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Pecorella G, De Rosa F, Licchelli M, Panese G, Carugno JT, Morciano A, Tinelli A. Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk? Int J Gynaecol Obstet 2024. [PMID: 38557928 DOI: 10.1002/ijgo.15464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Filippo De Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Martina Licchelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Josè Tony Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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Wang H, Xue F, Wang W. A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis. J Int Med Res 2024; 52:3000605241241010. [PMID: 38663910 PMCID: PMC11047230 DOI: 10.1177/03000605241241010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP). METHODS Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the β-human chorionic gonadotropin (β-hCG) concentration to normal and to the return of menstruation were compared. RESULTS The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for β-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group. CONCLUSION Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP.
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Affiliation(s)
- Hongyan Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Fangfang Xue
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Wenying Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
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Corazzelli G, Capece M, Pizzuti V, Leonetti S, D'Elia A, Santilli M, Aloj F, Innocenzi G. Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis. J Neurosurg Spine 2024; 40:125-131. [PMID: 37890188 DOI: 10.3171/2023.8.spine221332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/22/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar spinal canal. Surgical decompression has been shown to be superior to conservative management. Nonetheless, intraoperative and postoperative blood loss in elderly patients taking antiplatelet or anticoagulant drugs owing to cardiovascular comorbidities may be a special issue. This study describes and compares early outcomes after surgical procedures in different groups of patients receiving antithrombotic drugs. METHODS The authors' study retrospectively recruited 289 consecutive patients aged ≥ 65 years who received lumbar decompression for spinal stenosis between January 2021 and May 2022. First, 183 patients taking antiplatelet therapy were divided into two groups according to the rationale for use: primary versus secondary prophylaxis of cardiovascular events (group 1 vs group 2). Primary prevention was stopped preoperatively, or secondary prevention was not discontinued during the perioperative period. Secondly, 106 patients who were not taking antiplatelet mediation were divided into two groups, depending on whether preoperative low-molecular-weight heparin had not been administered or had been (group A vs group B). Intraoperative blood loss, surgical time, and postoperative hospitalization were analyzed. RESULTS No significant statistical differences were observed between groups 1 and 2 in terms of intraoperative blood loss and time of surgery, or between groups A and B in terms of all analyzed variables. No early or delayed complications were observed, perioperatively or during the postoperative 3-month follow-up period. CONCLUSIONS The results of this study suggest that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery could be devoid of early complications and could be safely continued perioperatively.
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Affiliation(s)
- Giuseppe Corazzelli
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy
| | - Mara Capece
- 2Department of Neurosurgery, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | - Fulvio Aloj
- 5Anaesthesiological Department, IRCCS Neuromed, Pozzilli (IS), Italy
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Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
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Sun Y, Liu L, Shi D, Ma C, Xu X. Assessment of a Real-world Learning Curve for the Endoscopic Resection of Gastric Gastrointestinal Stromal Tumors. J Int Med Res 2023; 51:3000605231194448. [PMID: 37646636 PMCID: PMC10469254 DOI: 10.1177/03000605231194448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Endoscopic resection (ER) is a proven treatment for gastric gastrointestinal stromal tumors (gGISTs). We aimed to assess the learning curve (LC) associated with ER for gGISTs and identify determinants. METHODS We conducted an analysis of 289 patients who underwent the ER of gGISTs by an experienced endoscopist. To characterize the LC, we employed cumulative sum analysis of the duration of surgery. The participants were divided into an early phase (cases 1-50) and a later phase (case 51-289), which were compared. Furthermore, we identified risk factors for the conversion from endoscopic to laparoscopic resection (LR). RESULTS The durations of surgery and hospitalization were shorter, and there were fewer complications and fasting days in the later phase. The conversion rates to LR were 6.0% and 2.5% in the early and later phases, respectively. The tumor diameter (≥3.0 cm) and invasion beyond the muscularis propria were significant risk factors for conversion to LR (odds ratio 17.92, 95% confidence interval 2.66-120.87; and 58.03, 6.40-525.84; respectively). CONCLUSIONS The LC for ER of gGISTs lasts for approximately 50 cases. In addition, tumors ≥3.0 cm in diameter and those that invade beyond the muscularis propria are more likely to require conversion to LR.
