ABSTRACT
Patients who undergo abdominal surgery present along a variable spectrum of health. This ranges from the healthy young patient undergoing elective hemorrhoid surgery to the octogenarian in unstable health with multiple comorbidities. Regardless of a patient's current state of health, a preoperative assessment is crucial in planning the operative approach and in recognizing the possible postoperative complications for the implementation of a proper intervention if necessary. A broad evaluation of the patient includes identifying conditions that may predispose the patient to risks and the complications not directly related to the surgical procedure. The purpose of this article is to review the preoperative assessment in patients undergoing simple to complex procedures. The article provides general guidelines for the preoperative workup, which should be individualized for each patient, and the planned procedure, with the goal of reducing the postoperative complications. Risk stratification depends on a patient's condition and the extension of the planned surgical approach. It may also help to improve the postoperative outcome. A further preoperative workup should be individualized and tailored to the complexity of each case.
Subject(s)
Abdomen/surgery , Postoperative Complications/prevention & control , Preoperative Care/methods , APACHE , Adrenergic beta-Antagonists/therapeutic use , Heart Function Tests , Humans , Morbidity , Myocardial Reperfusion , Radiography, Thoracic , Respiratory Function Tests , Risk Assessment , Surgical Procedures, Operative/methodsABSTRACT
Chronic leg ulcers are a major cause of mortality and morbidity. The efficacy of hyperbaric oxygen treatment is being evaluated in the management of nonhealing leg ulcers to improve skin graft survival. Twenty-seven patients with 36 chronic leg ulcers were examined. Each wound received 12 preoperative hyperbaric oxygen treatments, split-thickness skin grafting, followed by 12 postoperative hyperbaric oxygen treatments. Wound transcutaneous oxygen tension measurements (TCOM) were taken. The graft take was evaluated. At 18 months follow-up, 18 skin grafts (50%) showed complete take, 15 (41.7%) demonstrated partial take, and 3 (8.3%) failed. Hyperbaric oxygen treatment is an effective adjunct in the management of chronic leg ulcers, and its use resulted in increased graft take and survival.