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Milamed DR, Hedley-Whyte J. Contributions of the surgical sciences to a reduction of the mortality rate in the United States for the period 1968 to 1988. Ann Surg 1994; 219:94-102. [PMID: 7507658 PMCID: PMC1243096 DOI: 10.1097/00000658-199401000-00015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The authors sought to determine whether advances in the surgical sciences have led to a reduction in mortality rates for diseases treated by surgery during the past 25 years. They also wished to study changes in health care manpower for perioperative care during this period. SUMMARY BACKGROUND DATA Surgical operations requiring general anesthesia in the United States have risen to 25 million per year at an annual cost of approximately $125 billion. During the period 1968 to 1988, the number of anesthesiologists per 100,000 persons in the United States increased 98%, although the number of surgeons remained relatively constant. Between 1980 and 1989, the number of radiologists per 100,000 persons decreased to 29% below the figure for 1965. Membership in specialized nursing societies increased dramatically. METHODS The authors used vital statistics data from the National Center for Health Statistics (NCHS) to examine the mortality rates for diseases of the prostate, appendix, and gallbladder; hernia and intestinal obstruction; and ulcerative disease of the stomach and duodenum for the years 1968, 1978, and 1988. NCHS hospital discharge data were used to derive the rates of hospitalization and surgery for these conditions. Information on changes in health care manpower was obtained from published and other sources. RESULTS The mortality rates for the five diseases studied decreased from 40% to 69% between 1968 and 1978. Between 1978 and 1988, the mortality rates caused by benign prostatic hyperplasia declined an additional 54% and by appendicitis, an additional 43%. Deaths attributable to the other conditions remained relatively constant. The rates of hospitalization and surgery for these conditions varied. CONCLUSIONS Advances in surgery, anesthesiology, and information transfer and the availability of intensive care units and specialized hospital personnel have resulted in reduced mortality rates for diseases treated by surgery.
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27
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Nesterenko IA, Shovskiĭ OL. [Outcome of treatment of incarcerated hernia]. Khirurgiia (Mosk) 1993:26-30. [PMID: 8283842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Experience in surgical treatment of 632 patients for incarcerated hernias of different localization is analysed. The patients' ages ranged from 39 to 91, 448 (70.9%) patients were over 60 years of age. Inguinal and umbilical hernias were encountered most frequently--62.5%. The intestine was resected in 93 patients, 80 of them were over 60 years of age (86%). Among these patients 63 were admitted to the clinic 1 to 4 days after the incarceration had occurred. The causes of late hospitalization: through the patient's fault in 80 (24.8%) cases, due to the doctor's errors in the prehospital stage in 39 (12.1%) cases. Kerte's method for determining the viability of the incarcerated intestine is subjective to a certain measure--the surgeons made errors in 14% of cases (confirmed histologically). The mortality was 13.4%, in 85% death occurred at an age over 70 and in 74% of cases the patients were admitted 24 hours to 4 days after the incarceration. Incompetence of the sutures of the anastomosis (41%) was the main cause of death. Late hospitalization, elderly and old age, severe concomitant complications, and unwarrantably extended volume of the interventions were the main causes of unfavorable outcomes of the management of this category of patients.
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Striffeler H, Zufferey S, Schweizer W. [Quality control after introduction of a new hernia technique. Barwell transversal fascia-plasty]. HELVETICA CHIRURGICA ACTA 1993; 59:771-4. [PMID: 8376139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
From 1987 to 1991 we operated on 320 patients with 360 inguinal hernias with the recently introduced transversalis fascial repair after Barwell. The transversalis fascia is duplicated with an atraumatic looped nylon 0.43 trainees performed 70% of the operations. The follow-up was 30 months (6-62) for 317 (88%) hernias (two examiners). Over all we observed eleven (3.5%) recurrences, in 8 cases after primary operation. Two of this recurrences were initially missed femoral hernias. In the learning phase we found five early recurrences in the first 60 patients and in the following 257 patients with the same follow-up only 6 recurrences. We conclude that with the new technique of transversalis fascial repair after Barwell very good results can be achieved even with a big number of young surgeons in training.
