elective surgery

择期手术
  • 文章类型: Journal Article
    肾小球滤过率(GFR)受损在术中和术后早期都很常见。即使是选修的。在一些患者中,这种损害是微妙而持久的,甚至没有检测到血清肌酐(sCr)的增加,因此,程度不足以满足基于sCr的急性肾损伤(AKI)标准。在GFR下降幅度更大的患者中,sCr会显著增加,但是,不幸的是,通常在其进展的后期。已经提出尿和血清生物标志物都能够预测AKI的发展,但在大多数中心,它们并不广泛可用,也没有成本效益。在这种情况下,使用尿钠浓度(NaU)和钾(FeK)的排泄分数的尿液生化方法已被提出,预测肾脏微循环应激水平和GFR降低。提出了一个教育术后案例示例,强调了这种方法在正确解释sCr值方面的相关性,为肾功能监测带来更多活力。
    MacielAT.使用尿液生化方法优化术后急性肾损伤监测-为血清肌酐评估带来更多活力的时间!印度JCritCareMed2024;28(8):729-733。
    Glomerular filtration rate (GFR) impairment is common both intraoperatively and in the early postoperative period of major surgeries, even elective ones. In some patients, such impairment is subtle and short-lasting, not even detected by increases in serum creatinine (sCr) and, consequently, not of sufficient magnitude to fulfill acute kidney injury (AKI) sCr-based criteria. In patients with a GFR decrease of greater magnitude, significant increases in sCr will occur but, unfortunately, usually at a late time in its progression. Both urinary and serum biomarkers have been proposed to be capable of anticipating AKI development but they are not widely available nor cost-effective in most centers. In this context, a urine biochemical approach using urinary sodium concentration (NaU) and the fractional excretion of potassium (FeK) has been proposed, anticipating the level of renal microcirculatory stress and decreases in GFR. An educational postoperative case example is presented highlighting the relevance that this approach can have in the correct interpretation of sCr values, bringing more dynamism to renal function monitoring.
    UNASSIGNED: Maciel AT. Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach-Time to Bring More Dynamism to Serum Creatinine Evaluation! Indian J Crit Care Med 2024;28(8):729-733.
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  • 文章类型: Journal Article
    背景COVID-19大流行给全球医疗保健系统带来了前所未有的挑战,包括患者心理压力加剧。这项研究评估了在COVID-19大流行期间计划手术的患者的术前焦虑水平。方法这项横断面观察性研究于2020年4月至2022年3月进行。18-80岁的成年患者,计划进行选择性或紧急手术,包括在内。排除标准是精神疾病,沟通受损,和血流动力学不稳定。一份针对人口统计的预先验证的问卷,先前的手术暴露,手术相关的焦虑,并进行了与COVID-19相关的恐惧。焦虑水平以1-5李克特量表进行评分。使用SPSS版本22(IBMCorp.,Armonk,美国)。结果共有112例患者参加,平均年龄42.3±14.2岁。大多数是女性(61名患者,54.5%),已婚(96名患者,85.7%),居住在城市地区(85名患者,75.9%)。大多数患者没有手术史(87例,77.7%)。手术相关的恐惧很普遍,110例患者(98.2%)担心手术并发症,111例患者(99.1%)担心术后疼痛。与COVID-19相关的担忧也很严重,108例患者(96.4%)担心住院期间感染,100例患者(89.3%)担心感染家庭成员。轻度恐惧是最常见的焦虑水平(70名患者,62.95%),其次是中度恐惧(25名患者,22.5%)。讨论该研究强调了手术和大流行的双重压力源,导致术前焦虑加剧。研究结果表明,存在显著的焦虑水平,受与手术有关的恐惧驱使,麻醉,和COVID-19。这与其他报告因大流行而加剧的术前焦虑水平高的研究一致。对焦虑因素的全面评估强调了需要量身定制的干预措施来减轻这些焦虑。结论COVID-19大流行显著增加了手术患者的术前焦虑。解决手术和大流行相关的焦虑对于改善患者预后至关重要。医疗保健提供者应实施心理支持计划以减轻这些焦虑。了解大流行期间术前焦虑的多面性可以增强患者护理。
    Background The COVID-19 pandemic has introduced unprecedented challenges to global healthcare systems, including heightened psychological stress among patients. This study evaluates the preoperative anxiety levels among patients scheduled for surgery during the COVID-19 pandemic. Methods This cross-sectional observational study was conducted between April 2020 and March 2022. Adult patients aged 18-80 years, scheduled for elective or emergency surgery, were included. Exclusion criteria were mental illness, impaired communication, and hemodynamic instability. A pre-validated questionnaire addressing demographics, prior surgery exposure, surgery-related anxiety, and COVID-19-related fears was administered. Anxiety levels were scored on a 1-5 Likert scale. