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Postoperative Fever (postoperative + fever)
Selected AbstractsCarbon Dioxide Laser Endoscopic Diverticulotomy Versus Open Diverticulectomy for Zenker's Diverticulum ,THE LARYNGOSCOPE, Issue 3 2004C. W. David Chang MD Abstract Objectives/Hypothesis To compare open and CO2 laser,assisted endoscopic surgical management of Zenker's diverticulum. Study Design A retrospective review of 49 consecutive surgically treated patients with Zenker's diverticulum was conducted. Methods Patients' records were reviewed and analyzed for patient age and sex, size of diverticulum, incision time (time recorded from start of incision to surgical completion of case), length of hospital stay, complications, and follow-up management. A postoperative questionnaire inquiring about swallow function was conducted by mail or telephone. Swallow function was assessed on a four-point scale. Results Various procedures performed included endoscopic CO2 laser,assisted diverticulotomy (n = 24) and open diverticulectomy with cricopharyngeal myotomy (n = 28). The average incision time of laser endoscopic cases (47 min) was significantly shorter (P < .001) than that of open diverticulectomy cases (170 min). Length of hospital stay did not significantly vary between the two groups. Five patients (21%) initially treated with laser endoscopic diverticulotomy demonstrated symptomatic persistent Zenker's diverticulum; three underwent repeat operation. No open cases required repeat operation. One endoscopic case was aborted secondary to esophageal injury from placement of the endoscope. Postoperative fever was seen in two (8%) endoscopic cases and four (14%) open approach cases. No major complications (recurrent laryngeal nerve paralysis, mediastinitis, or death) were encountered. More than 90% of respondents in each treatment group reported normal or near-normal swallow function. Conclusion Laser endoscopic management is a reasonable and safe method for surgical treatment of Zenker's diverticulum in comparison with the open technique. Employment of the endoscopic approach reduces operative time and the complexity of postoperative care. Practitioners should be aware that the endoscopic approach may result in a higher failure rate. [source] Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in PakistanINTERNATIONAL WOUND JOURNAL, Issue 1 2008Ahmed Khan Sangrasi Abstract This prospective study aimed to determine the surgical site infection (SSI) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro. A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study. All four surgical wound categories were included. Primary closure was employed in all cases. Patients were followed up to 30th day postoperatively. All cases were evaluated for postoperative fever, redness, swelling of wound margins and collection of pus. Cultures were taken from all the cases with any of the above finding. Mean ± SD age of the patients was 38·8 ± 17·4 years with male to female ratio of 1·5:1. The overall rate of surgical site infection was 13·0%. The rate of wound infection was 5·3% in clean operations, 12·4% in clean-contaminated, 36·3% in contaminated and 40% in dirt-infected cases. Age, use of surgical drain, duration of operation and wound class were significant risk factors for increased surgical site infection (P < 0·05). Postoperative hospital stay was double in cases who had surgical site infection. Sex, haemoglobin level and diabetes were not statistically significant risk factors (P > 0·05). In conclusion, surgical site infection causes considerable morbidity and economic burden. The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended. [source] Safety of cesarean myomectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Byung-Joon Park Abstract Aim:, To examine the safety and appropriateness of uterine myomectomy during cesarean section. Methods:, We conducted a retrospective analysis of 97 patients who underwent myomectomy during cesarean section and 60 patients who had uterine myomas, but underwent cesarean section only, between January 2000 and December 2007. Based on the patients' medical records, we conducted an analysis of the characteristics of the uterine myomas, hematologic changes that occurred between the preoperative and postoperative phases, complications, and length of hospital stay. Results:, Changes in hemoglobin values between the preoperative and postoperative phases, indicating the degree of intraoperative bleeding, were evaluated. There were no significant differences between the two groups (cesarean myomectomy group [1.2 ± 1.2 g/dL] versus control group [1.1 ± 1.3 g/dL]). There were no significant differences in the frequency of blood transfusion, incidence of postoperative fever, duration of surgery, and length of hospital stay between the two groups. In patients who received a blood transfusion intraoperatively, the increased amount was added to the hemoglobin changes between the preoperative and postoperative phases (adjusted value). The difference in the adjusted value of hemoglobin change did not reach statistical significance (cesarean myomectomy group [1.3 ± 1.2 g/dL] versus control group [1.2 ± 1.1 g/dL]). When the size of the uterine myoma exceeded 6 cm, the operative time was longer in the cesarean myomectomy group. Conclusion:, Cesarean myomectomy is a safe surgical option with no significant complications if performed by an experienced practitioner. [source] Implementation of a Clinical Pathway in Management of the Postoperative Vestibular Schwannoma Patient,THE LARYNGOSCOPE, Issue 11 2001Katrina R. Stidham MD Abstract Objective The purpose of the study was to evaluate the effectiveness of a new clinical pathway in management of patients with postoperative vestibular schwannoma. The impact on duration of hospitalization and quality of care was evaluated. Study Design The study was a retrospective review of 59 consecutive patients undergoing surgical intervention for vestibular schwannoma between January 1995 and July 1999. Methods A new clinical pathway for management of postoperative vestibular schwannoma patients was implemented at The California Ear Institute at Stanford (Palo Alto, CA) in January 1995. All patients undergoing surgical intervention subsequent to initiation of the pathway were included in the study. Data including surgical approach, patient age, sex, and tumor size were included. Duration of hospitalization and postoperative complications were recorded. During the same time period, data for patients undergoing radiation therapy for vestibular schwannomas were evaluated for length of hospital stay and in-hospital complications. Data were compared with norms recorded in the literature for duration of hospitalization and complications following surgical intervention. Results Fifty-nine patients underwent 35 middle fossa approaches and 24 translabyrinthine approaches to their tumors. The average patient age was 53 years; there were 34 female and 25 male patients. The average length of hospital stay was 3.83 days (SD = 1.4 days) with a range from 2 to 10 days. Postoperative complications were observed in 19% of patients, including eight (13%) cerebrospinal fluid (CSF) leaks, two requiring lumbar drains (3.4%); one hematoma (1.6%), one postoperative fever (1.6%), and one dural tear with associated hyponatremia (1.6%). These results compared favorably with previously recorded average hospital stays of 5.95 to 9.5 days 1,5,7 and CSF leak complication rates of 7% to 15%. 9,10 Conclusions Implementation of a clinical pathway for management of the patient with postoperative vestibular schwannoma improves efficiency of patient care, allowing decreased duration of hospitalization. This goal is achieved without increasing complication rates and, in our experience, actually improving the quality of clinical care. The cost-effectiveness of clinical pathways may become increasingly important in a managed care,driven environment. [source] | ||||||||||