SEARCH · Search PubMed

Results for “risk reducing surgery”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed1979

Preoperative embolization of Wilms' tumors.

In two patients with Wilms' tumors, the ipsilateral kidney was nonfunctional. To facilitate initial surgical removal of the tumors, a preoperative transcatheter embolization was performed following diagnostic arteriography. Preoperative embolization of a renal tumor reduces the vascularity of the lesion prior to surgery, and a patient in whom primary surgical removal of the tumor would carry unacceptable risk may be converted into one in whom primary surgical removal is safe.

Child↗

PubMed1978

[Surgery for carcinoma of the oesophagus. A plea for precise technique and pleuro-mediastinal drainage (author's transl)].

During surgery for carcinoma of the oesophagus, the authors emphasise the need for selective intubation using a Carlens tube, of avoiding damage to the diaphragm and the phrenic nerve at all levels, and of draining the hemithorax involved in the operation by three drains: anterior and posterior thoracic and madiastino-abdominal. These precautions reduce post-operative difficulties, justifiy excision surgery for carcinoma of the oesophagus, and to a certain extent make it possible to reduce the contraindications, in particular in the presence of tracheo-bronchial spread. Amongst 107 patients undergoing surgery, in whom there was a risk of respiratory insufficiency in one quarter, surgery (sometimes with extension of the excision: one case in four) was associated with an operative and post-operative mortality of 18%.

Aged↗

PubMed1977

The changing status of ejection fraction as a predictor of early mortality following surgery for acquired heart disease.

Several reports in the literature and our experience prior to 1974 support the thesis that operative risk in patients with acquired heart disease and poor ventricular function (as assessed by a biplane ejection fraction [EF] less than or equal to 0.40) was very significantly increased over the risk in patients with normal ventricular function. These results led to disagreement in the literature regarding the advisability of surgery in patients with poor ventricular function. Various EFs from less than 0.31 to less than 0.50 were suggested as contradicting elective surgery, while more aggressive groups recommended surgery in all patients with angina. Precise comparison of the results reported by different groups was not always possible because of the common reliance on single-plane right anterior oblique ventriculograms, which tend to underestimate EF and overestimate operative risk. Using biplane ventribulograms for accurate estimation of EF, we have demonstrated a significant reduction in 30-day operative risk to a clinically acceptable 3 percent (1/32) for single valve replacement and aortocoronary surgery patients with poor ventricular function (EF less than or equal to 0.40) during 1974. Considering the high risk of medically treated patients with reduced ventricular function, these results support further evaluation of surgical palliation for patients with valvular or coronary heart disease and reduced ventricular function.

Cardiac Volume↗

PubMed1978

[The treatment of arterial occlusion by means of ultraviolet radiation of the blood (author's transl)].

The advantages of ultraviolet radiation of the blood are obvious. In many cases threatened amputation could be avoided. Ultraviolet radiation of the blood entails little risk and for this reason should be given preference over surgery whenever success with the reconstructive technique is questionable. The length of hospitalization can be reduced by using the ultraviolet radiation technique, and many patients can be treated exclusively on an outpatient basis using this technique. It offers not only medical but also social and economic advantages. Owing to the fact that the ultraviolet radiation technique has proved to be effective in other fields as well, it also deserves more attention from researchers.

Ambulatory Care↗

PubMedDate not supplied

Cricopharyngeus myotomy as the only treatment for Zenker diverticulum.

Cricopharyngeal dysfunction, one of the most common causes of pharyngeal dysphagia, exhibits a variety of manifestations, one of which is Zenker diverticulum. This paper examines the physiology of swallowing, pathophysiology of its aberrations, and various methods of treating Zenker diverticulum. It is our purpose to emphasize cricopharyngeus (CP) myotomy as the only needed treatment for this diverticulum. Even in its advanced stages, excision of the diverticulum is a needless surgical exercise. Seven cases of Zenker diverticulum are reported in elderly patients; one of them had an excision of the diverticulum prior to presentation. Some were either completely obstructed or aspirating on esophagram. Cricopharyngeus myotomy, the only treatment provided, proved to be safe and effective without morbidity or fatalities. Patients' ability to eat orally was restored on the night of or the morning after surgery. No Levin tube is necessary and there is no risk of suture line leakage after the conventional diverticulectomy and CP myotomy. Hospital stay is greatly reduced and there is no risk of structure formation. In contrast to endoscopic division of CP muscle, there is no risk of mediastinitis because there is no break through the mucosa.

