The American surgeon
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The American surgeon · Nov 1995
Comparative StudyIncreased incidence of nosocomial infections in obese surgical patients.
Obesity has long been considered a potential risk factor for poor outcome following surgical procedures. However, controversy exists regarding the clinical impact of this problem because of a paucity of data regarding the incidence and risk of nosocomial infections in obese surgical patients. This retrospective study was undertaken to compare the nosocomial infection rate in obese and normal weight surgical patients. ⋯ No differences in distribution between groups were evident. Mortality was similar among the groups. These data support the hypothesis that obesity is a significant risk factor for clinically relevant nosocomial infections in surgical patients.
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Pseudoaneurysms of the splenic artery have been well described in association with pancreatic pseudocysts secondary to pancreatitis. We present a case of a ruptured splenic artery pseudoaneurysm 14 years after splenectomy for trauma which, at that time, was complicated by a subphrenic abscess.
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The American surgeon · Nov 1995
The effect of epidural analgesia on the return of peristalsis and the length of stay after elective colonic surgery.
Epidural analgesia has been shown to improve pulmonary function and analgesia after abdominal surgery. Although epidural analgesia may increase colonic motility, its effect on the clinical outcome following colonic surgery is unclear. Therefore, the purpose of this study was to determine the effect of epidural analgesia on return of peristalsis and length of stay after elective colonic surgery as compared with traditional analgesia. ⋯ No statistically significant difference was found between epidural and traditional analgesia with regard to return of peristalsis or length of stay. Similarly, when considering the location of the anastomosis (left versus right colon), no statistically significant difference was demonstrated between the two groups. Also, there was no increased incidence in anastomotic leaks or mortality.
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The American surgeon · Oct 1995
ICU care after infra-inguinal arterial surgery: an analysis of indications and outcomes.
The authors analyzed 632 consecutive, nontrauma Surgical Intensive Care Unit (SICU) admissions after infra-inguinal arterial surgery over a 3-year period (4/89-3/92) for the need for postoperative SICU care. Group I consisted of 122 patients (58 males, 64 females) with at least one absolute indication for SICU care, including mechanical ventilation, pulmonary artery, catheter monitoring, or intravenous infusion of vasoactive or antiarrythmic drugs. Group II comprised 510 patients (275 males, 235 females) without an absolute indication for SICU care. ⋯ There was no significant difference in the age of Group I and Group II patients, but Group I patients had a significantly longer preoperative LOS (6.1 +/- 0.7 vs 3.2 +/- 0.3 days, P < 0.0005). In Group II patients there were significant correlations between patient age and postoperative death, as well as between preoperative LOS and SICU LOS > 1 day. Patient age > or = 80 years and preoperative LOS > 3 days are significant preoperative correlates of the need for SICU care following infra-inguinal arterial surgery in patients who do not have an absolute indication for such care.
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The American surgeon · Sep 1995
Randomized Controlled Trial Clinical TrialThe influence of anesthetic method on infrainguinal bypass graft patency: a closer look.
Although several studies have demonstrated a reduced incidence of postoperative deep venous thrombosis among patients who receive regional anesthesia, the influence of anesthetic method on early arterial bypass graft patency has not been well studied. The records of 78 consecutive patients undergoing elective femoro-popliteal (FP) or femoro-tibial (FT) bypass grafts, and who were randomized to receive general anesthesia and postoperative patient-controlled intravenous narcotic analgesia (GEN, n = 41), or epidural anesthesia and postoperative continuous epidural analgesia (EPI, n = 37), were retrospectively reviewed. The two groups were evenly matched with respect to demographic characteristics, risk factors, and vascular variables. ⋯ Graft occlusion occurred in 11 (17.1%) of the 64 limb salvage cases, including nine (27.3%) GEN and two (6.5%) EPI cases (P < 0.05), and in seven (12.7%) of 55 greater saphenous vein grafts, including six (22.2%) GEN and 1 (3.6%) EPI cases (P < 0.05). By multivariate analysis, FT grafts, preoperative plasminogen activator inhibitor-1 (PAI-1) levels, and GEN were predictive of early graft occlusion (P < 0.05). Furthermore, the levels of circulating PAI-1 were higher 24 hours postoperatively among patients in the GEN group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)