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, USA). Results A total of 112 patients participated, with a mean age of 42.3±14.2 years. The majority were female (61 patients, 54.5%), married (96 patients, 85.7%), and resided in urban areas (85 patients, 75.9%). Most patients had no prior surgical history (87 patients, 77.7%). Surgery-related fears were prevalent, with 110 patients (98.2%) fearing surgical complications and 111 patients (99.1%) fearing postoperative pain. COVID-19-related fears were also significant, with 108 patients (96.4%) fearing infection during hospital stay and 100 patients (89.3%) fearing infecting family members. Mild fear was the most common anxiety level (70 patients, 62.95%), followed by moderate fear (25 patients, 22.5%). Discussion The study highlights the dual stressors of surgery and the pandemic, contributing to heightened preoperative anxiety. Findings indicate that significant anxiety levels were present, driven by fears related to surgery, anesthesia, and COVID-19. This aligns with other studies that report high preoperative anxiety levels exacerbated by the pandemic. The comprehensive assessment of anxiety factors underscores the need for tailored interventions to mitigate these anxieties. Conclusion The COVID-19 pandemic has significantly increased preoperative anxiety among surgical patients. Addressing both surgical and pandemic-related anxieties is crucial for improving patient outcomes. Healthcare providers should implement psychological support programs to alleviate these anxieties. Understanding the multifaceted nature of preoperative anxiety during the pandemic can enhance patient care.
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  • 文章类型: Journal Article
    引言实验室检测是在手术前进行的,以确定不能通过临床评估单独检测的身体异常。通常鼓励进行低风险或中等风险手术的患者像往常一样接受一系列测试。这项横断面观察性研究评估了美国麻醉医师协会(ASA)I级常规术前实验室检查的状态,II,和在妇产医院接受择期手术的III名成年人,以及这些测试对麻醉前检查(PAC)结果的影响。方法对500例择期手术患者进行观察性研究。这些程序包括常规的妇科和产科手术,如腹部子宫切除术,抽真空,剖腹手术治疗异位妊娠,诊断活检,下段剖腹产,在其他人中。指定的麻醉师从完成的PAC表中收集信息。根据标准部门政策,每例患者均在PAC诊所接受临床检查和常规检查.除了人口统计和其他变量,我们对实验室检查结果和因异常而进行的任何围手术期干预进行了评估.调查已经完成,麻醉师问,并注意到所寻求的转介服务。注意到这些调查对麻醉决策的影响。数据以频率和百分比表示,并使用INSTAT软件(GraphPadPrismSoftwareInc.,LaZolla,美国)。结果患者的年龄和体重范围为20至70岁,55至95kg。大多数患者属于ASAII级(n=348,69.6%)。甲状腺功能减退是最常见的异常发现(n=122,22.4%)。贫血,高血压,在n=8(1.6%)中检测到糖尿病,n=82(16.4%),n=34(6.8%)的患者,分别。在488名(97.6%)患者中,名单上的一项或多项调查正在等待中。根据各种术前实验室检查的结果,87例(17.4%)患者在手术前被告知多种专业意见。共有453名(90.6%)在诊所就诊的患者被建议在等待的调查和专家咨询完成后复查他们的PAC。同时,n=41(8.2%)被发现适合手术,n=6(1.2%)被发现不适合手术并被推迟。结论在我们的研究中,测试结果异常的发生率较高。一个原因可能是研究中包括了一组特定的患者。术前实验室检查大大增加了成本。没有多少异常检查的患者可能需要改变其周围麻醉管理。尽管如此,实验室检查可以帮助确保患者处于理想的术前状态。术前实验室检查应根据具体情况建议,以免给患者带来不便,推迟外科手术,并抬高了手术治疗的费用。
    Introduction Laboratory testing is done before surgery to identify body abnormalities that cannot be detected through clinical evaluation alone. Patients going in for low- or intermediate-risk surgeries are often encouraged to undergo a battery of tests as usual. This cross-sectional observational study evaluated the status of routine pre-operative laboratory tests in American Society of Anaesthesiologists (ASA) Grade I, II, and III adults undergoing elective surgery at a maternity hospital, as well as the impact of these tests on the outcome of the pre-anaesthetic check-up (PAC). Methods The present observational study was conducted on 500 patients scheduled for elective surgery under anaesthesia. The procedures included routine gynaecological and obstetric surgeries like abdominal hysterectomy, suction evacuation, laparotomy for ectopic pregnancy, diagnostic biopsy, and lower segment caesarean section, among others. A designated anaesthesiologist gathered information from the completed PAC sheets. As per the standard departmental policy, each patient underwent a clinical examination and routine investigations at the PAC clinic. In addition to demographic and other variables, laboratory test results and any peri-operative interventions performed due to abnormalities were assessed. Investigations