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29
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Mütsch F, Glöckner. [Streptococcal infection after herniotomy: a rare, life-threatening complication]. Chirurg 1992; 63:842-3. [PMID: 1424981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Although the elective repair of groin hernias is advised to prevent strangulation, the likelihood of this complication occurring is unknown. To quantify this risk, the cumulative probability of strangulation in relation to the length of history has been calculated for inguinal and femoral hernias presenting to this hospital between 1987 and 1989. Of 476 hernias (439 inguinal, 37 femoral), there were 34 strangulations (22 inguinal, 12 femoral). After 3 months the cumulative probability of strangulation for inguinal hernias was 2.8 per cent, rising to 4.5 per cent after 2 years. For femoral hernias the cumulative probability of strangulation was 22 per cent at 3 months and 45 per cent at 21 months. The rate at which the cumulative probability of strangulation increased was in both cases greatest in the first 3 months, suggesting that patients with a short history of herniation should be referred urgently to hospital and given priority on the waiting list.
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31
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Heydorn WH, Velanovich V. A five-year U.S. Army experience with 36,250 abdominal hernia repairs. Am Surg 1990; 56:596-600. [PMID: 2221607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-six thousand two hundred fifty abdominal hernia repairs were performed in U.S. Army medical treatment facilities during a five-year period. This study presents data about the type of hernia, incidence of complications by obstruction or strangulation, age, sex, and mortality. Hernias occurring with intestinal obstruction or gangrene (strangulation) are referred to as complicated hernias. Inguinal hernias in children less than two years of age, femoral hernias, and unusual (such as internal or obturator) hernias were found to have an increased incidence of complications. Surgical repair of ventral, umbilical, and femoral hernias was done with a low surgical risk and the presence of complications did not significantly increase this risk. An increased risk of mortality is associated with the repair of complicated unusual hernias and complicated inguinal hernias in patients more than 60 years of age.
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MESH Headings
- Adolescent
- Adult
- Aged
- Child
- Child, Preschool
- Female
- Hernia, Femoral/complications
- Hernia, Femoral/mortality
- Hernia, Femoral/surgery
- Hernia, Inguinal/complications
- Hernia, Inguinal/mortality
- Hernia, Inguinal/surgery
- Hernia, Umbilical/complications
- Hernia, Umbilical/mortality
- Hernia, Umbilical/surgery
- Hernia, Ventral/complications
- Hernia, Ventral/mortality
- Hernia, Ventral/surgery
- Hospitals, Military
- Humans
- Infant
- Intestinal Obstruction/etiology
- Male
- Middle Aged
- United States/epidemiology
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Husmann DA, McLorie GA, Churchill BM, Ein SH. Inguinal pathology and its association with classical bladder exstrophy. J Pediatr Surg 1990; 25:332-4. [PMID: 2313504 DOI: 10.1016/0022-3468(90)90080-s] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
One hundred thirty-four cases of classical bladder exstrophy, managed at our institution, were reviewed. Fifty-six percent of the boys and 15% of the girls developed inguinal hernias over an average follow-up time-span of 10 years. Thirty-one percent of the patients with hernias underwent repair at the time of initial bladder closure. Forty-six percent of the patients who developed a hernia were diagnosed during the first year following their initial procedure. More than 50% of the individuals in the latter category presented with an incarcerated hernia, and required emergent management. Boys managed by staged reconstruction had a statistically significant risk of developing an inguinal hernia (P less than .001) compared with boys undergoing primary cystectomy and diversion. We believe the increased incidence of herniation with this congenital anomaly is secondary to a lack of obliquity of the inguinal canal, due to pubic diastasis along with an increased elevation of intraabdominal pressure following initial closure of the abdominal wall and bladder plate. To decrease the attendant morbidity of incarcerated hernias in this population, we stress the need for careful physical examination of the inguinal region and spermatic cord prior to surgery, along with repair of the patent processus vaginalis at the time of initial repair.
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Moran B. Strangulated external hernia. Trop Doct 1988; 18:73. [PMID: 3368955 DOI: 10.1177/004947558801800212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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35
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Abstract
By retrospective analysis of the medical records from 1978-1985, the rates of incarceration, postoperative complications and lethality were determined with particular consideration of elective and emergency operations. The proportion of over 60 year old patients with inguinal hernia was 37.3%. The rate of incarceration in these patients (9.8%) was more than five times as high as in patients under 60 years old (1.8%); with increasing age, it rose from 3% to 36%. The Bassini technique predominated in the surgical treatment of the hernia. The rate of postoperative complications was 7.5%, wound infections (3.35%) and hematomas (3.07%) being the most frequent. Four patients died postoperatively, mostly of pulmonary complications; this corresponds to a lethality of 1.1% as compared to this corresponds to a lethality of 1.1% as compared to 0% in patients under 60 years old. Emergency operations in incarcerated hernia display a lethality (5.71%) which is more than nine times as high as in elective operations (0.62%). The indication for surgery is hence to be established rather extensively in the elderly, since the danger of incarceration rises.