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Affiliation(s)
- Ying Sun
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Dongtao Shi
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Chao Ma
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
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Algarny S, Perera A, Egenolf P, Weber M, Heck V, Walter S, Eysel P, Scheyerer MJ, Lenz M. Postoperative Surgical Site Infections in Spine Surgery: Can the Duration of Surgery Predict the Pathogen Spectrum? In Vivo 2023; 37:1688-1693. [PMID: 37369515 DOI: 10.21873/invivo.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND/AIM Surgical site infection (SSI) is a severe complication of spinal surgery, which typically results in prolonged length of hospital stay, an increased number of revision surgeries, re-hospitalizations, worse clinical functional outcomes, and increased healthcare costs. The aim of the present study was to analyse if the duration of surgery can predict the spectrum of pathogens causing SSI in orthopaedic spine surgery. PATIENTS AND METHODS We conducted a retrospective study over a period of two years at the University Hospital of Cologne in which all patients with postoperative surgical site infections were included. In addition to descriptive characteristics (such as sex, age, BMI), the duration of the surgery, the administration of intra-operative antibiotics, the main diagnosis, the postoperative course of the infection parameters (CRP & WBC) and the responsible pathogens were analysed. RESULTS A total of 75 patients were included with a median age of 64 years. The mean time of operation time was 131.52±70.91 min (range=23-285 min). The most frequently isolated germs in the postoperative blood culture were S. aureus (n=7), S. haemolyticus and S. hominis (n=2). There was a significant correlation between the duration of the primary surgical intervention and the postoperatively detected pathogens (p=0.002). CONCLUSION A significant correlation was shown between the duration of surgery and the species of pathogens detected causing postoperative SSI. The use of perioperative antibiotics, the use of longer-lasting antibiotics or the repeated intravenous administration of prophylactic antibiotics should be evaluated.
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Affiliation(s)
- Saeed Algarny
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany;
| | - Akanksha Perera
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Philipp Egenolf
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Maximilian Weber
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Vincent Heck
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sebastian Walter
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Max J Scheyerer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Duesseldorf, Düsseldorf, Germany
| | - Maximilian Lenz
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
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Ke J, Xie Y, Liang J, Wang M, Lin W. Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review. J Thorac Dis 2023; 15:2261-2276. [PMID: 37197518 PMCID: PMC10183507 DOI: 10.21037/jtd-23-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
Background and Objective Esophageal cancer is one of the common malignant tumors in China. Previous studies have shown that surgery alone is less effective. Neoadjuvant therapy refers to preoperative chemoradiotherapy, which is the standard treatment for locally advanced and operable esophageal cancer. Selection of appropriate surgical methods and timing after neoadjuvant therapy is of great significance for improving the prognosis of patients and reducing postoperative complications. Methods An online electronic search of all eligible literature through PubMed, Google Scholar, and the Cochrane Library database was conducted using a combination of the following keywords: esophageal cancer, neoadjuvant therapy, neoadjuvant chemotherapy, chemoradiotherapy, immunotherapy, targeting, surgery, complications. With a focus on the use of surgery after neoadjuvant therapy, Eligible articles were identified by one or both authors. Key Content and Findings Neoadjuvant chemoradiotherapy combined with radical surgical resection remains the current standard of care for resectable esophageal cancer, significantly improving survival and pathologic complete response (PCR) compared with preoperative chemotherapy Recently, studies have also found that immunotherapy combined with chemotherapy has a more advantageous pathological response in patients with locally advanced disease. Although the emergence of targeted drugs has led to a change in treatment mode from traditional chemoradiotherapy to precision therapy, the postoperative progression-free survival (PFS) and overall survival (OS) need to be explored as well as how surgery-related risks caused by treatment can be reduced. Traditionally, surgery is performed 4-6 weeks after neoadjuvant therapy, and optimal timing for surgery after treatment is still being explored as research progresses, the surgical method also should be determined according to the specific situation of the patient. Postoperative complications should be dealt with in a timely manner, and of course, active preoperative intervention is equally important. Conclusions Neoadjuvant therapy combined with surgery is the gold standard for resectable esophageal cancer. However, optimal timing of surgery after preoperative treatment remains unclear. Minimally invasive thoracoscopic surgery (including robotic surgery) has gradually replaced traditional open surgery. Active prevention before operation, accurate and meticulous operation during operation, and timely treatment after operation can minimize the incidence of adverse events.