already done, asked by anaesthesiologists, and referral services sought were noted. The impact of these investigations on anaesthetic decision-making was noted. Data were expressed in frequencies and percentages and statistically analysed using INSTAT software (GraphPad Prism Software Inc., La Zolla, USA). Results The age and weight of the patients range from 20 to 70 years and 55 to 95 kg. Most patients belonged to ASA Grade II (n=348, 69.6%). Hypothyroidism was the most common abnormal finding (n=122, 22.4%). Anaemia, hypertension, and diabetes were detected in n=8 (1.6%), n=82 (16.4%), and n=34 (6.8%) of patients, respectively. In 488 (97.6%) patients, one or more of the investigations from the list were pending. Based on the results of various preoperative laboratory investigations, 87 (17.4%) patients were advised of multiple specialty opinions before surgery. A total of 453 (90.6%) patients attending the clinic were recommended to review their PACs after their pending investigations and specialist consultations were completed. At the same time, n=41 (8.2%) was found to be fit for surgery, and n=6 (1.2%) was found unfit for surgery and was postponed. Conclusions The incidence of tests with abnormal results was a little high in our study. One reason could be that a particular group of patients is included in the study. Preoperative laboratory investigations substantially increase the costs. Not many patients with abnormal tests may require changes in their peri-anaesthetic management. Nonetheless, laboratory tests can help ensure the patient is in an ideal preoperative condition. Pre-operative laboratory investigations should be advised on a case-by-case basis to avoid inconveniencing the patient, delaying the surgical procedure, and driving up the cost of surgical treatment.
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  • 文章类型: Journal Article
    背景:i-gel®Plus是i-gel®声门上气道装置的改进型。它包含更宽的排水口;更长的尖端;呼吸通道内的坡道;以及用于输送氧气的附加端口。在临床实践中尚未对该装置进行前瞻性评估。
    方法:这个国际,多中心,前瞻性队列研究旨在评估i-gelPlus在全身麻醉下接受择期手术的成年患者中的表现。主要结果是总体插入成功率,定义为从插入装置到外科手术结束通过装置提供有效气道管理的能力。次要结果包括器械性能和术后不良事件的发生率。报告了来自前1000名患者的数据。
    结果:总计,1012名患者入选;由于数据不完整,最终分析中排除了12种形式,留下了1000名患者(545名女性)。总体插入成功率为98.6%,首次尝试插入成功率为88.2%。总体成功率在女性和男性之间存在显着差异(97.4%vs.分别为99.6%),但不是第一次尝试成功插入。平均(SD)口咽密封压为32(7)cmH2O。增加首次尝试失败风险的唯一独立因素是低操作经验。并发症包括:在0.6%的患者中,去饱和<85%;在装置上的血液痕迹为7.4%;在0.5%的患者中,喉痉挛;在0.2%的患者中,碗内的胃内容物。
    结论:i-gelPlus似乎是一种有效的声门上气道装置,具有较高的插入成功率和较低的并发症发生率。
    BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice.
    METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported.
    RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients.
    CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.
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  • 文章类型: Journal Article
    在过去的几十年里,我们对乙状结肠憩室炎的病理生理学和自然史的认识有了很大的提高.这些知识挑战了憩室炎管理中的许多传统原则,例如在所有情况下的常规抗生素给药,基于数字的择期手术建议,以及在急诊手术中进行结肠造口术的必要性。这篇综述将涵盖乙状结肠憩室炎的治疗范围,涵盖简单和复杂的疾病以及选择性和紧急疾病的介绍。将强调管理中的新概念,特别侧重于一级数据,可用时。
    Over the last few decades, our understanding of the pathophysiology and natural history of sigmoid diverticulitis has greatly improved. This knowledge has challenged many of the traditional principles in the management for diverticulitis, such as routine antibiotic administration in all cases, number-based recommendations for elective surgery, and the necessity for an end colostomy in emergency surgery. This review will cover the breadth of management for sigmoid diverticulitis, covering both uncomplicated and complicated disease as well as elective and emergent disease presentations. New and emerging concepts in management will be highlighted with a particular focus on level-1 data, when available.
