Medical Management of the Surgical Patient

Abstract

Now in its fifth edition, Medical Management of the Surgical Patient: A Textbook of Perioperative Medicine has been fully revised and updated and continues to provide an authoritative account of all aspects of perioperative care for surgical patients. Including recommended plans which aid accurate treatment of patients, it provides an evidence-based approach for consulting physicians to care for patients with underlying medical conditions that will affect their surgical management. The latest minimally invasive surgical techniques are included, with new chapters on thoracic aortic disease, reconstruction after cancer ablation, lung transplantation, esophagomyotomy, vasectomy and thyroid malignancies, amongst others. With detailed descriptions of nearly one-hundred operations, highlighting their usual course as well as their common complications, the book encourages learning from experience. This definitive account includes numerous contributions from leading experts at national centers of excellence. It will continue to serve as a significant reference work for internists, hospitalists, anesthesiologists and surgeons.

Geographical Variation in Outcomes of Primary Hip and Knee Replacement

“…We classified potential factors as patient, surgical, or hospital organizational factors (eTable 1 in the Supplement). Patient factors included calendar year of THR or TKR; age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared 10 ; American Society of Anesthesiologists (ASA) grade 11 ; area-level socioeconomic deprivation using the Index of Multiple Deprivation, based on patient residential post code; rural vs urban indicator; primary indication; Charlson Comorbidity Index (CCI) score; baseline OHS or OKS score; and the baseline European Quality of Life-Five Domain (EQ-5D-3L) score. Surgical factors included lead surgeon experience, surgical volume per lead surgeon and year, surgical volume per unit and year, minimally invasive surgery (yes or no), thromboprophylaxis, mechanical prophylaxis, anesthetic type, and type of approach.…”

Untitled

“…On the other hand, some evidence exists that previous treatment with DA may increase complication rates and lower remission rates. Therefore early surgery is preferred for patients in whom this modality of treatment is indicated [61]. After initiating medical treatment it is important to control PRL levels after one month [3].…”

“…Patients with macroprolactinomas usually need greater doses of DA, which is associated with more side effects and poor compliance [55]. Therefore, pituitary surgery can be considered as a first-line treatment for patients with macroprolactinomas in centres with well-trained neurosurgeons, since DA can cause tumour fibrosis and higher rates of post-operative complications [61]. Biochemical revaluation is recommended 3, 6 then 9 months after surgery, and MRI should be repeated 3-6 months after surgery.…”