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Affiliation(s)
- Junli Ke
- Department of Cardiothoracic Surgery, Graduate School of Guangdong Medical University, Zhanjiang, China
| | - Yujie Xie
- Thoracic Surgery Department, Gaozhou People’s Hospital, Maoming, China
| | - Jin Liang
- Department of Cardiothoracic Surgery, Graduate School of Guangdong Medical University, Zhanjiang, China
| | - Maosheng Wang
- Thoracic Surgery Department, Gaozhou People’s Hospital, Maoming, China
| | - Wanli Lin
- Thoracic Surgery Department, Gaozhou People’s Hospital, Maoming, China
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Syundyukov AR, Nikolaev NS, Vissarionov SV, Kornyаkov PN, Bhandarkar KS, Emelianov VU. Less correction with minimally invasive surgery for adolescent idiopathic scoliosis compared to open surgical correction. J Child Orthop 2023; 17:141-147. [PMID: 37034192 PMCID: PMC10080243 DOI: 10.1177/18632521221146642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/05/2022] [Indexed: 04/11/2023] Open
Abstract
Purpose In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis. Methods The correlations between the Cobb's angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation. Results The Cobb's angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° (p < 0.001) in the open surgical correction group and from 51.2° ± 11.4° to 11.7° ± 5.8° (p < 0.001) in the minimally invasive surgery group before and after surgery, respectively. The percentage of curvature correction was 88.2% ± 8.0% and 77.7% ± 10.7% (p < 0.001) in the open surgical correction and minimally invasive surgery groups, respectively. The estimated blood loss was higher in the open surgical correction group than in the minimally invasive surgery group (208.7 ± 113.4 vs 564.3 ± 242.7 mL). Axial rotation was changed from 29.1°± 7.5 to 17.1°± 6.8 (p < 0.001) in the open surgical correction group and from 28.9°± 7.8 to 19.4°± 6.4 (p < 0.001) in the minimally invasive surgery group. The duration of surgery was shorter in the open surgical correction group than in the minimally invasive surgery group (266.6 ± 64.3 vs 346.2 ± 70.5 min). A positive correlation between time of operation and Cobb's angle correction (in °) in open surgical correction (r = 0.37) and minimally invasive surgery (r = 0.43) was found. Conclusion The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb's angle. Level of evidence III.
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Affiliation(s)
- Ayrat R Syundyukov
- Federal State Budgetary Institution,
Federal Center for Traumatology, Orthopedics and Arthroplasty of the Ministry of
Health of the Russian Federation, Cheboksary, Russian Federation
| | - Nikolai S Nikolaev
- Federal State Budgetary Institution,
Federal Center for Traumatology, Orthopedics and Arthroplasty of the Ministry of
Health of the Russian Federation, Cheboksary, Russian Federation
- Chuvash State University named after
I.N. Ulyanov, Cheboksary, Russian Federation
| | - Sergei V Vissarionov
- H. Turner National Medical Research
Center for Children’s Orthopedics and Trauma Surgery, Saint Petersburg, Russian
Federation
| | - Pavel N Kornyаkov
- Federal State Budgetary Institution,
Federal Center for Traumatology, Orthopedics and Arthroplasty of the Ministry of
Health of the Russian Federation, Cheboksary, Russian Federation
| | - Kalind S Bhandarkar
- Chuvash State University named after
I.N. Ulyanov, Cheboksary, Russian Federation
| | - Vladimir U Emelianov
- Federal State Budgetary Institution,
Federal Center for Traumatology, Orthopedics and Arthroplasty of the Ministry of
Health of the Russian Federation, Cheboksary, Russian Federation
- Chuvash State University named after
I.N. Ulyanov, Cheboksary, Russian Federation
- Vladimir U Emelianov, Federal State
Budgetary Institution, Federal Center for Traumatology, Orthopedics and
Arthroplasty of the Ministry of Health of the Russian Federation, Cheboksary,
Russian Federation.
