Validity time of normal results of preoperative tests for surgical reintervention and the impact on postoperative outcomes / Tempo de validade dos exames pré-operatórios normais para uma reintervenção cirúrgica e o impacto nos desfechos pós-operatórios

Abstract Background and objective: There are few data defining the period of time in which preoperative tests can be considered valid. The purpose of this study was to determine the likelihood of changes in the results of preoperative tests previously normal in relation to time, and the impact of these changes on postoperative outcomes. Methods: A total of 970 patients with normal preoperative tests before the first surgery and who required a new intervention were included. The preoperative tests performed for the first procedure were compared with those performed for the second procedure. The following variables were assessed regarding their potential to induce changes in test results: sex, age, surgical risk, previous chemotherapy or radiotherapy, and presence of comorbidities. In-hospital outcomes were analyzed. Results: The median time between procedures was 27 months (6-84). The probability of change in at least one of the preoperative exams was 1.7% (95% CI: 0.5-2.9), 3.6% (95% CI: 1.8-5.4), and 6.4% (95% CI: 3.9-8.9) during the 12, 24, and 36-month intervals, respectively, for patients aged <50 years and 2.1% (95% CI: 0.7-3.5), 9.2% (95% CI: 5.9-12.5), and 13.4% (95% CI: 9.3-17.5), respectively, for patients ≥50 years of age. Age (p = 0.009), surgical risk (p < 0.001), chemotherapy (p = 0.001), radiotherapy (p = 0.012), and comorbidities (p < 0.001) were associated with the likelihood of changes in test results. Test changes were not significantly associated with in-hospital adverse outcomes (p = 0.426). Conclusion: For patients undergoing a second surgical procedure, the probability of change in previously normal preoperative tests is low during the first years after the first surgical intervention, and when changes occurred, they did not adversely affect the in-hospital postoperative outcomes.

Resumo Justificativa e objetivo: Existem poucos dados que delimitam o período de tempo em que os exames pré-operatórios podem ser considerados válidos. O objetivo deste estudo foi determinar a probabilidade de mudanças nos resultados de exames pré-operatórios previamente normais em relação ao tempo e o impacto dessas alterações nos desfechos pós-operatórios. Métodos: Foram incluídos 970 pacientes com exames pré-operatórios normais antes da primeira cirurgia e que requereram uma nova intervenção. Os exames pré-operatórios feitos para o primeiro procedimento foram comparados com aqueles feitos para o segundo procedimento. As seguintes variáveis foram analisadas em relação ao seu potencial para induzir alterações nos resultados dos exames: sexo, idade, risco cirúrgico, quimioterapia ou radioterapia prévia e presença de comorbidades. Desfechos intra-hospitalares foram analisados. Resultados: A mediana temporal entre os procedimentos foi de 27 meses (6-84). A probabilidade de alteração em pelo menos um dos exames pré-operatórios foi de 1,7% (IC 95%: 0,5-2,9), 3,6% (IC 95%: 1,8-5,4) e 6,4% (IC 95%: 3,9-8,9) nos intervalos 12, 24 e 36 meses, respectivamente, para pacientes < 50 anos e 2,1% (IC 95%: 0,7-3,5), 9,2% (IC 95%: 5,9-12,5) e 13,4% (IC 95%: 9,3-17,5), respectivamente, para pacientes ≥ 50 anos. Idade (p = 0,009), risco cirúrgico (p < 0,001), quimioterapia (p = 0,001), radioterapia (p = 0,012) e presença de comorbidades (p < 0,001) estavam associadas com a probabilidade de mudanças nos resultados dos exames. Alterações nos exames não se associaram significativamente a desfechos intra-hospitalares adversos (p = 0,426). Conclusão: Para pacientes submetidos a um segundo procedimento cirúrgico, a probabilidade de alteração nos exames pré-operatórios previamente normais é baixa durante os primeiros anos após a primeira intervenção cirúrgica e quando ocorreram mudanças não afetaram adversamente os desfechos pós-operatórios intra-hospitalares.

Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management

<p><b>INTRODUCTION</b>The purpose of this study was to compare the clinical outcomes of elderly hip fracture patients who received surgical treatment with those who received non-surgical treatment.</p><p><b>METHODS</b>This retrospective study involved 2,756 elderly patients with hip fractures who were admitted over a six-year period. The patients' biodata, complications, ambulatory status at discharge and length of hospital stay were obtained from the institution's hip fracture registry.</p><p><b>RESULTS</b>Among the 2,756 hip fracture patients, 2,029 (73.6%) underwent surgical intervention, while 727 (26.4%) opted for non-surgical intervention. The complication rate among the patients who underwent surgical intervention was 6.6%, while that among the patients who underwent non-surgical intervention was 12.5% (p < 0.01). The mean length of hospital stay for the surgical and non-surgical hip fracture patients was 15.7 days and 22.4 days, respectively (p < 0.01).</p><p><b>CONCLUSION</b>Surgical management of hip fractures among the elderly is associated with a lower complication rate, as well as a reduced length of hospital stay.</p>

Effects of Ulinastatin on Postoperative Blood Loss and Hemostasis in Atrioventricular Valve Surgery with Cardiopulmonary Bypass

BACKGROUND: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. MATERIALS AND METHODS: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. RESULTS: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. CONCLUSION: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

Effects of Ulinastatin on Postoperative Blood Loss and Hemostasis in Atrioventricular Valve Surgery with Cardiopulmonary Bypass

BACKGROUND: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. MATERIALS AND METHODS: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. RESULTS: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. CONCLUSION: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

Effect of Gender on Outcomes of Off-pump Coronary Artery Bypass Surgery / 대한마취과학회지

BACKGROUND: Although female gender is associated with higher prevalence of perioperative morbidity and mortality than male gender in conventional coronary artery bypass surgery (CABG) using cardiopulmonary bypass, the impact of gender as an independent risk factor for morbidity and mortality following off-pump CABG (OPCAB) is controversial. Therefore, we prospectively investigated the impact of gender on intraoperative variables and postoperative outcome and complications in OPCAB. METHODS: One hundred patients (69 males and 31 females) undergoing OPCAB by a single cardiac surgeon during 5 months period were prospectively enrolled. Preoperative patient's characteristics, intraoperative hemodynamics and medications and postoperative outcome and complications were recorded during hospital stay. RESULTS: There were no significant differences in preoperative characteristics including age, NYHA class and incidence of concomitant diseases between the male and female groups, except body surface area which was less in the female group. There were no significant differences in intraoperative hemodynamics and use of cardiotonic drugs between the groups. Frequency and amount of blood transfusion were greater, and length of ventilatory care and stay in intensive care unit were longer in female group. Other postoperative outcomes were similar between the groups. CONCLUSIONS: Gender did not significantly affect postoperative outcome, except use of blood products, length of ventilatory care and stay in intensive care unit in OPCAB. These results may be attributable to comparable preoperative patient's characteristics between the groups.