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36
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Anatol T. The pattern of gastro-intestinal obstruction in Trinidadian children. W INDIAN MED J 1985; 34:238-43. [PMID: 4090469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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37
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Oluwole SF, Lawal OO. Factors influencing the morbidity of strangulated inguinal hernia in Ife, Nigeria. EAST AFRICAN MEDICAL JOURNAL 1984; 61:817-823. [PMID: 6535705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
In a 10 year period, 1,496 patients aged 65 years or older were treated for groin hernias. A total of 1,755 hernias were diagnosed, of which 243 were incarcerated and 1,279 were surgically repaired. Emergency operations were performed in 235 patients with a mortality rate of 7.5 percent, compared with 1.3 percent for the elective cases. The postoperative morbidity rate was 56 percent in emergency cases and 20 percent in the elective cases. Patients with cardiovascular and pulmonary diseases had the worst prognosis. Local anesthesia had the least sequelae. We conclude that groin hernias in elderly patients should be repaired under elective conditions in the properly prepared patient, preferably while under local anesthesia.
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39
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Chatterjee SK, Sarangi NB. Emergency presentation of pediatric inguinal hernia. Indian Pediatr 1979; 16:503-6. [PMID: 533722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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40
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Iles JD. Surgery and anesthesia in Ontario. CANADIAN MEDICAL ASSOCIATION JOURNAL 1978; 118:114. [PMID: 757374 PMCID: PMC1880373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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41
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Klimniuk IG. [Analysis of the fatal outcomes in strangulated external abdominal hernias]. Khirurgiia (Mosk) 1975:117-21. [PMID: 1228298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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42
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Abstract
One hundred severty-one cases of mechanical intestinal obstruction were studied. One hundred fifteen had small bowel obstruction and fifty-six had large bowel obstruction. Adhesion (32.8 per cent), hernia (21.6 per cent), and neoplasm (18.1 per cent) were the cause of obstruction in more than 70 per cent of all cases. More than 40 per cent of patients were older than 60 years and the average age was 52.7. The numbers of males and females were approximately equal. There were twice as many whites as blacks, and the mortality rate was higher among blacks. The overall uncorrected mortality rate was 18.7 per cent. Operation was performed in 105 patients (61.4 per cent), with a postoperative mortality of 19 per cent and corrected postoperative mortality of 4.5 per cent. Contributing factors that were significant were high incidence of metastatic diseases, elderly patients, and delay in admission.
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43
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Hancock BD. Basoga hernia prevalence in abdominal emergencies in Busoga, Uganda. TROPICAL AND GEOGRAPHICAL MEDICINE 1974; 26:15-25. [PMID: 4830614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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44
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45
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Wapnick S, Mhazo E. Strangulated groin hernia in the tropics. S Afr Med J 1972; 46:1463-6. [PMID: 4637798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
MESH Headings
- Adolescent
- Adult
- Aged
- Child, Preschool
- Female
- Gangrene/epidemiology
- Hernia, Femoral/diagnosis
- Hernia, Femoral/epidemiology
- Hernia, Femoral/mortality
- Hernia, Femoral/surgery
- Hernia, Inguinal/diagnosis
- Hernia, Inguinal/epidemiology
- Hernia, Inguinal/mortality
- Hernia, Inguinal/surgery
- Humans
- Infant
- Infant, Newborn
- Malawi
- Male
- Middle Aged
- Mozambique
- Prognosis
- Time Factors
- Zimbabwe
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46
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Seidel W, Spelsberg F, Niedring O, Zenker R. [Indications for operative treatment of inguinal and femoral hernias]. Dtsch Med Wochenschr 1972; 97:963-7. [PMID: 5030351 DOI: 10.1055/s-0028-1107476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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47
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Daum R, Meinel A. [Surgical treatment of infantile inguinal hernias. Analysis of 3,111 cases]. Chirurg 1972; 43:49-54. [PMID: 5027672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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48
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49
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Guillen J, Aldrete JA. Anesthetic factors influencing morbidity and mortality of elderly patients undergoing inguinal herniorrhaphy. Am J Surg 1970; 120:760-3. [PMID: 5488328 DOI: 10.1016/s0002-9610(70)80044-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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50
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Hecker WC, Popp H. [On the treatment of inguinal hernia in childhood. Experiences of 2502 cases]. BRUNS' BEITRAGE FUR KLINISCHE CHIRURGIE 1968; 216:687-92. [PMID: 4389052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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