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  • 文章类型: Journal Article
    目的:接受盆腔尖部器官脱垂手术的妇女对于特定的手术方法有几种医学上合理的选择。
    方法:我们回顾了与脱垂手术相关的共同决策原则。我们回顾了支持上sc结肠外固定术作为脱垂的持久治疗方法的文献,以及可能将其与其他修复方法在风险和收益方面区分开的因素。
    结果:我们强调患者和外科医生在手术决策中合作的重要性。
    结论:所有希望进行脱垂重建手术的医学上合适的患者都应进行骶结肠切除术。
    OBJECTIVE: Women undergoing surgery for apical pelvic organ prolapse have several medically sound options for specific surgical approaches.
    METHODS: We review the principles of shared decision-making as they pertain to surgery for prolapse. We review the literature supporting the superior sacrocolpopexy as a durable treatment for prolapse and the factors that may differentiate it from other repairs in risk and benefit.
    RESULTS: We emphasize the importance of collaboration between patients and surgeons in surgical decision-making.
    CONCLUSIONS: All medically appropriate patients who desire reconstructive surgery for prolapse should be offered sacrocolpopexy.
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  • 文章类型: Journal Article
    背景和目的:这项回顾性研究旨在调查COVID-19大流行对最常见的择期儿科外科手术和住院人数的影响,并将其与大流行前和大流行后时期进行比较。材料和方法:受试者是18岁以下的患者,他们于2019年3月1日至8月31日,2020年,2021年和2022年在克罗地亚的一个三级中心定期接受选择性择期手术。数据是从外科手术和住院的电子日志中收集的,一天手术的日志,病人的医疗记录,和出院信。这项研究的主要结果是确定之前的选择性外科手术数量的演变,during,在COVID-19大流行的高峰之后;还有,我们的目的是确认和客观化有关住院人数和外科手术数量减少的全球数据和声明.次要结果指标包括住院时间,并发症的数量和类型,和再入院。结果:2020年,择期手术数量减少28.3%,住院人数减少36.2%;2021年,与大流行前(2019年)相比,择期手术数量减少30.8%,住院人数减少14.2%。2022年,与2019年相比,选择性手术增加了22.8%,住院人数减少了2.9%。就并发症而言,研究的各个年份之间的并发症发生率没有统计学差异(p=0.869)。结论:与大流行前相比,COVID-19大流行期间的择期手术和住院人数显著减少。在医疗系统适应大流行的条件后,尽管有COVID-19,但择期手术的数量显著增加,而住院治疗的数量与大流行前大致相同.
    Background and Objectives: This retrospective study aimed to investigate the impact of the COVID-19 pandemic on the most frequently performed elective pediatric surgical procedures and the number of hospitalizations and compare it to the pre-pandemic and post-pandemic periods. Materials and Methods: The subjects were patients under 18 years of age who were regularly admitted for selected elective procedures in a single tertiary center in Croatia from 1 March to 31 August of 2019, 2020, 2021, and 2022. Data were collected from the electronic logs of surgical procedures and hospital admissions, logs of one-day surgeries, patients\' medical records, and discharge letters. The primary outcome of this study was to determine the evolution of the number of elective surgical procedures before, during, and after the peak of the COVID-19 pandemic; also, we aimed to confirm and objectify global data and statements about the decrease in the number of hospital admissions and surgical procedures. Secondary outcome measures included the length of hospitalization, the number and types of complications, and readmissions. Results: In 2020, the number of elective procedures decreased by 28.3% and the number of hospitalizations decreased by 36.2%; in 2021, the number of elective procedures decreased by 30.8% and the number of hospitalizations decreased by 14.2% compared to the pre-pandemic period (2019). In 2022, there was a 22.8% increase in elective procedures and a 2.9% decrease in hospitalizations compared to 2019. No statistical difference was found in the rates of complications between the individual years studied in terms of complications (p = 0.869). Conclusions: The number of elective procedures and hospitalizations during the COVID-19 pandemic has decreased significantly compared to the pre-pandemic period. After the healthcare system adapted to the conditions of the pandemic, the number of elective procedures increased significantly despite COVID-19, while the number of hospitalizations remained approximately the same as before the pandemic.
