Canadian journal of surgery. Journal canadien de chirurgie
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Three strategies are used to prevent complications in colorectal surgery: heparin and antibiotics given perioperatively and abdominal drains placed intraoperatively. To investigate the appropriate and inappropriate use of these prophylactic techniques and to assess the costs associated with their inappropriate use, we studied patients who underwent elective colorectal procedures. ⋯ We observed considerable inappropriate use of heparin, antibiotic and drain prophylaxis. Considering the number of elective colorectal procedures performed annually, these inappropriately used strategies represent a substantial cost to the health care system. Improved education of surgeons and residents is needed to change to evidence-based practice habits.
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Elderly patients who suffer trauma have a higher mortality and use disproportionately more trauma resources than younger patients. To compare these 2 groups and determine the outcomes and characteristics of elderly patients, we reviewed patients in these 2 groups admitted and treated in our tertiary care provincial trauma centre. ⋯ Aggressive care for geriatric trauma patients is warranted, and resources should be directed toward rehabilitation. Based on our findings, we expect that creating a directed care pathway for these patients, targetting complications and earlier discharge, will further improve their outcomes.
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The benefit of administering beta-adrenergic blocking agents perioperatively to surgical patients at high risk for myocardial ischemia has been demonstrated in several well-designed randomized controlled trials. These benefits have included a reduction in the incidence of myocardial complications and an improvement in overall survival for patients with evidence of or at risk for coronary artery disease (CAD). We designed a retrospective study at the Ottawa Civic Hospital to investigate the use of beta-blockers in the perioperative period for high-risk general surgery patients who underwent laparotomy and to explore the reasons for failure to prescribe or administer beta-blockers when indicated. ⋯ A significant proportion (> 60%) of general surgery patients who were identified as having definite evidence of, or being at risk for, CAD were not prescribed beta-blockers preoperatively. More than 30% of patients who were on beta-blockers preoperatively did not have them reordered postoperatively. These results may reflect controversy surrounding the recommendations, miscommunication between surgeons and anesthesiologists and errors in postoperative ordering.
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Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70-79 years and those aged 80 years and older. ⋯ Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70-79 yr or > or = 80 yr) does not affect mortality, morbidity or length of hospital stay.