Surgery in practice and science最新文献

Introduction

Materials and Methods

Results

Conclusion

Introduction

Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy.

Methods

We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific.

Results

Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (n = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors.

Conclusion

This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.

Introduction

Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) represent a high-risk for venous thromboembolism (VTE) due to malignancy, prolonged surgery and immobility. We investigated the incidence of and risk factors for VTE following CRS/IPC.

Materials and methods

Data was analysed on 130 CRS/IPC performed over a 6-year period at a single centre, the Western Australian Peritonectomy Service (WAPS), on lower gastrointestinal neoplasia: pseudomyxoma peritoneii (PMP), colorectal cancer (CRC) and appendix cancer (AC). Data was analysed by univariate and multivariate logistic regression to identify risk factors for VTE.

Results

31 patients (24 %) experienced a VTE. The percentages of VTE among patients with PMP (n = 50), CRC (n = 53) and AC (n = 27) were 36 %, 17 % and 15 % respectively. 60 % of these cases were asymptomatic. The odds of VTE were higher for PMP patients than in patients with a other histopathology (OR=2.9, p = 0.01). Other significant risk factors for VTE on univariate analysis were PCI (OR=1.07, p = 0.001), pelvic dissection (OR=5.52, p = 0.001) and operation time (OR=1.36, p = 0.001).

Conclusion

This study demonstrates high rates of VTE in patients undergoing CRS/IPC. Patients with PMP have a three-fold higher risk of VTE compared to other malignancies (CRC+AC). As most VTE cases were asymptomatic, aggressive early investigation and intervention is indicated for patients undergoing CRS/IPC.

Background

Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).

Methods

We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (N = 473). The Unmarried group included never married, divorced, and widowed individuals (N = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's t-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at p$\le 0.05.$

Results

Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups.

Conclusion

This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.

Objective

Guided imagery is a relaxation technique that uses mental visualization to help individuals relax and focus their minds. This systematic review examines the effect of guided imagery on perioperative anxiety in hospitalized adult patients. The aim is to provide a comprehensive analysis of the existing evidence on the efficacy of guided imagery as an intervention for reducing perioperative anxiety.

Methods

A systematic search was conducted on databases including Web of Science, PubMed, Scopus, and PsycINFO. After screening titles and abstracts, full-text articles were assessed for eligibility. The selected studies were analyzed for their findings related to the effect of guided imagery on perioperative anxiety in adult patients.

Results

Nine studies met the inclusion criteria and provided sufficient data for analysis. The majority of the included studies reported a statistically significant reduction in perioperative anxiety following guided imagery interventions. The variations in intervention protocols, such as the content, duration, and frequency of guided imagery, were observed across the studies. Patient satisfaction and acceptance of guided imagery interventions were generally high.

Conclusion

The findings of this systematic review suggest that guided imagery is an effective intervention for reducing perioperative anxiety in hospitalized adult patients. Despite the limitations of small sample sizes and variability in measurement tools, the consistent positive results and high patient satisfaction indicate the potential benefits of incorporating guided imagery into perioperative care protocols. More comprehensive research with bigger samples and standardized tools is essential for guiding imagery integration in clinical practice.

Introduction

Third molar extractions present a wide spectrum of reported complications, spanning from 2.6 % to 30.9 %, making it challenging to predict outcomes for individual patients.

This study seeks to evaluate third molar extractions conducted exclusively by stomatology or maxillofacial surgery residents, examining associated complications. Its aim also extends to delineating the related risks concerning epidemiological and clinical factors, juxtaposed against findings in the existing literature.

Materials and methods

An observational prospective cohort study was conducted at the Clinical and Academic Centre of Coimbra, Portugal, from July 2021 to December 2023. Descriptive statistics were used considering the adequate statistical parameters. Inferential statistical analysis was performed using Student's t-test, the Chi-squared test, and Spearman rank correlation to analyze the relationship between study variables. A p-value of less than 0.05 was considered statistically significant.

Results

485 patients underwent third molar extractions performed exclusively by stomatology and maxillofacial surgery residents, comprising a total of 686 extracted teeth and resulting in 71 reported complications (14.6 % per patient and 10.3 % per extracted tooth). Results revealed that patients undergoing lower third molar extraction faced a 3.7 times higher risk of complications compared to those undergoing upper third molar extraction. Teeth categorized as “IIIC” by Pell and Gregory's classification and those undergoing osteotomy and odontosection also exhibited a higher-than-expected complication rate with statistically significant differences being observed. No other variables showed a positive or negative statistically significant correlation with complication occurrence.

Discussion and conclusion

Despite the expectation of a heightened complication rate, this study revealed that a successful and comprehensive training regimen results in encountering complication rates akin to those documented in established literature.

These findings also underscore the importance of recognizing that a resident's surgical accomplishment is intrinsically tied to acknowledging and respecting their learning curve.

Methods

We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.

Results

We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, p = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, p = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, p = <0.004).

Conclusions

Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.

Introduction

Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.

Materials and Methods

A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery (“Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie” or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients’ characteristics, diagnoses, and treatments were analyzed.

Results

In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all p < 0.001), and cutaneous abscess (p = 0.01). The proportion of complicated appendicitis (p = 0.02), complicated hernia (p < 0.001), and complicated gallstone disease (choledocholithiasis p = 0.01; inflammation, p = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (p < 0.001).

Conclusions

The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.