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Ebner F, de Gregorio N, Lato C, Ohly V, Janni W, Spohrs J, Jerg-Bretzke L, Walter S. Choosing a Surgical Access Point for Hysterectomy: A Paradigm Shift Over a 10-Year Span. Front Med (Lausanne) 2020; 7:569895. [PMID: 33324658 PMCID: PMC7724105 DOI: 10.3389/fmed.2020.569895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background: When choosing a surgical procedure for a hysterectomy, doctors and patients have various options in terms of the multiple surgical access points available. The aim of this study was to descriptively analyze developments concerning the surgical access point selected over the past 10 years at Ulm University Hospital, (south) Germany, assess the variables associated with the surgical method and explore any potential significant correlations that influence these surgical access routes. Explicitly, we wished to investigate whether the approval of ulipristal acetate and the warning issued by the Food and Drug Administration (FDA) in connection with its use changed existing trends. Material and Methods: This monocentric study retrospectively assessed data from all patients who underwent a hysterectomy due to a benign disease or endometrial cancer from January 2007 until December 2016. Results: Of the benign indications considered, myomas and descensus genitalis occurred most frequently (49.5 and 30.6%, respectively). The percentage of abdominal procedures declined from 61.4 to 13.4% between 2007 and 2016 for all hysterectomies, whilst it increased from 4.1 to 69.7% for laparoscopic hysterectomies. The rate of vaginal hysterectomies increased to 45.5% until 2013 and declined in the years afterwards. Laparoscopic assisted vaginal hysterectomies were comparatively rare. The trends in terms of surgical routes were similar for endometrial cancer. During the observation period, the share of abdominal hysterectomies fell from 100 to 11.3%, whilst the share of laparoscopic hysterectomies increased from 0 to 86.6%. The other two procedures were less frequently used. Use of the laparoscopic hysterectomy procedure also increased significantly after the FDA's 2014 warning. Ulipristal acetate may have tended to influence the process. Conclusion: Contrary to the national decrease in hysterectomy numbers, the annual number of hysterectomies at Ulm University Hospital remained stable during the observation period. Nevertheless, there was a clear shift in the preferred surgical routes for hysterectomy.
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Affiliation(s)
- Florian Ebner
- Department of Gynaecology, Helios Amper-Hospital Dachau, Dachau, Germany.,Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Niko de Gregorio
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christiane Lato
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Valerie Ohly
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Jennifer Spohrs
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Steffen Walter
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
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Mishra AK, Kumar S, Dorairajan LN, Manikandan R, Ramkumar G, Sreerag KS, Mittal JK. Study of ureteral and renal morphometry on the outcome of ureterorenoscopic lithotripsy: The critical role of maximum ureteral wall thickness at the site of ureteral stone impaction. Urol Ann 2020; 12:212-219. [PMID: 33100744 PMCID: PMC7546072 DOI: 10.4103/ua.ua_95_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/22/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose is to study the association of stone, ureteral, and renal morphometric parameters with the relevant outcome variables, i.e., complication rate, stone-free rate (SFR), and operating time of ureterorenoscopic lithotripsy. Although a safe procedure, it still occasionally has major complications. Computed tomography (CT) scan is often performed to diagnose ureteral calculi, providing opportunities for ureteral morphometry that may have a bearing on the outcome of the procedure. Materials and Methods: Ureteric, renal, and stone morphometric parameters were measured from CT of the abdomen and pelvis of the 110 patients with ureteral calculi who underwent ureteroscopic lithotripsy (URSL). Data were collected retrospectively in 25 patients and prospectively in 85 patients. Association of these parameters with the outcome variables of the procedure mentioned above was studied. Results: On univariate analysis, body mass index, stone size, and maximum ureteral wall thickness (MUWT) were found to have a significant association with URSL complications, SFR, and duration of surgery. On multivariable analysis, only MUWT was found to be an independent risk factor for URSL complications. In 90% of total patients with residual stones, MUWT was found to be >4.8 mm. Conclusion: Ureteral wall thickness of >4.8 mm is associated with prolonged duration of surgery and lower SFR. Patients with ureteral wall thickness of >4.8 mm at the site of ureteral stone who are planned for URSL must be counseled about the higher chances of residual stones and the need for additional procedure.