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  • 文章类型: Journal Article
    对患者预后和死亡的国家机密调查(NCEPOD)审查了为接受克罗恩病手术的成年患者提供的护理质量。这项研究回顾了选修课程,和急诊手术路径,该报告强调了应进行的临床和组织变革,以改善患者护理和预后。
    The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed the quality of care provided to adult patients undergoing surgery for Crohn\'s disease. The study reviewed elective, and emergency surgical pathways and the report highlighted clinical and organisational changes that should be made to improve patient care and outcomes.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:尽管选修程序具有改变生活的潜力,所有手术都有再次手术的固有风险。在调查骨科再次手术风险的知识方面存在差距。我们旨在确定非计划再手术率最高的选择性骨科手术,以及这些手术具有如此高的再手术率的原因。
    方法:使用CPT和ICD-10代码对NSQIP数据库中的患者进行鉴定。从2018年到2020年,我们隔离了612815个骨科手术,并确定了10个无计划返回手术室率最高的CPT代码。对于每个索引过程,我们确定了再手术的ICD-10代码,并将其分类为感染,机械故障,骨折,伤口破裂,血肿或血清肿,神经病理学,other,和未指定。
    结果:膝关节以下截肢(BKA)(CPT27880)的再手术率最高,为6.92%(535例患者中有37例)。后路胸椎(5.86%)或颈椎(4.14%)关节固定术和颈椎椎板切除术(3.85%),翻修全髋关节置换术(5.23%),转换为全髋关节置换术(4.33%),和翻修肩关节置换术(4.22%)是其余最高的再手术率。再次手术的总体主要原因是感染(30.1%),机械故障(21.1%),再手术率最高的10例手术和血肿或血清肿(9.4%)。
    结论:本研究成功确定了30天OR率最高的择期骨科手术。其中包括BKA,后胸椎和颈椎关节固定术,髋关节翻修术,翻修全肩关节置换术,和颈椎椎板切除术.有了这些数据,我们可以确定骨科的领域,在这些领域中,修订协议可以改善患者的预后,并限制患者和医疗保健系统的再手术负担。未来的研究应集中在这些再操作可能对患者和医院系统产生的长期身体和财务影响上。
    方法:IV.
    BACKGROUND: Although elective procedures have life-changing potential, all surgeries come with an inherent risk of reoperation. There is a gap in knowledge investigating the risk of reoperation across orthopaedics. We aimed to identify the elective orthopaedic procedures with the highest rate of unplanned reoperation and the reasons for these procedures having such high reoperation rates.
    METHODS: Patients in the NSQIP database were identified using CPT and ICD-10 codes. We isolated 612,815 orthopaedics procedures from 2018 to 2020 and identified the 10 CPT codes with the greatest rate of unplanned return to the operating room. For each index procedure, we identified the ICD-10 codes for the reoperation procedure and categorized them into infection, mechanical failure, fracture, wound disruption, hematoma or seroma, nerve pathology, other, and unspecified.
    RESULTS: Below knee amputation (BKA) (CPT 27880) had the highest reoperation rate of 6.92% (37 of 535 patients). Posterior-approach thoracic (5.86%) or cervical (4.14%) arthrodesis and cervical laminectomy (3.85%), revision total hip arthroplasty (5.23%), conversion to total hip arthroplasty (4.33%), and revision shoulder arthroplasty (4.22%) were among the remaining highest reoperation rates. The overall leading causes of reoperation were infection (30.1%), mechanical failure (21.1%), and hematoma or seroma (9.4%) for the 10 procedures with the highest reoperation rates.
    CONCLUSIONS: This study successfully identified the elective orthopaedic procedures with the highest 30-day return to OR rates. These include BKA, posterior thoracic and cervical spinal arthrodesis, revision hip arthroplasty, revision total shoulder arthroplasty, and cervical laminectomy. With this data, we can identify areas across orthopaedics in which revising protocols may improve patient outcomes and limit the burden of reoperations on patients and the healthcare system. Future studies should focus on the long-term physical and financial impact that these reoperations may have on patients and hospital systems.
    METHODS: IV.
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