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Vascular Surgical Patients (vascular + surgical_patient)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

A meta-analysis of the prospective randomised trials of coronary revascularisation before noncardiac vascular surgery with attention to the type of coronary revascularisation performed

ANAESTHESIA, Issue 10 2009
B. M. Biccard
Summary Prospective randomised trials of coronary revascularisation prior to noncardiac surgery have shown no survival benefit following noncardiac surgery. However, these studies have not differentiated the outcomes associated with coronary artery bypass grafting (CABG) and percutaneous coronary interventions. We performed a meta-analysis of the randomised controlled trials of pre-operative coronary revascularisation for noncardiac surgery, extracting data for 30 day and long term all-cause mortality and myocardial infarction (MI) following revascularisation, according to the type of revascularisation performed. Pre-operative percutaneous coronary intervention was associated with significantly increased 30 day MI and composite death and MI. Pre-operative CABG was associated with a significantly improved long term composite outcome of death and MI compared to percutaneous coronary interventions. The adverse effect of percutaneous coronary interventions on both short and long term outcomes in vascular surgical patients should be taken into consideration when interpreting these trials. CABG may improve long term outcomes in vascular surgical patients. The indications for and timing of CABG in vascular surgical patients needs further research. [source]

A meta-analysis of the utility of C-reactive protein in predicting early, intermediate-term and long term mortality and major adverse cardiac events in vascular surgical patients

ANAESTHESIA, Issue 4 2009
L. Padayachee
Summary We conducted a meta-analysis of the utility of pre-operative C reactive protein (CRP) in predicting early (< 30 days), intermediate (30,180 days) and long term (> 180 days) mortality and major adverse cardiac events (MACE; cardiac mortality and nonfatal myocardial infarction (MI) combined) following vascular surgery. Of 291 studies identified, ten prospective patient cohorts were identified. A pre-operative CRP > 3 mg.l,1 was not associated with 30-day all-cause mortality, cardiac mortality, nonfatal myocardial infarction or MACE. Intermediate-term all-cause mortality, cardiac death and MACE showed a trend to a worse outcome (odds ratio (OR) 9.07, 95% confidence interval (CI) 0.86,96.28, p = 0.07; OR 8.71, 95% CI 0.5,153.1, p = 0.14 and OR 2.81, 95% CI 0.78,5.18, p = 0.15 respectively). Long term all cause mortality (OR 2.40, 95% CI 1.15,5.02, p = 0.02), cardiac death (OR 5.66, 95% CI 1.71,18.73, p = 0.005) and MACE (OR 2.76, 95% CI 1.38,5.55, p = 0.004) were significantly increased. [source]

Delays in discharge of vascular surgical patients: a prospective audit

ANZ JOURNAL OF SURGERY, Issue 6 2010
Senarath Edirimanne
Abstract Aim:, To quantify delays in discharge for vascular surgical patients and identify causes of such delays. Methods:, A prospective audit of delays in discharge of vascular surgical admissions over a 6-month period was performed. Expected date and time of discharge was compared with actual date and time of discharge. Day-case patients, patients who died during admission and patients not under the direct care of the vascular team were excluded. Results:, There were 99 elective and 51 acute admissions accounting for 729 hospital bed days. The median (range) age was 72 years (21,92) and 94% of patients were living independently in the community. Forty-seven percent of patients were discharged on the planned day and time, 21% on the planned day but at a later-than-predicted time and 32% were delayed by more than 1 day. Delays identified in this audit accounted for 135 bed days. Fifteen percent of delays were due to causes that can be improved by internal organization (e.g. delayed paperwork). The majority of the delays (85%) were due to external factors such as lack of rehabilitation beds or lack of placement facilities in nursing homes. Elderly patients and acute admissions were more likely to have long delays in discharge. Conclusion:, Delays in discharge of vascular surgical patients use a lot of acute surgical bed days. Strategies to prevent delays in discharge should include not only improving internal organization and early identification and referral of patients who require rehabilitation/placement but also increased funding for such essential non-acute services. [source]

PERIOPERATIVE HIGH-DOSE OXYGEN THERAPY IN VASCULAR SURGERY

ANZ JOURNAL OF SURGERY, Issue 6 2007
Phillip J. Puckridge
Background: Patients undergoing infrainguinal bypass surgery have reduced baseline tissue oxygen tension and high rates of wound infections. The hypoxaemia worsens during surgery, potentially reducing the ability to combat bacterial lodgement. We investigated whether high-dose perioperative oxygen administration to patients undergoing infrainguinal arterial surgery results in increased tissue oxygenation. Methods: Ten consecutive patients undergoing infrainguinal arterial surgery had transcutaneous partial pressure of oxygen (TcpO2) measured preoperatively, intraoperatively after arterial clamps applied, postoperatively and at discharge. Measurements were taken with inspired oxygen concentration (FiO2) of 30% then 80%. Arterial blood gases were measured at the same times. Results: Tissue oxygenation showed no difference intraoperatively while arterial clamps were in place, but significantly higher tissue oxygenation was seen with use of high-dose oxygen (FiO2 80%) postoperatively (P < 0.05). Carbon dioxide levels in tissue increased while arterial clamps were in place (P < 0.01) and pH fell intraoperatively and following reperfusion (P < 0.05). Conclusion: The administration of high-dose oxygen to vascular surgical patients undergoing lower-limb arterial surgery results in increased tissue oxygen concentrations when perfusion is not reduced by the presence of arterial clamps. These results suggest the administration of high-dose oxygen intraoperatively may be beneficial in reducing wound infections, but further research is required. [source]