1945). The diagnosis generally offers no difficulty, but the question as to whether and when a patient with this condition should be submitted to operation is not always readily answered. In this connexion it is important to know the expectation of life in a case of coarctation of the aorta not submitted to an operation; the mortality of surgical treatment in these cases; and the results obtained by resection of the stenosis. As early as 1928, investigations made by Hamilton and Abbott showed that the average age of untreated patients was 33.5 years, and Reifenstein, Levine, and Gross (1947) found an average of 35 years in 104 post-mortem cases. Since the mortality of the operation in uncomplicated cases in the favourable age group has become low, the general opinion is that patients in whom coarctation has been diagnosed should be considered for surgical treatment. Some maintain, however, that no operation must be resorted to in patients over 25 years of age who are asymptomatic. In 1948, Newman reported on the results of his investigations in 23 older patients with coarctation of the aorta. Three had been soldiers during the first world war. Of these three, one died at the age of 68. This led the author to the conclusion that the prognosis of coarctation of the aorta in older subjects is not so unfavourable if the condition does not give rise to symptoms before the age of 25, but it should be pointed out that Newman's series is too small to sustain his conclusion. Bramwell (1947) also believed that the expectation of life in patients with coarctation of the aorta was good if the condition caused no symptoms before the thirtieth year of life. Gross (1953) maintained that the operation should preferably not be performed in patients over 25 years of age because, in these patients, the aorta often already shows such changes as increase the risk entailed by a vascular suture. Groves and Effler (1960) reported on three surgical patients more than 45 years of age. Two of these died, one as a result of mycotic aneurysm and the other because of encephalomalacia of the right cerebral hemisphere. The authors believed that the cause should be found in the inadequate oxygen supply to the markedly arteriosclerotic cerebrum as a result of the decrease in blood pressure in the upper half of the body after the operation. They believed that no rules should be set up regarding an age limit; each case should be individually evaluated. We, too, were reserved in determining surgical indications in older patients with asymptomatic coarctation of the aorta. The case histories of the following patients show, however, that coarctation of the aorta can cause vitally dangerous complications even if it causes no symptoms or does so only at a more advanced age.

Borras, P. E.: Morbidity and Mortality in Surgical Treatment of Uterine Tumors: An. Catedra de clin. ginec. 2: 90–96, 1943.

Borras, P. E.: Morbidity and Mortality in Surgical Treatment of Uterine Tumors: An. Catedra de clin. ginec. 2: 90–96, 1943.