RESUMEN
AIMS: Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs. METHODS: The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis of five-year results and longitudinal analysis for all timepoints was performed to compare the two groups. RESULTS: Overall, 104 (80%) patients of the original 130 who received surgery were available at five years (55 robotic, 49 manual). Both procedures reported successful results over all outcomes. At five years, there were no statistical differences between the groups in any of the patient reported or clinical outcomes. There was a lower reintervention rate in the robotic arm-assisted group with 0% requiring further surgery compared with six (9%) of the manual group requiring additional surgical intervention (p < 0.001). CONCLUSION: This study has shown excellent clinical outcomes in both groups with no statistical or clinical differences in the patient-reported outcome measures. The notable difference was the lower reintervention rate at five years for roboticarm-assisted UKA when compared with a manual approach. Cite this article: Bone Joint J 2021;103-B(6):1088-1095.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Actividades Cotidianas , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Rango del Movimiento Articular , Recuperación de la Función , Reoperación/estadística & datos numéricosRESUMEN
BACKGROUND: We hypothesized that time of day of surgery would influence the incidence of anesthetic adverse events (AEs). METHODS: Clinical observations reported in a quality improvement database were categorized into different AEs that reflected (1) error, (2) harm, and (3) other AEs (error or harm could not be determined) and were analyzed for effects related to start hour of care. RESULTS: As expected, there were differences in the rate of AEs depending on start hour of care. Compared with a reference start hour of 7 am, other AEs were more frequent for cases starting during the 3 pm and 4 pm hours (p < 0.0001). Post hoc inspection of data revealed that the predicted probability increased from a low of 1.0% at 9 am to a high of 4.2% at 4 pm. The two most common event types (pain management and postoperative nausea and vomiting) may be primary determinants of these effects. CONCLUSIONS: Our results indicate that clinical outcomes may be different for patients anesthetized at the end of the work day compared with the beginning of the day. Although this may result from patient related factors, medical care delivery factors such as case load, fatigue, and care transitions may also be influencing the rate of anesthetic AEs for cases that start in the late afternoon.
Asunto(s)
Anestesiología/normas , Auditoría Médica/métodos , Errores de Medicación/estadística & datos numéricos , Quirófanos/normas , Gestión de Riesgos/métodos , Tolerancia al Trabajo Programado , Anestesiología/estadística & datos numéricos , Citas y Horarios , Fatiga , Femenino , Hospitales Universitarios/normas , Humanos , Masculino , Errores de Medicación/clasificación , North Carolina , Observación , Quirófanos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Náusea y Vómito Posoperatorios/epidemiología , Modelos de Riesgos Proporcionales , Vigilancia de Guardia , Factores de TiempoRESUMEN
Failure to suppress thrombin generation during cardiac surgery promotes fibrin generation, fibrinolysis, and a consumptive coagulopathy. Acquired deficiencies of antithrombin III may play a contributory role. We hypothesized that antithrombin III supplementation to normal physiologic concentrations would decrease thrombin generation and potentially reduce peri-operative bleeding. Twenty patients undergoing coronary artery bypass graft surgery were randomized for this prospective, double-blind, placebo-controlled study. Ten patients received antithrombin III supplementation (50 U/kg) by intravenous infusion prior to incision, and 10 patients received a placebo. Blood samples were obtained pre-operatively, at 1 and 2 h following initiation of cardiopulmonary bypass (CPB), and at 1, 3, and 24 h after completion of CPB. Samples were analyzed for antithrombin III, thrombin-antithrombin III (TAT) complex, and D-dimer concentrations. Cumulative blood loss was recorded at 6 and 12 h after CPB. No statistically significant differences in patient demographics or total heparin dose administered were observed between groups. As expected, plasma antithrombin III concentrations were maintained near pre-operative values in the treatment group, but not in the placebo group. Despite this difference, no statistically significant alterations in generation of TAT complex, D-dimer, or blood loss occurred between groups. Antithrombin III supplementation to maintain normal physiologic concentrations during CPB did not alter significantly thrombin generation, fibrinolytic activity, or blood loss in adults undergoing elective cardiac surgery.
