ABSTRACT
ANTECEDENTES Y OBJETIVOS: La evidencia y las pautas para el uso de intervenciones específicas después de la liberación del túnel carpiano son limitadas. El objetivo principal de este estudio fue determinar los diferentes enfoques terapéuticos empleados en la práctica clínica habitual entre los profesionales de diferentes países tras la liberación del nervio mediano en la muñeca. MATERIAL Y MÉTODOS: Se diseñó una encuesta de 15 ítems en lengua inglesa, que fue distribuida por correo electrónico y a través de las redes sociales a profesionales de diferentes países. RESULTADOS: En nuestro estudio identificamos una gran variedad en el abordaje posquirúrgico del síndrome del túnel del carpo en 23 países diferentes. DISCUSIÓN Y CONCLUSIONES: No hay criterios comunes en las técnicas de tratamiento empleadas tras la liberación del nervio mediano en la muñeca
BACKGROUND AND OBJECTIVES: Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. MATERIAL AND METHODS: A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. RESULTS: In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. DISCUSSION AND CONCLUSIONS: There are no common criteria in the techniques used after surgical decompression of the median nerve
Subject(s)
Humans , Carpal Tunnel Syndrome/therapy , Postoperative Care/classification , Cross-Sectional Studies , Surveys and Questionnaires , Postoperative Period , Patient Education as TopicABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Spain , Vascular Diseases/metabolism , Heart Failure/congenital , Anemia/pathology , Postoperative Care/methods , Anemia/classification , Anemia/complications , Postoperative Care/classification , Postoperative Care , Vascular Diseases/diagnosis , Heart Failure/genetics , Anemia/blood , Postoperative Care/standardsABSTRACT
Liver transplantation has become an effective and valuable option for patients with end-stage liver disease and hepatocellular carcinoma. Liver failure, an acute or chronic condition, results in impaired bile production and excretion, clotting factor production, protein synthesis, and regulation of metabolism and glucose. Some acute conditions of liver disease have the potential to recover if the liver heals on its own. However, chronic conditions, such as cirrhosis, often lead to irreversible disease and require liver transplantation. In this publication, we review the pathophysiology of liver failure, examine common conditions that ultimately lead to liver transplantation, and discuss the postoperative management of patients who are either hemodynamically stable (type A) or unstable (type B).
Subject(s)
Liver Failure/physiopathology , Liver Transplantation , Postoperative Care/classification , Postoperative Complications , Chronic Disease , Humans , Immunosuppression Therapy , Liver Transplantation/methods , Postoperative Care/methodsABSTRACT
AIM: There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to evaluate whether costs saved by reduced postoperative resource utilisation would offset the financial burden of setting up and maintaining such an ERAS programme. METHODS: A cost-effectiveness analysis from a healthcare provider perspective using a case-control model. The study group consisted of patients enrolled in the ERAS program for elective colonic surgery at Manukau Surgical Centre between December 2005 and March 2007. The control group consisted of consecutive patients from September 2004 to September 2005 (before the start of ERAS). Groups were matched with respect to operation, BMI, ASA, and Cr-POSSUM score. RESULTS: Data were available for 50 patients in each group. There was a significant reduction in total hospital stay, intravenous fluid use, and duration of epidural use in the ERAS group. There were significantly fewer complications in the ERAS group. Implementation of ERAS cost approximately $NZ102,000, but this has been more than offset by costs saved in reduced postoperative resource utilisation, with an overall cost-saving of approximately NZ$6900 per patient. CONCLUSION: Implementing an ERAS program is cost-effective in the medium term, with costs offset by those recovered by reduced resource utilisation in the postoperative period.
Subject(s)
Colectomy/economics , Colonic Diseases/surgery , Elective Surgical Procedures/economics , Postoperative Care/economics , Postoperative Care/statistics & numerical data , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cost-Benefit Analysis , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Models, Economic , New Zealand , Postoperative Care/classification , Program EvaluationABSTRACT
INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support.
Subject(s)
Extracorporeal Circulation/adverse effects , Hospital Mortality , Myocardial Revascularization/adverse effects , Postoperative Care/adverse effects , Preoperative Care/adverse effects , Aged, 80 and over , Combined Modality Therapy , Diabetes Complications , Endocarditis/complications , Epidemiologic Methods , Female , Humans , Male , Myocardial Revascularization/mortality , Postoperative Care/classification , Preoperative Care/classification , Shock, Cardiogenic/complicationsSubject(s)
Cardiac Surgical Procedures/methods , Early Ambulation/methods , Extracorporeal Circulation/methods , Length of Stay/trends , Postoperative Care/methods , Asia , Canada , Early Ambulation/classification , Early Ambulation/standards , Europe , Hospitals , Humans , Intubation, Intratracheal , Length of Stay/statistics & numerical data , Postoperative Care/classification , Postoperative Care/standards , South America , Terminology as Topic , United StatesABSTRACT
INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5 percent. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45 percent. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, ...