Aged↗

PubMed1976

Antithrombotic drugs: part I.

There are three categories of antithrombotic agents: drugs which prevent fibrin fromation (the anticoagulants and defibrinating enzymes), drugs which prevent platelet adhesion or aggregation (the antiplatelet drugs), and thrombolytic drugs which induce fibrin degradation. Clinical studies have now led to a better understanding of the relative value of these drugs in different thrombotic disorders. In addition, knowledge of the mechanism of action of some of these drugs has recently been much advanced. The anticoagulant drugs in clinical use are heparin and the oral anticoagulants. Heparin is a potent inhibitor of several steps on the intrinsic coagulation pathway through its effect on a plasma cofactor, antithrombin III. its action is immediate, but heparin must be given parenterally. Oral anticoagulants act more slowly, by reducing the hepatic synthesis of biologically active factors II, VII, IX and X, but can be given by mouth. Heparin is therefore most suitable for starting anticoagulant treatment, while oral anticoagulants are generally used for prolonged therapy. The value of the anticoagulants as antithrombotic agents has been best assessed by studying their effectiveness in preventing and treating venous thromboembolic disease. Oral anticoagulants have been repeatedly shown to prevent venous thrombosis and pulmonary embolism in patients at high risk of developing these complications. However, the increased risk of postoperative bleeding has prevented their widespread use for this purpose in surgical patients. Recently, the use of low doses of heparin, given subcutaneously before and after surgery, has been shown to markedly reduce the incidence of venous thrombosis and pulmonary embolism (including fatal pulmonary embolism) after major elective abdominal surgery, and to produce only a slight increase of postoperative bleeding. This represents a major advance in anticoagulant prophylaxis of venous thromboembolism insurgical patients. However, low dose heparin prophylasix is relatively ineffective in patients having hip surgery, and has not been evaluated in patients having other types of orthopaidic surgery. There is direct evidence that antocoagulant therapy prevents death and recurrent embolism in patients who have developed pulmonary embolism, and considerable indirect evidence that it prevents pulmonary embolism, and considerable indirect evidence that it prevents pulmonary embolism (and death from pulmonary embolism) in patients who have venous thrombosis. The incidence of further venous thromboembolism or bleeding during treatment appears to be minimised when heparin is given by continuous intravenous infusion in a dose sufficient to produce a moderate, but no excessive, prolongation of a heparin-sensitive, in vitro coagulation test. The tests most commonly used to monitor heparin therapy was based on either the whole blood clotting time or the activated partial thromboplastin time...

Anticoagulants↗

PubMed1979

Cardiac risk factors in patients undergoing noncardiac surgery.

Cardiac risks of noncardiac surgery are associated with some noncardiac risk factors but are primarily a function of the patient's underlying cardiac disease. Elective surgery should only be performed when the patient is in optimal condition--i.e., with no evidence of heart failure, at least 6 months after a previous myocardial infarction, and so forth. Careful monitoring of fluid status should lead to reduced cardiac morbidity and mortality after surgery in these patients.

Anesthesia↗

PubMed2026

Effect of intraoperative 40-hz gamma-frequency auditory stimulation on postoperative delirium in older adults undergoing major surgery: a randomized clinical trial protocol.