Asunto(s)
Antitrombina III/administración & dosificación , Procedimientos Quirúrgicos Cardíacos , Hemostasis/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Antitrombina III/farmacología , Pérdida de Sangre Quirúrgica/prevención & control , Método Doble Ciego , Hemostáticos/antagonistas & inhibidores , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Prospectivos , Inhibidores de Serina Proteinasa/administración & dosificación , Inhibidores de Serina Proteinasa/farmacología , Trombina/antagonistas & inhibidores , Trombina/biosíntesisRESUMEN
Carcinoma of the esophagus is a highly lethal disease in which surgical resection is part of every treatment regimen carried out with curative intent. The development of surgical resection of the esophagus for carcinoma has been a long and tortuous one. Its evolution depended not only on a thorough knowledge of surgical anatomy and technique, but also on important developments in endoscopy, radiology, anesthesia, nutrition, pulmonary physiology, and intensive care.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/historia , Neoplasias Esofágicas/historia , Neoplasias Esofágicas/cirugía , Esofagectomía/historia , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , HumanosAsunto(s)
Ecocardiografía Transesofágica/instrumentación , Ecocardiografía Transesofágica/métodos , Cuidados Intraoperatorios , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodos , Anestesiología , Aorta/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Válvulas Cardíacas/diagnóstico por imagen , Humanos , Venas Pulmonares/diagnóstico por imagen , Radiología , SeguridadAsunto(s)
Ecocardiografía Transesofágica , Cuidados Intraoperatorios , Ultrasonografía Intervencional , Anestesiología , Aorta/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía Transesofágica/instrumentación , Ecocardiografía Transesofágica/métodos , Atrios Cardíacos/diagnóstico por imagen , Tabiques Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Radiología , Seguridad , Válvula Tricúspide/diagnóstico por imagen , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodosAsunto(s)
Artroplastia de Reemplazo de Cadera , Embolia Grasa , Complicaciones Posoperatorias , Embolia Pulmonar , Anciano , Embolia Grasa/patología , Resultado Fatal , Humanos , Pulmón/patología , Masculino , Bloqueo Nervioso , Complicaciones Posoperatorias/patología , Periodo Posoperatorio , Embolia Pulmonar/patologíaAsunto(s)
Enfermedades Pulmonares Obstructivas/cirugía , Neumonectomía , Anestesia General , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Disnea/cirugía , Tolerancia al Ejercicio , Volumen Espiratorio Forzado/fisiología , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Costos de la Atención en Salud , Humanos , Pulmón/fisiopatología , Pulmón/cirugía , Enfermedades Pulmonares Obstructivas/diagnóstico por imagen , Enfermedades Pulmonares Obstructivas/fisiopatología , Trasplante de Pulmón , Selección de Paciente , Neumonectomía/efectos adversos , Neumonectomía/economía , Neumonectomía/métodos , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Pronóstico , Enfisema Pulmonar/diagnóstico por imagen , Enfisema Pulmonar/fisiopatología , Enfisema Pulmonar/cirugía , Calidad de Vida , Radiografía , Mecánica Respiratoria/fisiología , Tasa de SupervivenciaRESUMEN
STUDY OBJECTIVES: To determine the usefulness of radioaerosol ventilation scans for the detection and localization of air leaks from the lungs or bronchial tree. DESIGN: Selected patients with suspected air leaks underwent ventilation scans. Retrospective analysis of data was carried out. SETTING AND PATIENTS: Twenty-eight hospitalized patients were included in the study. INTERVENTIONS: Ventilation scintigraphy using 99mTc-DTPA (technetium aerosol) was carried out in patients with air leaks. MEASUREMENTS AND RESULTS: Of the total group, there were 50% true-positive scans, 36% true-negative scans, and 14% false-negative scans giving a sensitivity of 78%, specificity of 100%, and accuracy of 86%. CONCLUSIONS: 99mTc-DTPA ventilation scintigraphy is useful in some patients with air leaks from the lung or tracheobronchial tree and may help to guide surgical intervention should this become necessary.
