The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.
The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
ObjectiveTo investigate the incidence and predictors of wound dehiscence in patients undergoing radical cystectomy (RC).
Patients and MethodsIn all, 1 776 patient records with Current Procedural Terminology (CPT) codes for radical cystectomy (RC) were extracted from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) between 2005 and 2012. Stratification was made based on the occurrence of postoperative wound dehiscence, defined as loss of integrity of fascial closure. Descriptive and logistic regression models were used to identify predictors of postoperative wound dehiscence. The implications of wound dehiscence on peri-and postoperative outcomes such as complications, mortality, prolonged length of stay (>11 days), and prolonged operative time (>411 min), were assessed.
ResultsOf 1 776 patients analysed, 57 (3.2%) had a documented wound dehiscence. In multivariable analyses, chronic obstructive pulmonary disease (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0-4.0; P = 0.03) and high body mass index (OR 2.3, 95% CI 1.3-4.4; P = 0.008) were significant predictors of wound dehiscence. While female gender had significantly lower proportions of wound dehiscence, multivariable analyses did not confirm this (OR 0.4, 95% CI 0.4-1.4; P = 0.75).
ConclusionsOur study is the first to identify predictors of wound dehiscence after RC in a large, contemporary multiinstitutional cohort. Identifying patients at risk of postoperative wound complications may guide the use of preventative measures at the time of surgery.
Rapid buildup of gas within the cranial vault can result in a life-threatening condition known as “tension pneumocephalus,” necessitating immediate surgical intervention. Nitrous oxide (N2O), a commonly used inhaled anesthetic, is associated with the development of tension pneumocephalus and its role in neurosurgical procedures has been debated in the literature. We present a case of tension pneumocephalus with preexisting pneumocephalus secondary to the usage of N2O as an inhaled anesthetic. Included is a literature review of studies discussing the role of N2O in the development of tension pneumocephalus. N2O is associated with tension pneumocephalus especially in the setting of preexisting pneumocephalus. Tension pneumocephalus can manifest as Cushing response and immediate decompression is life-saving. Nitrous oxide should be used cautiously in neurosurgical procedures, especially with preexisting pneumocephalus.
Background:Nerve decompression has been recently described as a therapy for migraine headaches. Multiple studies have demonstrated significant symptomatic relief or complete resolution of migraine symptoms in patients with surgical decompression. However, there is no study describing a causal relation between migraine headaches and nerve compression and resolution of symptoms with tumor removal and nerve decompression.Methods:We were presented with a biological example of compression neuropathy causing migraine headaches due to greater occipital nerve compression by a lipoma from a remote head trauma. Included is a literature review of nerve decompression therapy for migraine.Results:Migraine symptoms were completely resolved on removal of the mass and nerve decompression. The patient has not required any migraine medications since the surgery.Conclusions:This case serves as a biological example to validate the true causal relationship between greater occipital nerve compression and migraine headaches.
The large angle of rotation coupled with the ability to complete the procedure without repositioning the patients makes trapezius myocutaneous flap an attractive option for posterior skull reconstruction. In our limited experience, the pedicled trapezius flaps are a reliable alternative as they are well vascularized and able to obliterate the soft-tissue defect completely. The recipient site healed completely in infected as well as irradiated wound beds. In addition, the donor site can be primarily closed with minimal donor-associated complication.
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