Factores predictivos de reintervención en cirugía colorrectal laparoscópica / Predictive factors for reoperation after colorrectal laparoscopic surgery

Introducción: son varios los criterios que se han propuesto para determinar los factores predictivos de complicaciones en cirugía colorrectal laparoscópica. Objetivo: identificar los posibles factores predictores de reintervención después de cirugía colorrectal laparoscópica. Métodos: se revisaron las historias clínicas de los pacientes reintervenidos por complicaciones después de cirugía colorrectal laparoscópica en el Centro Nacional de Cirugía de Mínimo Acceso (CNCMA), en el período comprendido de enero de 2007 a diciembre de 2011. A través de un modelo de regresión logística, se estudió la asociación entre la reintervención y las siguientes variables independientes: edad, sexo, enfermedad de base (indicación quirúrgica), tiempo quirúrgico, tipo de anastomosis, tipo de sutura mecánica. Se consideró estadísticamente significativo un valor p < 0,05. Resultados: se reintervinieron 27 pacientes de 330 operados. La técnica quirúrgica (Dixon bajo) y el tipo de anastomosis (extracorpórea) fueron las variables que se asociaron de manera estadísticamente significativa con la presencia de reintervención en la cirugía colorrectal. Conclusiones: la técnica quirúrgica (Dixon bajo) y el tipo de anastomosis (extracorpórea) son posibles factores predictivos de reintervención en los operados de enfermedades colorrectales por vía laparoscópica(AU)

Introduction: numerous criteria have been stated in order to determine predictive factor for laparoscopic colorectal surgery. Objective: to identify possible predictive factors for reoperation after laparoscopic colorectal surgery. Methods: the medical records of re-operated patients due to complications after laparoscopic colorectal surgery at the National Center of Minimal Access Surgery were checked from January 2007 to December 2011. A logistic regression model allowed analyzing the association between reoperation and the following independent variables: age, gender, underlying disease (surgery indications), surgical time, type of anastomosis, type of mechanical suture. The statistically significant value of p< 0.05 was taken. Results:twenty seven out of 330 patients with laparoscopic colorectal surgery were re-operated. The surgical procedure (low Dixon) and type of anastomosis (extracorporeal) showed statistically significant association with reoperation after laparoscopic colorectal surgery. Conclusions: the surgical procedure (low Dixon) and type of anastomosis (extracorporeal) were possible predictive factors for re-operation after laparoscopic colorectal surgery(AU)

Surveillance & management of out-of-plan re-operations / 中华医院管理杂志

A series of surveillance and management actions was taken to minimize out-of-plan re-operations. These actions include: 1) Building and completing the surveillance and management mechanism against unplanned re-operations; 2) Building a real-time surveillance and reporting mechanism; 3) Enhancing quality control and continuous improvement at the operating departments; 4) Enhancing the supervision on regulations implementation by quality control departments of the hospital; 5) Enhancing quality control for medical records; 6) Building a feedback mechanism for surveillance results; 7) Building a penalty and reward mechanism. Efforts for one year and a half on such surveillance and management proved successful, as the incidence of out-of-plan re-operations fell from 1.7% before these actions to 1.0% afterwards.

Two Successful Proximal Reoperation Cases after Acute Type A Dissection Repair / 日本心臓血管外科学会雑誌

We report 2 cases of successful proximal reoperations after acute type A dissection. Case 1 : A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm (74 mm) and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2 : A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm (55 mm) and arch aneurysm (65 mm) with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.