Operative mortality rates among surgeons

Tekkis, Paris; Kocher, Hemant M.; Bentley, Alison; Cullen, P. T.; South, L. M.; Trotter, G. A.; Ellul, J. P. M.

doi:10.1007/bf02236732

Cited by 103 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The decision to withdraw treatment should be based on validated prognostic scales that are used to objectively assess the general condition based on physiological variables and factors associated with greater perioperative mortality. Most reports [13,16,17]. Our study showed that the scores of the P-POSSUM scale corresponded closely with the actual treatment outcomes of patients with acute mesenteric ischemia.…”

Section: Discussionsupporting

confidence: 75%

Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

Jagielski

Piątkowski

Jackowski

2020

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Introduction. Acute mesenteric ischemia, although rare, is associated with numerous complications and death. This work presents acute mesenteric ischemia treatment based on an analysis of various management strategies and identifies prognostic factors that influence therapy effectiveness. Material and Methods. We conducted a retrospective analysis of all patients who were diagnosed with acute mesenteric ischemia due to occlusion and hospitalized between January 1, 2002, and December 31, 2018. Results. Acute ischemia of the bowel mesentery was diagnosed in 41 patients (27 women and 14 men; mean age, 65.4 years). All patients underwent laparotomy. For 13 (31.71%) patients, surgery was performed within the first 24 hours of the clinical symptom onset. Mesenteric artery embolectomy without intestine resection was performed for 7 (17.07%) patients. Partial intestine resection due to necrosis was performed for 21 (51.22%) patients. Exploratory laparotomy without a therapeutic procedure was performed for 13 (31.71%) patients. Fifteen (36.59%) patients were discharged home in good general condition. Twenty-six (63.41%) patients died. The time from the clinical symptom onset until intervention exceeded 24 hours for all patients who died. Surgery within the first 24 hours reduced mortality associated with acute mesenteric ischemia (P=0.001). Female sex, age older than 65 years, obesity (body mass index>30), diabetes, chronic kidney disease, and smoking were adverse prognostic factors for increased mortality for patients with acute bowel ischemia. Conclusion. The time from clinical symptoms to acute mesenteric ischemia treatment was the main prognostic factor and helped determine appropriate management. Early diagnosis and rapid intervention improved treatment outcomes and survival.

show abstract

Section: Discussionsupporting

confidence: 75%

Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

Jagielski

Piątkowski

Jackowski

2020

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…The POSSUM score is calculated using a combination of 12 physiological and 6 operative data variables for each patient to calculate percentage risk. Originally developed in 1991 by Copeland et al (Copeland et al 1991 ), it has been evaluated widely, including in orthopaedic, vascular, head and neck and colorectal surgeries (Mohamed et al 2002 ; Prytherch et al 2001 ; Myers 1993 ; Griffiths et al 2002 ; Tekkis et al 2000 ). The OS-MRS uses a binary point scoring system based on five variables to stratify patients into three main groups (DeMaria et al 2007 ).…”

Section: Methodsmentioning

confidence: 99%

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

2018

View full text Add to dashboard Cite

BackgroundAs the prevalence of obesity is increasing, the number of patients requiring surgical intervention for obesity-related illness is also rising. The aim of this pilot study was to explore predictors of short-term morbidity and longer-term poor weight loss after bariatric surgery.MethodsThis was a single-centre prospective observational cohort pilot study in patients undergoing bariatric surgery. We assessed the accuracy (discrimination and calibration) of two previously validated risk prediction models (the Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality, POSSUM score, and the Obesity Surgical Mortality Risk Score, OS-MS) for postoperative outcome (postoperative morbidity defined using the Post Operative Morbidity Survey). We then tested the relationship between postoperative morbidity and longer-term weight loss outcome adjusting for known patient risk factors.ResultsComplete data were collected on 197 patients who underwent surgery for obesity or obesity-related illnesses between March 2010 and September 2013. Results showed POSSUM and OS-MRS were less accurate at predicting Post Operative Morbidity Survey (POMS)-defined morbidity on day 3 than defining prolonged length of stay due to poor mobility and/or POMS-defined morbidity. Having fewer than 28 days alive and out of hospital within 30 days of surgery was predictive of poor weight loss at 1 year, independent of POSSUM-defined risk (odds ratio 2.6; 95% confidence interval 1.28–5.24).ConclusionsPOSSUM may be used to predict patients who will have prolonged postoperative LOS after bariatric surgery due to morbidity or poor mobility. However, independent of POSSUM score, having less than 28 days alive and out of hospital predicted poor weight loss outcome at 1 year. This adds to the literature that postoperative complications are independently associated with poor longer-term surgical outcomes.

show abstract

“…As expected, the 2 older cohorts of patients appeared to be at greater risk, as demonstrated by a higher percentage of patients with an American Society of Anesthesiologists' score of 3 or 4 and a higher predicted morbidity and mortality rate by POSSUM. [30][31][32][33][34]…”

Section: Commentmentioning

confidence: 99%

Advantages of Laparoscopic Colectomy in Older Patients

et al. 2003

View full text Add to dashboard Cite

Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3, 181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3.0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.

show abstract

Operative mortality rates among surgeons

Cited by 103 publications

References 14 publications

Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

Advantages of Laparoscopic Colectomy in Older Patients

Contact Info

Product

Resources

About