Analysis of Cause for Cancellation of Elective Operation / 대한마취과학회지

BACKGROUND: Cancellations of elective operations are due to various reasons, which can be categorized into those initiated by patients or their guardians and those initiated by hospital staff. Cancellations of elective operations result not only in time and economic loss but also in negative psychological effects for patients and guardians and operational inefficiency for hospitals among other problems. As such, by studying and analyzing the causes of such cancellations, one may categorize them into involuntary ones and preventable ones, with the aim to reduce the occurrence of the latter that will lead to reduction in cancellation of elective operations. METHODS: 11,082 cases of elective operation were reviewed and analyzed retrospectively from January 2002 to December 2006. Total number, department, anesthetic type and cause of cancellation were recorded daily. Emergency operation and operation under local anesthesia were excluded. RESULTS: Total number of cancellation was 762 cases and mean cancellation rate was 6.9%. The most common cause of cancellation was co-existing disease or abnormal laboratory finding (25.3%). Especially in urology the most common cause of cancellation was the relief from diseases or symptoms. Plastic surgery showed the highest cancellation rate among all at 12%. CONCLUSIONS: Setting up standards that help determine the driving factors behind cancellations of elective operations within anesthesiology departments and utilizing a patient evaluation system, after categorizing the causes of cancellations into involuntary and preventable ones and analyzing them, will lead to reduction in cancellation of operations and solve problems faced by patients and guardians, and hospitals and their staff.

The Gamma Intramedullary Nailing for Peritrochanteric Fractures / 대한정형외과학회잡지

This study consisted of 66 peritrochanteric fractures which were treated by the modified Gamma nail (Asian Pacific nail) from August 1993 to October 1995. Sixty-one intertrochanteric fractures and five subtrochanteric fractures were treated in our institution. Average length of follow-up was 15.0 months. Four patients died during follow-up. The results were as follows; Lag screws were ideally introduced in 55 (83%) cases. The mean length in lag screw sliding was 4.3 mm in stable trochanteric fractures and 5.7 mm in unstable ones. Fifty-one out of 62 patients (82%) were returned to their previous ambulatory status. Intraoperative complications were as follows; distal crack (3 cases); rotation of femoral head (2 cases); entry point crack (I case); medialization of proximal fragment (7 cases); and missing of the interlocking screw (1 case). All of these complications did not affect the outcome. All medial cortical gaps were closed after sliding of lag screws. Three distal cracks did not propagate to the shaft. Postoperative complications were a case of superior cut-out, and two second fractures after falls. Callus formed more early in the stable trochanteric fractures (5+/-2.1 weeks) than unstable fractures (7.3+/-2.1 weeks). It was statistically significant. Union time between stable and unstable trochanteric fractures was not statistically significant. In conclusion, the Asian Pacific (AP) nail could appropriately fix the osteoporotic peritrochanteric fractures in elderly patient. It could offer early rehabilitation to these patients and decrease the mortality and morbidity.

Osteoid Osteoma in Intertrochanteric Cancellous Portion of the Femur in Adult: a case report / 대한정형외과학회잡지

Osteoid Osteoma occurs anywhere in skeleton. They are most common in lower extremity, particularly femur about 40%. Two-thirds of femoral lesions is in the intertrochanter or intracapsular regions of the hip. The lesion is usually cortical and may extend into the periosteal or endosteal surface of the bone. It is rare in the cancellous bone. We experienced a case of osteoid osteoma in intertrochanteric cancellous portion of the femur in 50 year old man. Many complained right hip pain worsend three weeks before his visit. Radiograph shows sclerosis around a lucent nidus in cancellous portion. The lesion did not extend to the endosteal surface. We have removed nidus and surrounding reactive portion completely with curettage. Follow up radiographic results after 20 weeks, showed no evidence of recurrence.