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Affiliation(s)
| | | | | | | | - G Ramkumar
- Department of Radiodiagnosis, JIPMER, Puducherry, India
| | - K S Sreerag
- Department of Urology, JIPMER, Puducherry, India
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11
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Wang JL, Cui ZY, Zhu SF, Yang WZ, Zhou HY, Zhang SQ, Fu ZS, Sun YF. Treatment of renal calculi without hydronephrosis using a standard channel assisted by a visual puncture system. J Int Med Res 2020; 48:300060519893869. [PMID: 31939324 PMCID: PMC7114277 DOI: 10.1177/0300060519893869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To study the safety and efficacy of standard channel establishment using a visual puncture system in the treatment of renal calculi without hydronephrosis. Methods We retrospectively analyzed data from 46 patients undergoing percutaneous nephrolithotomy via a standard channel assisted by a visual puncture system, including number of punctures, duration of procedure, hemoglobin level after surgery, calculi clearance rate, and postoperative complications. Results Sixty-nine channels were established, including a single channel in 26 cases, double channel in 17 cases, and three channels in 3 cases. The mean number of punctures was 1.50, mean time to establish the standard channel was 2.6 minutes, and duration of surgery was 31.3 minutes. No significant change in hemoglobin was observed after surgery. Forty-three patients had no residual calculi and three had small residual calculi on the day after surgery, representing a first-phase clearance rate of 93.48% (43/46). No significant complications were observed. Conclusions Hemorrhage during operation can be significantly reduced by establishing a standard channel using a visual puncture system. Moreover, the number of standard channels can be reduced and the incidence of complications lowered using this approach, which should be adopted widely for the treatment of renal calculi without hydronephrosis.
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Affiliation(s)
- Ji-Liang Wang
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Zhen-Yu Cui
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Shi-Fan Zhu
- Unit 66069-79 of the PLA, Luoyang, Henan, P. R. China
| | - Wen-Zeng Yang
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Hong-Yue Zhou
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Shi-Qing Zhang
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Ze-Sheng Fu
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Yun-Fei Sun
- Medical College of Hebei University, Baoding, Hebei, P. R. China
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12
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Tangbumrungtham N, Hwang PH, Maul X, Borchard NA, Dholakia SS, Patel ZM, Nayak JV, Choby G. The effect of topical epinephrine 1:1000 with and without infiltration of 1% lidocaine with epinephrine 1:100,000 on endoscopic surgical field visualization: a double-blind randomized controlled study. Int Forum Allergy Rhinol 2019; 10:147-152. [PMID: 31671251 DOI: 10.1002/alr.22468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/25/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this study is to determine whether the infiltration of 1% lidocaine with 1:100,000 epinephrine in addition to topical application of 1:1000 epinephrine significantly improves surgical field grading scale score over topical 1:1000 epinephrine alone. METHODS A prospective, double-blind, randomized, controlled study was performed of 40 patients undergoing bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Patients were enrolled and randomly assigned to receive infiltration with 1% lidocaine with 1:100,000 epinephrine on 1 side of the nasal cavity vs plain saline on the other side in preparation for ESS. Both groups received topical application of 1:1000 epinephrine. Surgical videos were recorded and Wormald surgical field grading scale was assigned by 2 blinded reviewers. The number of extra 1:1000 epinephrine pledgets used during the surgery, estimated blood loss, and surgical duration were also recorded. RESULTS There were no statistically significant differences in Wormald surgical field grading scale, number of extra pledgets used, or estimated blood loss between the nasal cavity side infiltrated with 1% lidocaine with 1:100,000 epinephrine in comparison to infiltration with saline. The side infiltrated with 1% lidocaine with 1:100,000 epinephrine had a reduced operative time compared to the side infiltrated with saline (p = 0.002). There were no differences in postoperative bleeding from questionnaire completed by patient at the first postoperative visit. CONCLUSION Addition of infiltration of 1% lidocaine with epinephrine 1:100,000 to topical application of epinephrine 1:1000 for preparation of ESS does not significantly improve surgical field of view compared to topical epinephrine alone.
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Affiliation(s)
- Navarat Tangbumrungtham
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.,Department of Otorhinolaryngology, Ramathibodi Hospital, Bangkok, Thailand
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Ximena Maul
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.,Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole A Borchard
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Sachi S Dholakia
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Garret Choby
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
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13
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Peleg D, Ahmad RS, Warsof SL, Marcus-Braun N, Sciaky-Tamir Y, Ben Shachar I. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. Am J Obstet Gynecol 2018; 218:343.e1-7. [PMID: 29496259 DOI: 10.1016/j.ajog.2018.01.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. OBJECTIVE The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. STUDY DESIGN This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. RESULTS Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P < .001, 95% confidence interval, 67.69-138.47 seconds). Knotless barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P < .001), and blood loss measured during incision closure was significantly lower (mean 221 mL vs 268 mL, P < .005). CONCLUSION The use of a knotless barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss.
