Scand J Surg
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"Open abdomen" is a strategy used to avoid or treat abdominal compartment syndrome. It has reduced mortality both in trauma and non-trauma abdominal catastrophes but also has created a challenging clinical problem. Traditionally, open abdomen is closed in two phases; primarily with a free skin graft and later with a flap reconstruction. ⋯ These techniques can be combined. Choice of the treatment depends on the condition of the patient and size of the fascia and skin defect, and the state of the abdominal contents. In this paper we review the literature on the closure of an open abdomen and present the policy used in our institution in the open abdomen situations.
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Atrial fibrillation is a common arrhythmia after cardiac surgery. It increases morbidity, length of hospital stay, and costs of operative treatment. Beta-blockers, sotalol, amiodarone, corticosteroids, and biatrial pacing have been shown to be efficient in the prevention of postoperative atrial fibrillation. The aim of this study was to find out how widely different prophylactic strategies for postoperative atrial fibrillation are used in Scandinavian countries. ⋯ There is still widely varying implementation of strategies for atrial fibrillation prophylaxis among Scandinavian cardiac surgeons. Lack of confidence in the efficacy of these approaches is the main rationale for nonimplementation.
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Surgery cancelations cause inappropriate use of hospital resources and additional financial and psychological stress to patients. Cancelation rates have been described to be even more than 10% of scheduled cases. Preoperative anesthesia evaluation clinics have been initialized to decrease cancelation rates. At Hyvinkää hospital, 95% of elective surgical patients are admitted on the morning of operation, and only 25% of these patients visit preoperative anesthesia evaluation clinic prior to surgery. Cancelation rate in Finnish hospitals has not been described. ⋯ Day of surgery cancelation rate was low in same-day admission, although it varied between specialties. Specialties having explicit surgery indications had fewer cancelations than specialties having surgery indications based on more subjective diagnostic. Process improvements need to be considered continuously to further decrease cancelation rate.
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Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use. ⋯ The rates of all cholecystectomies decreased despite marked increase in laparoscopic cholecystectomies performed. The increase in risk factors for gallstones in Finland implied more marked increase in laparoscopic cholecystectomies. The possible role of statins on gallstone disease is discussed.
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Comparative Study
Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients.
Both cemented and uncemented hemiarthroplasties are acceptable methods for treating displaced femoral neck fractures. Cemented hemiarthroplasty has traditionally been recommended as being more safe and reliable. However, the cementing process carries a risk of fat embolism and cardiovascular problems. This study attempted to determine whether these complications can be avoided when using a modern uncemented stem. ⋯ Nine perioperative fat-embolic events were found in the cemented group and none in the uncemented group. During the initial hospital treatment, there were five deaths (4.1%) in the cemented group and one death (1%) in the uncemented group. There were significantly more perioperative fractures in the uncemented versus cemented group (7% versus 0.8%). We conclude that uncemented hemiarthroplasty is associated with more perioperative fractures than cemented hemiarthroplasty. However, perioperative cardiovascular disturbances may be less frequent with uncemented hemiarthroplasty, and early mortality may be lower with uncemented hemiarthroplasty.