Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Introduction: Despite the use of less invasive and increasingly effective techniques\nin order to reduce the morbi-mortality per and post-operative, the\nCPPO remain an important problem in surgery. Objectives: To determine\nthe rate of per and post-operative complications, to describe the types of\ncomplications and to identify their risk factors. Methodology: This was a\nprospective study carried out from 04 April to 03 June 2016 in the surgical\ndepartment of CHU-Gabriel TOURE. All patients aged 18 and over operated\nin the Surgical Department (General Surgery, Gynaecology and Obstetrics,\nUrology, Traumatology, Otolaryngology, Neurosurgery and Emergency Department),\nhaving been hospitalized at least for 24 hours after surgery, were retained.\nThe method of sampling N = P(1- P)Za2I2was used; the minimum size\nnecessary was 209 patients. We conducted invitations and the phone call to\ndetermine the occurrence of complications and survival of patients up to 30\ndays after surgery Results: We counted 262 patients, of whom 142 (54.2%)\nwere women and 120 (45.8%) were men with a sex ratio = 0.85. The average\nage was 41.48 years, with extremes of 18 and 86 years. We found 71 complications\nin 61 patients, an early CPPO rate of 23.28%. The various complications\nencountered were: urinary tract infections (26.76%), surgical site infections\n(28.17%), pulmonary infections (12.68%) and Deaths (21.13%). The\noccurrence of complications prolonged the hospital stay by 6 days and increased\nthe average cost of care of 102,700 FCFA. According to Clavien Dindoâ??s\nclassification, the severe postoperative complication in our series was\n9.16% (grade III + IV + V). Factors favoring the occurrence of CPPO were\nage > 41 years old, ASA > II, the classes of Altemeier 3 and 4, NNISS score 1\nand 2, diabetes and hemoglobin rate 8 g/dl. Conclusion: Complications per and\n post-operative (CPPO) are common in the department of Surgery of\nCHU-Gabriel TOURE and are dominated by post-operative infection. These\ncomplications seem to be favored by multiple factors more related to the patients\nthan to the hospital structure....
Background: Recurrence after incisional hernia repair is one of the major problems related with this operation. Our\nobjective is to analyze the influence of abdominal wall surgery expertise in the results of the open elective repair of\nincisional hernia.\nMethods: We have compiled the data of a cohort of patients who received surgery for an incisional hernia from\nJuly 2012 to December 2015 in a University Hospital. Data were collected prospectively and registered in the\nSpanish Register of Incisional Hernia (EVEREG). The short- and long-term complications between the groups of\npatients operated on by the Abdominal Wall Surgery (AWS) unit and groups operated on by surgeons outside of\nthe specialized abdominal wall group (GS) were compared.\nResults: During the study period, a total of 237 patients were operated on by the open approach (114 AWS; 123\nGS). One hundred seventy-five patients completed a median follow-up of 36.6 months [standard deviation (SD) = 6].\nGroups were comparable in terms of age, sex, body mass index (BMI), comorbidities, and complexity of hernia.\nComplications were similar in both groups. Patients in the AWS group presented fewer recurrences (12.0% vs.\n28.9%; P = 0.005). The cumulative incidence of recurrence was higher in the GS group [log rank 13.370; P < 0.001;\nodds ratio (OR) = 37.8; 95% confidence interval (CI) = 30.3-45.4]. In the multivariate analysis, surgery performed by\nthe AWS unit was related to fewer recurrences (OR = 0.19; 95%CI = 0.07-0.58; P < 0.001).\nConclusion: Incisional hernia surgery is associated with better results in terms of recurrence when it is performed\nin a specialized abdominal wall unit....
