The American surgeon
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The American surgeon · Sep 2009
Comparative StudyIncidence of anastomotic leak in patients undergoing elective colon resection without mechanical bowel preparation: our updated experience and two-year review.
Mechanical bowel preparation before elective colon resection has recently been questioned in the literature. We report a prospective study evaluating the anastomotic leak rate in patients undergoing elective colorectal surgery without preoperative mechanical bowel preparation. One hundred fifty-three patients undergoing elective colon resection from July 2006 to June 2008 were enrolled into this Institutional Review Board-approved study. ⋯ Five of the eight patients who developed an anastomotic leak had significant preoperative comorbidities, including neoadjuvant radiation therapy, diabetes mellitus, end-stage renal disease, prior anastomotic leak, and tobacco use. Elective colon resection can be performed safely without preoperative mechanical bowel preparation. Vigilance for anastomotic leak must be maintained at all times, especially in patients with comorbidities that predispose to anastomotic leak.
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The American surgeon · Sep 2009
Comparative StudyElective surgery in patients with end stage renal disease: what's the risk?
Little research has been performed in regards to the morbidity and outcomes associated with elective general surgery performed on patients with end stage renal disease (ESRD). With minimal data about the severity of disease in these patients, we sought to quantify the differences in the ESRD patient undergoing elective surgical procedures compared with matched controls. A review of all ESRD patients undergoing elective surgical procedures at a University Medical Center between 2001 and 2005 was performed. ⋯ Incidence of death (4%) in the ESRD group was increased as well. Patients with ESRD require longer hospital stays and have an increased overall incidence and frequency of complications than patients with normal renal function undergoing elective general surgery procedures. The significantly increased morbidity should be considered when evaluating expected outcomes.
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The American surgeon · Sep 2009
Comparative StudyResection of portovenous structures to obtain microscopically negative margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is worthwhile.
Locally advanced pancreatic adenocarcinoma may require resections of the portal vein and/or its major tributaries to achieve tumor extirpation, albeit with the potential for increased morbidity and mortality. However, major venous resections can impart complete tumor extirpation and thereby a survival advantage compared with resections with residual microscopic disease. This study was undertaken to determine if resection of the portal vein and/or its splenic or superior mesenteric venous (SMV) tributaries is a worthwhile endeavor. ⋯ There was no difference in survival after PD without portovenous resection (17 months) versus PD with portovenous resection (18 months). Resections with complete tumor extirpation (i.e., R0 resections) provide superior long-term survival; all efforts to obtain R0 resections should be undertaken. Portovenous resections during pancreaticoduodenectomy can be undertaken safely and are worthwhile when complete tumor extirpation is attainable.
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The American surgeon · Sep 2009
Comparative StudyUnplanned intubation after surgery: risk factors, prognosis, and medical emergency team effects.
Unplanned intubation after surgery is a marker for severe adverse events. We investigated the incidence, risk factors, and prognosis of unplanned intubation after general and vascular surgery and sought to determine whether the deployment of a hospital-wide medical emergency team (MET) had a preventive effect. We included all patients undergoing general and vascular surgical procedures between April 1, 2006, and June 30, 2008, from our American College of Surgeons National Surgical Quality Improvement Program data. ⋯ Most (84%) unplanned intubations occurred in a critical care setting and the most common underlying reason was sepsis (40%). The overall case fatality rate was 43 per cent but varied significantly depending on the underlying reason for unplanned intubation. Incidence rates of unplanned intubation did not change significantly after MET deployment, suggesting that other strategies are needed to prevent this rare but highly morbid and mortal event.