Subject(s)
Aged, 80 and over , Female , Humans , Male , Extracorporeal Circulation/adverse effects , Hospital Mortality , Myocardial Revascularization/adverse effects , Postoperative Care/adverse effects , Preoperative Care/adverse effects , Combined Modality Therapy , Diabetes Complications , Epidemiologic Methods , Endocarditis/complications , Myocardial Revascularization/mortality , Postoperative Care/classification , Preoperative Care/classification , Shock, Cardiogenic/complicationsABSTRACT
BACKGROUND: Postoperative deaths and neurological injury have resulted from hyponatraemia associated with the use of hypotonic saline solutions following surgery. We aimed to determine the rates and types of intravenous fluids being prescribed postoperatively for children in the UK. METHODS: A questionnaire was sent to members of the British Association of Paediatric Surgeons (BAPS) and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) based at UK paediatric centres. Respondents were asked to prescribe postoperative fluids for scenarios involving children of different ages. The study period was between May 2006 and November 2006. RESULTS: The most frequently used solution was sodium chloride 0.45% with glucose 5% although one quarter of respondents still used sodium chloride 0.18% with glucose 4%. Isotonic fluids were used by 41% of anaesthetists and 9.8% of surgeons for the older child, but fewer for infants. Standard maintenance rates or greater were prescribed by over 80% of respondents. CONCLUSION: Most doctors said they would prescribe hypotonic fluids at volumes equal to or greater than traditional maintenance rates at the time of the survey. A survey to describe practice since publication of National Patient Safety Agency (NPSA) recommendations is required.
Subject(s)
Fluid Therapy/classification , Fluid Therapy/statistics & numerical data , Hypotonic Solutions/administration & dosage , Postoperative Care/classification , Postoperative Care/statistics & numerical data , Appendectomy , Child , Cysts/surgery , Drug Administration Schedule , Drug Dosage Calculations , Electrolytes/administration & dosage , Electrolytes/pharmacokinetics , Gastrointestinal Diseases/surgery , Glucose/administration & dosage , Health Care Surveys , Humans , Hypoglycemia/therapy , Hyponatremia/chemically induced , Hypotonic Solutions/adverse effects , Hypotonic Solutions/classification , Infant , Infant, Newborn , Infusions, Intravenous , Intussusception/surgery , Isotonic Solutions/administration & dosage , Laparotomy , Medication Errors/statistics & numerical data , Monitoring, Physiologic , Prescriptions/statistics & numerical data , Surveys and Questionnaires , United Kingdom/epidemiologyABSTRACT
Se abordan tópicos sobre las Infecciones postoperatorias, y su clasificación. Teniendo en cuenta su localización; Infección del Sitio Operatorio; el agente patógeno. Se analizan los factores que intervienen en la génesis de una infección; diagnóstico; profilaxis y tratamiento...(AU)
Topics are approached on the postoperative Infections, and their classification. Keeping in mind their localization; Infection of the Operative Place; the agent patógeno. The factors are analyzed that intervene in the genesis of an infection; diagnosis; prevention and treatment...(AU)
Subject(s)
Humans , Postoperative Care/classification , Surgical Wound Infection/diagnosis , Infection Control/methods , Surgical Wound Infection/therapyABSTRACT
La corrección quirúrgica de la escoliosis idiopática es tema de controversia, en cuanto a su efectividad en el plano transverso. La deformidad no ocurre por rotación sino por desplazamiento ventrolateral de la columna. Pensamos que con un nuevo instrumento, siguiendo la técnica de Cotrel-Dubousset y con la experiencia del Dr. Luque, en México, se logrará la corrección en todos los planos. Los pacientes tratados tenían una escoliosis idiopática operaron 8, aquí mostramos la evaluación postoperatoria de 2, siete meses después de la cirugía, donde se logró la disminución de la escoliosis costal y la medialización de las vértebras en los planos sagital, coronal y transverso, se espera que la modificación será mayor además de la ausencia de complicaciones postquirúrgicas
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Humans , Postoperative Care/classification , Scoliosis/surgery , Scoliosis/rehabilitation , Scoliosis/therapy , Traction/classification , Traction/instrumentationSubject(s)
Humans , Male , Female , Cleft Palate/surgery , Postoperative Care/classification , Postoperative Care/methods , Preoperative Care/classification , Preoperative Care/methods , Diet , Palate/surgery , Oral Surgical Procedures/classification , Oral Surgical Procedures/methods , Surgery, OralABSTRACT
OBJECTIVE: To determine the usefulness of severity of illness measures in explaining the variation in costs observed in economic analyses of clinical trials. METHOD: Hospital costs and three severity of illness measures (Medical Illness Severity Grouping System [MedisGroups], Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III) were calculated for patients undergoing surgical management of gastrointestinal malignancies. Regression models were developed to determine the predictive ability of the severity of illness measures on total costs and length of stay of surgical patients. RESULTS: There was not a significant reduction in the cost variance among patients after correcting for severity with use of the MedisGroups score. APACHE II scores were a better predictor of total costs, although this relationship did not reach statistical significance. As a continuous variable, APACHE III scores explained $326 of extra cost for each point on the scale, and as a categorical variable, identified those patients who were most expensive to care for and with long lengths of stay. CONCLUSION: Neither MedisGroups nor APACHE II were found to be useful in explaining cost variations in a clinical trial. The APACHE III system was more useful in discriminating resource intensive patients.
