mRCRI score ≥ 3 is associated with increased postoperative non-cardiac morbidity and prolonged hospital stay after elective orthopaedic procedures. mRCRI can contribute to objective risk stratification of postoperative morbidity.
Cancer is a leading cause of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths reported in 2012. 1 Over the next 20 years, the number of new cancer cases is expected to rise by about 70% to 22 million new cases per year by 2030. 1 Surgical tumour resection remains the cornerstone of treatment for most cancers and with the increasing incidence of solid tumour diagnoses, surgery is likely to increase. With this comes an anticipated increase in health expenditure. These cost increases are not only attributed to an ageing and co-morbid population but more to a rapid advancements in available diagnostics and treatment. A considered and consistent decision-making process for those considered for high-risk surgery, including major cancer surgery, is paramount to ensure patients have the best outcome(s) and finite healthcare resources are utlilised effectively. 2 One such is the multidisciplinary team (MDT) approach described in some high-risk surgical groups. 2 The aim of this article is to discuss the role and important concepts of the MDT approach in high-risk surgery, with a focus on major cancer surgery.
A 51-year-old gentleman with tetralogy of Fallot underwent pulmonary valve replacement and tricuspid valve annuloplasty necessitating endocardial pacing system extraction so that the annuloplasty ring could be sited. During the same operation, an epicardial pacing system was implanted with the generator positioned subcutaneously in an epigastric position.Six months later, the box was moved to the left iliac fossa because of pocket pain and a Medtronic extension connector box was used to extend the lead so that it could be implanted in a subrectus position. Several months later, the patient presented with intermittent skeletal muscle twitching in the abdomen.Lead impedance had fallen from 746 to 562 Ohms suggestive of a current leak. A radio-opaque marker was placed over the site of maximal twitching on abdominal x-ray (figure 1) which appeared to overly a lead fracture and so the patient was admitted electively for surgical exploration. During the operation, no fracture could be identified but rather the large screws used to secure the existing lead to the connector box were exposed resulting in a current leak. Figure 2 shows the surgeon placing medical adhesive over one of the screws. Due to the infrequent use of this equipment, the insulating glue was overlooked at the time of initial implantation. This case illustrates the need for a full understanding of all pacing hardware not in routine use prior to the start of a case and the importance of close collaboration between surgeons and pacing specialists when the need arises. Competing interests None.Provenance and peer review Not commissioned; externally peer reviewed. Figure 1 A radio-opaque marker was placed over the site of maximal abdominal twitching and appeared to overly a lead fracture. Figure 2 Surgeons place medical insulating glue over the bare screws which caused the current leak.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.