Background: To study different value of estimated glomerular filtration rate with normal serum creatinine whether\nis a risk factor for hidden renal function of cardiac surgery outcomes.\nMethods: A total of 1744 cardiac surgery patients with serum creatinine less than equal to1.2 mg/dL (female)/1.5 mg/dL (male)\nwere divided into 3 groups: estimated glomerular filtration rate Greater than equal to 90 mL/min/1.73 m2 (no renal dysfunction,\nn = 829), 60 less than equal to estimated glomerular filtration rate < 90 mL/min/1.73 m2 (hidden renal dysfunction, n = 857),\nestimated glomerular filtration rate < 60 mL/min/1.73 m2 (known renal dysfunction, n = 58) and followed up for\n3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury.\nResults: The proportion of preoperative hidden renal dysfunction was 67.1% among patients Greater than equal to 65 years old\nand 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years,\nknown renal dysfunction was a risk factor for postoperative acute kidney injury (P < 0.01) and progressive chronic\nkidney disease (P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney\ndisease (P = 0.024). For patients Greater than equal to 65 years, only known renal dysfunction was a risk factors for 3-year\nmortality (P = 0.022) and progressive chronic kidney disease (P< 0.01).\nConclusion: Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac\nsurgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent\nrisk factor for progressive chronic kidney disease....
Objective: To assess the anatomical and functional results after surgical management\nof leg shaft mal-union in African environment. Methodology: This\nwas a retrospective study of patients operated for leg mal-union at Brazzaville\nUniversity Hospital between January 2014 and December 2018. The studied\nparameters were epidemiological and therapeutic. The anatomical evaluation\nwas based on the quality of the legâ??s relaxation and bone healing, which was\nindicated on standard X-rays. The functional evaluation was based on Thorensenâ??s\ncriteria. Results: Five patients were selected for this study. There\nwere 3 men and 2 women with an average age of 39 years with extremes of 27\nand 59 years. Three patients were treated with locked intramedullary nail and\n2 patients with screwed plate. At an average follow-up of 9 months, bone\nconsolidation was achieved in all our patients. The average consolidation\ntime was 4 months (range 3 to 7 months). We noted 1 case of residual\nmal-union in valgus (5Degree) on screwed plate and 1 case of valgus angulation\n(5Degree) on locked intramedullary nail. Walking was considered normal in 3 patients.\nThe wearing of a 2 cm heel was indicated in 2 patients. According to\nThorensenâ??s criteria, the overall results were considered good in 3 patients\nand average in 2 patients. Conclusion: Leg shaft mal-union are likely to cause\nserious functional issues. Their treatment is strictly surgical and osteotomy is\nthe only management option to restore the anatomy of the deformed limb....
Objective: We aimed to determine the impact of surgical experience and frequency of practice on perioperative\nmorbidity and mortality in pancreatic surgery.\nMethods: 1281 patients that underwent pancreatic resections from 1993 to 2013 were retrospectively analyzed using\nlogistic regression models. All cases were stratified according to the surgeonâ??s level of experience, which was based on\nthe number of previously performed pancreatic resections and the extent of received supervision (novice: n < 20 /\nintensive; intermediate: n =21-90 / decreasing; and experienced surgeon: n > 90 / none). Additional stratification was\nbased on the frequency of practice (sporadic: 3 resections > 6 weeks, frequent: 3 resections less than equal to6 weeks).\nResults: The novice and experienced categories were related to a decreased risk of postoperative pancreatic fistulas\n(odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26-0.82 and 0.54, 95% CI 0.36-0.82) and in-hospital mortality (OR 0.45,\n95% CI 0.17-1.16 and 0.42, 95% CI 0.21-0.83) compared to the intermediate category. Frequent practice was associated\nwith a significantly lower risk of delayed gastric emptying (OR 0.56, 95% CI 0.38-0.83), postpancreatectomy hemorrhage\n(OR 0.64, 95% CI 0.42-0.98) and in-hospital mortality (OR 0.45, 95% CI 0.24-0.87).\nConclusions: Our results emphasize the importance of supervision within a pancreatic surgery training program. In\naddition, our data underline the need of a sufficient patient caseload to ensure frequent practice....
Loading....