Category Archives: Risk

Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery

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“Despite advances in perioperative care in the last few decades, postoperative pulmonary complications (PPCs) are probably the leading cause of morbidity and mortality in adults undergoing chest and abdominal surgery. PPCs and cardiac complications are commonly regarded as the two major causes of perioperative problems in selected groups of patients undergoing these high-risk surgical procedures. However, PPCs are more common than postoperative cardiac complications and play a bigger role in mortality and healthcare costs. Despite these factors, the natural history of PPCs and the necessity of preventive strategies have not been well recognized in studies to date.”

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Risk Factors for Chronic Pain after Open Ventral Hernia Repair by Underlay Mesh Placement

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“Incisional hernia is one of the most frequent long-term complications after abdominal surgery (11%–20%). After primary repair, rates of recurrence range from 24% to 54%. It has been clearly demonstrated that the use of prostheses for a tension-free repair allows for a
significant reduction in recurrence rate, and even for the treatment of small defects. However, the type and position of the mesh and the mesh fixation technique used are still a matter of debate. The underlay position of the mesh allows for easy treatment of major parietal defects with limited dissection and potentially lower rates of mesh infection, but this position exposes the patient to the risk of small bowel occlusion and enterocutaneous fistula.”

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Retained surgical sponges: occurrences and contributing factors.

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“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.”

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Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

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“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.”

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Predictive factors of splenic injury in colorectal surgery

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“Splenic injury is a major intraoperative complication of abdominal surgery and places patients at a higher risk of morbidity and mortality, of longer operating time, and of longer hospital stay. Splenic injuries may be managed nonoperatively or by splenorrhaphy, partial splenectomy, or complete splenectomy. Because splenectomy is reported to have higher mortality rates than splenorrhaphy, great effort is taken to preserve the spleen; however, excessive blood loss can mandate splenectomy.”

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Predicting the Risk of Readmission From Dehydration After Ileostomy Formation

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“Readmission within 30-days of hospital discharge has received widespread attention as a
potential healthcare quality indicator. In 2013, the Center for Medicare and Medicaid
Services established the Hospital Readmission Reduction Program (HRRP), a cost-
containment strategy that financially penalizes hospitals with higher than expected 30-day
readmission. Though conditions targeted by the HRRP have been predominately medical, it
is anticipated that readmission after surgical procedures will be used to structure financial
incentives and hospital compensation in the near future.”

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Perioperative protocol for pancreatic resections in patients who refuse blood transfusions.

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“The refusal of blood transfusion for surgical procedures at high risk of bleeding, such as pancreatic resection, forces surgeons to face ethical challenges and raises concerns about appropriate perioperative management. In the last two decade the rate of transfusion in high volume centers has gradually decreased thanks to the application of patient blood management (PBM) protocols.”

“In our single-institution experience, patients that categorically refused transfusion were Jehovah’s Witnesses (JW). JW is a religious movement, membership in which accounts for about 0.3% of Western countries’ populations, with USA and Italy having the highest percentages of followers. JW followers believe neither whole blood nor its four major components, namely red cells, white cells, platelets and plasma, should be donated, stored, or accepted in any circumstance, even in life-threatening situations. Advances in transfusion medicine have led the JW’s denomination to modify its position about what is deemed acceptable.”

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