Articles: postoperative-complications.
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Critical care medicine · Mar 2021
Randomized Controlled Trial Multicenter StudyA Multicenter, Open-Label, Randomized Controlled Trial of a Conservative Fluid Management Strategy Compared With Usual Care in Participants After Cardiac Surgery: The Fluids After Bypass Study.
There is little evidence to guide fluid administration to patients admitted to the ICU following cardiac surgery. This study aimed to determine if a protocolized strategy known to reduce fluid administration when compared with usual care reduced ICU length of stay following cardiac surgery. ⋯ A protocol-guided strategy utilizing stroke volume variation to guide administration of bolus fluid when compared with usual care until desedation or up to 24 hours reduced the amount of fluid administered but did not reduce the length of stay in ICU.
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J. Thorac. Cardiovasc. Surg. · Mar 2021
Multicenter StudyFactors associated with unplanned reinterventions and their relation to early mortality after pediatric cardiac surgery.
Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. ⋯ uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.
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Langenbecks Arch Surg · Mar 2021
Multicenter Study Observational StudySuspected appendicitis and COVID-19, a change in investigation and management-a multicentre cohort study.
The COVID-19 pandemic has reformed global healthcare delivery. On 25 March 2020, Intercollegiate guidelines were published in the UK to promote safe surgical provision during the COVID-19 outbreak advocating non-operative management or avoidance of laparoscopy when surgery is essential. The effects of this on the investigation and management of appendicitis remain unknown. ⋯ Introduction of the guidelines was associated with changes in practice. Despite these changes, short-term complications did not increase and LOS decreased. Questions remain on the longer-term complication rates in non-operatively managed patients.
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Langenbecks Arch Surg · Mar 2021
Multicenter StudyAppendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany.
The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. ⋯ The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.
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Multicenter Study
Prediction of Worse Functional Status After Surgery for Degenerative Cervical Myelopathy: A Machine Learning Approach.
Surgical decompression for degenerative cervical myelopathy (DCM) is one of the mainstays of treatment, with generally positive outcomes. However, some patients who undergo surgery for DCM continue to show functional decline. ⋯ The reasons for worse mJOA are frequently multifactorial (eg, adjacent segment degeneration, tandem lumbar stenosis, ongoing neuroinflammatory processes in the cord). This study successfully used ML to predict worse functional status after surgery for DCM and to determine associated predictors.