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Thorarinsson A, Fröjd V, Kölby L, Modin A, Lewin R, Elander A, Mark H. Blood loss and duration of surgery are independent risk factors for complications after breast reconstruction. J Plast Surg Hand Surg 2017; 51:352-357. [PMID: 28122466 DOI: 10.1080/2000656x.2016.1272462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Complications after breast reconstructive surgery are common, and they can be caused by a wide range of factors. The aim of the present study was to identify independent perioperative risk factors for postoperative complications after breast reconstruction. METHODS A retrospective study was performed of 623 consecutive breast cancer patients who had undergone deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap, lateral thoracodorsal flap (LTDF), or tissue expander with secondary implant (EXP). Data on demography, perioperative parameters, and complications were collected. Logistic regression models adjusted to the reconstruction method and to confounding demographic factors were used for statistical analysis. RESULTS Increased blood loss for each 10-ml step increased the risk for overall early complications (p = 0.017), early seroma (p = 0.037), early resurgery (p = 0.010), late local overall complications (p = 0.024), and late fat necrosis (p = 0.031). Longer duration of surgery for each 10-minute step increased the risk of overall early complications (p = 0.019), but, in the univariate model, there was an increased risk for nine different types of complications (p = 0.004-0.029). There was no association between the experience of the surgeon performing the procedure and the frequency of complications. CONCLUSIONS Duration of surgery and blood loss during surgery are independent risk factors for postoperative complications, and should be minimised. Further research is needed to establish the association between the experience of the surgeon and the occurrence of complications.
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Affiliation(s)
- Andri Thorarinsson
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Victoria Fröjd
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Lars Kölby
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Albert Modin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Richard Lewin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Anna Elander
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Hans Mark
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
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Young SW, Mutu-Grigg J, Frampton CM, Cullen J. Does speed matter? Revision rates and functional outcomes in TKA in relation to duration of surgery. J Arthroplasty 2014; 29:1473-1477.e1. [PMID: 24726183 DOI: 10.1016/j.arth.2014.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 02/01/2023] Open
Abstract
Longer operative times may be required in complex total knee arthroplasty (TKA), however little is known about outcomes in procedures performed rapidly. We analysed 58,009 primary TKAs from the New Zealand National Joint Registry. The mean surgical duration was 89 minutes, and 50% of procedures lasted between 60 and 89 minutes. There was no difference in adjusted revision rates for groups lasting between 40 and 120 minutes, however procedures lasting >120 minutes had significantly higher revision rates. There was a higher revision rate in TKAs lasting <40 minutes (0.71 vs 0.48 revisions per 100 component years) but this was not statistically significant (P = 0.1). For primary TKAs lasting less than 120 minutes, further shortening operative time did not improve outcome, and very rapid procedures (<40 minutes) may lead to an increased risk of revision.
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Affiliation(s)
- Simon W Young
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - John Mutu-Grigg
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | | | - John Cullen
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
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Abstract
Risk stratification has proven to be a useful tool in surgical site infection prevention. The duration of the surgical procedure has been recommended for use in surgical site infection (SSI) risk stratification (Infect Control Hosp Epidemiol 20:247-248, 1999). A retrospective analysis of 6489 patients who underwent total knee replacement (TKR) between 1993 and 1999 assessed the association between the duration of the surgical procedure and the risk of postoperative infection. One hundred thirteen infected patients were matched with 236 controls, and nominal variables were statistically processed. Patients without infections (n = 236) had surgery durations of 94 +/- 28 min, and patients with infection (n = 104) had durations of 127 +/- 45 min (p < 0.001). Operation time has positive correlations with weight (r = 0.3, p < 0.001), body mass index (r = 0.3, p < 0.001), and the total number of comorbidities (r = 0.2, p < 0.001; n = 340). The results confirm that the duration of the surgical procedure can be used as a risk predictor for SSI in TKR.
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Affiliation(s)
| | - R. Laskin
- The Hospital for Special Surgery, Weill Medical School of Cornell University, New York, NY USA
| | - J. Davis
- The Hospital for Special Surgery, Weill Medical School of Cornell University, New York, NY USA
| | - M. G.E. Peterson
- The Hospital for Special Surgery, Weill Medical School of Cornell University, New York, NY USA
| | - T. Richart
- ACZA Campus Stuivenberg, Antwerp, Belgium
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