INTRODUCTION: Postoperative delirium (POD) is a common and clinically significant complication among older adults undergoing major surgery under general anesthesia. Gamma-frequency (40-Hz) auditory stimulation has demonstrated potential neuroprotective and cognition-enhancing effects, suggesting a plausible role in perioperative delirium prevention. However, direct clinical evidence supporting intraoperative 40-Hz auditory stimulation in reducing POD remains limited, warranting rigorous evaluation in a randomized trial. PATIENTS AND METHODS: This prospective, parallel-group, randomized controlled trial will enroll 550 older adults scheduled for major noncardiac, nonneurosurgical surgery under general anesthesia. Participants will be randomized in a 1:1 ratio to either the active stimulation group, receiving intraoperative 40-Hz gamma-frequency auditory stimulation delivered via headphones for 2 h following successful anesthesia induction, or the sham stimulation group, wearing headphones without active auditory output. The primary outcome is the incidence of POD on postoperative day 1 though 3, assessed using the Confusion Assessment Method (CAM) or the CAM for the ICU (CAM-ICU). Secondary outcomes include POD severity, sleep quality, pain scores, analgesic consumption, the incidence of postoperative nausea and vomiting (PONV), rescue antiemetic use, duration of post-anesthesia care unit (PACU) stay, length of hospital stay, quality of postoperative recovery, incidence of perioperative adverse events; postoperative morbidity, health-related quality of life, and all-cause 30-day mortality. DISCUSSION: This trial will determine whether intraoperative 40-Hz gamma-frequency auditory stimulation reduces the incidence of POD among older adults undergoing major surgery under general anesthesia. If efficacious, this noninvasive intervention could constitute a feasible perioperative strategy to mitigate delirium risk and enhance postoperative recovery. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500115156).

Humans↗

PubMed1979

[Radioimmunological determination of parathyroid hormone: regional localization in hypercalcaemic hyperparathyroidism (author's transl)].

Angiographic or scintigraphic localization of parathyroid adenomas is successful in only a small number of patients with hypercalcaemic hyperparathyroidism. This report is concerned with the preoperative localization of parathyroid adenomas by regional catheterization of the thyroid veins in patients with hypercalcaemic hyperparathyroidism (n = 7). PTH was determined radioimmunologically, using an antiserum specific for PTH1-84 and the carboxyl-terminal fragment of the hormone. Determination of regional differences in the plasma concentration of PTH permitted the preoperative localization of PTH secreting adenomas. The preoperative localization of parathyroid adenomas was confirmed in each instance by surgery. Thus, the regional determination of plasma PTH represents a tool to improve the preoperative localization of parathyroid adenomas in patients with hypercalcaemic hyperparathyroidism and, hence, to reduce the risk of an unsuccessful operation.

Adenoma↗

PubMed1977

[Possibilities for the use of lasers in dental surgery].

The use of the Nd:YAG laser in everyday oral surgery in patients with a hemorrhagic diathesis is reported. It proved successful in various hemorrhagic disorders mild forms of hemophilia A. The most essential including step forward seems to be that this may simplify the so far complicated treatment of this group of patients in a hospital, as it may enable outpatient therapy to be performed and considerably reduce the cost of treatment. In addition, the risk of hepatitis is smaller for all those patients in whom missing clotting factors have had to be substituted up to the present.

Hemophilia A↗

PubMed1979

[Value of allergic intradermal reactions to antibiotics in preparation for surgery (in patients with a history of drug allergy)].

An allergological examination technique for application in patients with a history of hypersensitivity to antibiotics is described with reference to a personal series of 250 subjects admitted to the Bologna University obstetric and gynaecological pathology department for small pelvis surgery. The method of investigation is described and the results obtained are reviewed. It is felt that the investigation is of value in preoperative screening insofar as it eliminates or reduces the risk of allergic shock, and enables more precisely directed antibiotic management to be employed.

Adolescent↗

PubMed1979

[Use of electrolyte solutions in surgery (author's transl)].

The use of isotonic saline and Ringer's lactate in surgery has become widespread following the work of Shires on the sequestration of extra-cellular fluid in hemorrhagic shock. Their use both in military and civilian practice and during hemodilutions in cardiac surgery have shown their efficacy. During intensive care, the risk of pulmonary edema is insignificant when less than 4 liters are given daily. Apart from cases of severe renal failure, they increase diuresis and reduce post-operative renal failure. Their use in appropriate cases permits economies in blood transfusion.

Cardiac Surgical Procedures↗

PubMed1979

[Diplopia frequency as a result of the surgical treatment of concomitant squint].