Asunto(s)
Fístula Bronquial/diagnóstico por imagen , Fístula/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Pentetato de Tecnecio Tc 99m , Humanos , Cintigrafía , Estudios Retrospectivos , Sensibilidad y EspecificidadAsunto(s)
Educación Médica/economía , Sistemas Multiinstitucionales/organización & administración , Investigación/economía , Centros Médicos Académicos/organización & administración , Hospitales con Fines de Lucro/organización & administración , Sistemas Multiinstitucionales/economía , Política Organizacional , Estados UnidosRESUMEN
The first case of prosthetic valve thrombosis treated with an accelerated regimen of TPA is reported. The experience suggests that this therapeutic approach is feasible and may produce higher rates of patency for thrombosed prosthetic valves than other thrombolytic therapies currently available. This therapeutic strategy is worthy of further evaluation as a treatment for this disorder.
Asunto(s)
Trombosis/tratamiento farmacológico , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Masculino , Válvula MitralRESUMEN
Lung cancer is the leading cause of cancer death in both men and women in the United States. Although lung cancer has been treated aggressively by surgery, radiation therapy, and chemotherapy, alone or in combination, survival is still in the 12% to 15% range at 5 years. All curative treatment plans for patients with non-small cell lung cancer include resectional surgery. Despite the dismal outlook there is hope, because improvements in outcome for patients undergoing surgical treatment have been realized. Definite progress has been made in reducing operative mortality and morbidity, helping to increase long-term survival. Advances that have contributed to these successes include improved preoperative evaluation in staging and patient selection criteria, the use of newer techniques such as video-assisted or open limited resections in selected instances, and the use of neoadjuvant therapy. These topics are addressed here, as are techniques for locally advanced tumors and options for palliation.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Causas de Muerte , Terapia Combinada , Endoscopía , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Masculino , Estadificación de Neoplasias , Cuidados Paliativos , Selección de Paciente , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Tasa de Supervivencia , Resultado del Tratamiento , Grabación en VideoAsunto(s)
Adenocarcinoma Papilar/diagnóstico , Obstrucción de las Vías Aéreas/diagnóstico , Flujo Espiratorio Forzado/fisiología , Neoplasias de la Tráquea/diagnóstico , Adenocarcinoma Papilar/fisiopatología , Adenocarcinoma Papilar/cirugía , Obstrucción de las Vías Aéreas/fisiopatología , Obstrucción de las Vías Aéreas/cirugía , Asma/fisiopatología , Broncoscopía , Diagnóstico Diferencial , Femenino , Humanos , Terapia por Láser , Persona de Mediana Edad , Tráquea/fisiopatología , Tráquea/cirugía , Neoplasias de la Tráquea/fisiopatología , Neoplasias de la Tráquea/cirugíaRESUMEN
A prospective analysis of placement of left-sided plastic double-lumen tubes in 100 patients is presented. Intubation of the left bronchus was successfully accomplished using only auscultation and clinical signs ("blind" placement) in 91 patients. Double-lumen tubes were positioned in less than five minutes in 84 patients. The most common problem encountered (30%) was initial intubation of the right main bronchus. Seven of these patients required bronchoscopic assistance to guide the tube into the left bronchus. There were four minor intraoperative complications due to DLT malposition that were recognized and corrected by withdrawing the tube slightly back in the bronchus. The plastic double-lumen tubes functioned properly during the procedure in all 100 patients.
Asunto(s)
Bronquios , Intubación/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plásticos , Estudios Prospectivos , Cirugía TorácicaRESUMEN
OBJECTIVE: To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine. DESIGN: A randomized, prospective, double-blind study. SETTING: A university-affiliated medical center. PARTICIPANTS: Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy. INTERVENTION: Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period. MEASUREMENTS AND MAIN RESULTS: Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia. CONCLUSION: Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.