“Inadvertent enterotomy (IE) is one of the underreported complications in abdominal surgery. Krabben et al reported a 19% incidence of IE in patients who had a repeat
laparotomy. The incidence of and risk factors for IE during enterolysis were reported in a cohort of patients reoperated on. According to Krabben et al, the risk of inadvertent enterotomy in open surgery is more than 10-fold in patients with a history of 3 or more previous laparotomies.”
“Unintended retentions of a foreign object after surgery (e.g. sponge, needle, and instrument) (URFO) remain the sentinel events most frequently reported to The Joint
Commission (TJC). Although these events have happened in other invasive procedures, URFOs are estimated to occur in 1:5500 surgeries. These serious adverse events have resulted in patient harm involving reoperation, readmission/prolonged hospital stay, infection or sepsis, fistulas/ bowel obstructions, visceral perforation, and death.”
“Hospital-associated venous thromboembolism (HA-VTE), commonly defined as deep vein thrombosis (DVT), pulmonary embolism (PE), or both occurring during or within 90 days of hospital admission, is a frequent complication of hospitalization, accounting for approximately one-half to two-thirds of VTE incidence worldwide. HA-VTE events are associated with substantial burdens. They are a leading factor associated with hospital mortality and lost disability-adjusted life-years.”
“Palliative care (PC) interventions in the critically ill have been associated with reduced subsequent ICU admissions and reduced ICU length of stay. Barriers to PC integration
and utilization in the ICU include unrealistic expectations of ICU interventions by patients and families, barriers related to ICU culture as well as cultural attributes of patients and families, insufficient training in PC principles for ICU clinicians, PC workforce shortages,
and inability of patients to participate in treatment discussions. Overcoming these barriers and assessing patient and provider needs for specialty PC depends on the availability and capabilities of PC services at the institutional level, the bandwidth of providers and characteristics of the patient population.”
“Acute pancreatitis is the most common pancreatic disease worldwide. Necrotizing pancreatitis develops in approximately 20 to 30% of patients with acute pancreatitis. Pancreatic and peripancreatic necrosis that becomes infected nearly always leads
to invasive intervention. The current standard approach for infected necrotizing pancreatitis is a minimally invasive step-up approach with catheter drainage as the first step. International guidelines advise postponement of catheter drainage and administration of antibiotics until the infected pancreatic and peripancreatic necrosis has become encapsulated; such walled-off necrosis usually takes 4 weeks to develop.”
“It has been estimated that approximately 4.4% of the United States population has symptomatic hemorrhoids, contributing to as many as 2.5 million ambulatory visits
annually. Excisional hemorrhoidectomy is the preferred treatment for grade 3-4 hemorrhoids and patients unresponsive to non-operative treatment. Despite being a relatively quick, outpatient procedure, one potential serious complication includes post-hemorrhoidectomy
bleeding. Reported rates of this complication have varied. Studies suggest that .4-10% of hemorrhoidectomy cases will be complicated by bleeding and many requiring a second intervention.”
“Urologists who perform urinary diversions should not only be familiar with surgical techniques to create these diversions but should also be aware of metabolic changes that arise when intestinal segments are used to divert or to store urine. Many patients have a long life expectancy, even after oncological surgery with urinary diversion. The advance of medical care makes urinary diversion possible in older, less fit patients with impaired renal function. The duration of contact between urine and bowel, the segment and length of bowel used are factors that determine the nature and grade of metabolic effects. Diversion will result in immediate changes in metabolism.”
“The most popular diversions to date are made from ileal or ileocolonic segments. Noncontinent ileocutaneostomy or Bricker diversion is the most frequently used type of
diversion. This procedure was popularized by Bricker. In this procedure, a conduit is made from approximately 15 to 25 centimeters of preterminal ileum. Reasons for this
popularity over other types of diversion are the relative ease and simplicity of the procedure, the predictable functional results (no risk for incontinence, retention, and catheterization problems), and the fact that this type of diversion results in less metabolic changes (shorter bowel segment, no urinary storage).”
Surgical Focus 