Postoperative diplopia in cases of congenital strabismus or early onset occured in 5% of patients operated on in 1977. We cannot calculate the frequency of diplopia in children operated on up to the age of 9 years old (290 cases) since no child suffered from diplopia. Its incidence-5% (9 out of 177 cases) relates to patients older than 9 years at the time of surgery, 6 patients out of 20 cases with consecutive exotropia complained of diplopia (following revision surgery). Amblyopia - foveal or eccentric fixation-alone seems to be a less important risk than consecutive exotropia. Preoperative wearing of prism to compensate the objective angle of squint over a few days can reduce but not exclude the general risk of postoperative diplopia.

Adolescent↗

PubMed1979

A retrospective analysis of conservative versus active management in severe open myelomeningocele.

88 patients with thoraco-lumbar myelomeningocele not operated upon in the 1976-1977 period were compared with 76 patients with the same condition operated upon in the 1964-1971 period. There was no significant difference in sex and hydrocephalus at birth in the two groups. Mortality was less in the surgically treated group only after the age of three months. Ventriculitis appeared to be related to the incidence of hydrocephalus in the surgically treated group. There was a reduced risk of developing progressive hydrocephalus after birth in the untreated group, and the neurological status of the survivors at one year was the same in both groups. Interpreting the results as indicating that early surgery increased the incidence of progressive hydrocephalus and ventriculitis, and might increase survival of more disabled infants, then non-surgical treatment is justified since survivors are no worse as a result of this non-active approach.

Cerebral Ventricles↗

PubMed2026

Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data Analysis of the STRIVE Trial.

STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To re-evaluate vancomycin as a preventive measure for surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: Intrawound vancomycin powder is used to prevent SSIs in spinal surgery. Prior studies, often limited to single institutions or small samples, have shown mixed efficacy and potential increases in non- S. aureus and Gram-negative infections. We hypothesized that SSIs rates would be similar with and without intrawound vancomycin in posterior spinal fusion (PSF) surgery. METHODS: Prospectively collected data from the 3595 patients in the STaphylococcus aureus suRgical Inpatient Vaccine Efficacy (STRIVE) trial were stratified by intrawound antibiotic usage. Multivariate logistic regression assessed the effect of vancomycin use on SSI, adjusting for patient demographics and SSI-associated risk factors. Secondary outcomes included critical care stay, reoperation, sepsis, and hospital readmission. RESULTS: Of 3311 patients who underwent surgery, 847 (26%) received only intrawound vancomycin and 1534 (46%) received no intrawound antibiotics. Sixty (8%) patients developed postoperative SSI, of whom 20 (33%) had received intrawound vancomycin. Receiving intrawound vancomycin was not associated with SSI incidence versus no intrawound antibiotics [odds ratio (OR): 0.77; 95% CI: 0.42-1.42], critical care stay (OR: 0.94; 95% CI: 0.78-1.12), or sepsis (OR: 2.04; 95% CI: 0.62-6.73). However, intrawound vancomycin was associated with increased odds of hospital readmission (OR: 1.82; 95% CI: 1.28-2.6; P < 0.001) and reoperation (OR: 1.75; 95% CI: 1.18-2.6; P = 0.005). Factors significantly associated with intrawound vancomycin use included intraoperative antibiotic readministration (OR: 2.97; 95% CI: 1.36-6.5; P =0.006) and hospital location, lower odds in Europe (OR: 0.13; 95% CI: 0.06-0.29; P < 0.001) or Asia (OR: 0.02; 95% CI: 0-0.08; P < 0.001) versus North America. CONCLUSIONS: Intraoperative vancomycin use was not associated with reduced SSI incidence compared with no intrawound antibiotics after PSF surgery. LEVEL OF EVIDENCE: Level II.

Humans↗

PubMed1977

The use of the carbon dioxide laser in plastic surgery.

For centuries, surgical technics have included sharp metal instruments for incisions and dissections together with time-consuming clamping and tying of vessels with associated blood loss. The CO2 laser presents the first major change in these basic technics. Our brief experience with the Sharplan 791 indicates consistently marked reduced blood loss, less postoperative edema, and less postoperative pain with no increased risk to the patient and no compromise in the end results. Admittedly, much more investigation is necessary to determine its full potential, and perhaps its contraindications. However, it would appear at this time that the proper use of this new modality should be incorporated into our armamentarium of tools for plastic surgical advantages consistent with sound surgical judgment.

Carbon Dioxide↗

PubMed2026

Higher versus Routine Intraoperative Blood Pressure Targets in Noncardiac Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis of Randomized Trials.

BACKGROUND: Observational studies consistently link intraoperative hypotension to adverse postoperative outcomes, leading guidelines to recommend maintaining mean arterial pressure 60 to 65 mmHg or greater during noncardiac surgery. Whether targeting higher intraoperative blood pressure values improves clinical outcomes remains uncertain. METHODS: The authors conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses-guided search on PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Embase from inception to April 2026. Randomized trials comparing higher intraoperative blood pressure targets, either as fixed absolute thresholds or personalized to preoperative baseline, versus routine blood pressure management in adults undergoing elective noncardiac surgery with general anesthesia were included. Outcomes included in-hospital or 30-day mortality, postoperative delirium, acute kidney injury (AKI), 30-day major cardiovascular events, acute myocardial injury, stroke, length of stay, and intraoperative hypotension. RESULTS: Fifteen trials (15,603 patients) were included. Higher targets did not reduce AKI (risk ratio [RR], 0.95; 95% CI, 0.85 to 1.06; P = 0.36; I 2 = 16%) or acute myocardial injury (RR, 1.02; 95% CI, 0.94 to 1.12; P = 0.59; I 2 = 0%) compared with routine targets, with firm evidence from trial sequential analysis. Higher targets were associated with a significant reduction in postoperative delirium (RR, 0.73; 95% CI, 0.54 to 0.98; P = 0.04; I 2 = 26%), although trial sequential analysis indicated the cumulative evidence remained insufficient to draw firm conclusions. No significant effect was observed on in-hospital or 30-day mortality (RR, 1.00; 95% CI, 0.75 to 1.34; P = 1.00; I 2 = 0%); evidence on 30-day major cardiovascular events, stroke, and length of stay was similarly insufficient to draw firm conclusions. CONCLUSION: In adults undergoing elective noncardiac surgery, targeting higher intraoperative blood pressure values does not improve major postoperative outcomes compared with routine management. A potential reduction in postoperative delirium warrants confirmation in adequately powered trials.

Humans↗

PubMed2026

Rationale, design, and experiences from the vanguard phase of the bariatric surgery for the reduction of cardiovascular events (BRAVE) trial.

BACKGROUND: Observational studies suggest that metabolic/bariatric surgery (MBS) reduces mortality and major adverse cardiovascular events in patients with obesity, but adequately powered randomized trials (RCTs) are lacking. The Bariatric Surgery for the Reduction of Cardiovascular Events (BRAVE) trial was designed to address this evidence gap. METHODS: BRAVE is an investigator-initiated, multi-center, open-label RCT with blinded endpoint adjudication comparing MBS vs guideline-based medical weight management (MWM) in adults with obesity and high-risk cardiovascular disease (CVD). Eligible participants have a body-mass index ≥35 kg/m² or ≥30 kg/m² with type 2 diabetes or age >55 years, and prior myocardial infarction (MI), coronary intervention, heart failure (HF), atrial fibrillation (AF) with elevated CHA₂DS₂-VASc score, cerebrovascular disease, or peripheral arterial disease. Participants are randomized 1:1 to MBS (sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch) or MWM, which includes dietary, behavioral, and pharmacologic therapies. The primary outcome is the composite of all-cause death, MI, stroke, HF events, coronary revascularization, AF hospitalization, and renal events. A vanguard phase of 200 participants was implemented to optimize recruitment and logistics. RESULTS: As of October 2025, 2,514 individuals have been screened from 17 centers in Canada, Brazil, Italy and Spain, with 444 entered MBS work-up, and 200 have been randomized. The randomized cohort (mean age 59.8 years; 37% female; mean BMI 44.0 kg m⁻²) has high burden of hypertension (82%), diabetes (45%), coronary artery disease (44%), HF (39%), and AF (48%). Recruitment barriers were identified and addressed through targeted education and enhanced patient engagement. CONCLUSIONS: BRAVE is the first large RCT evaluating whether MBS safely reduces major cardiovascular events compared with medical therapy in high-risk patients with obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05531474.

Humans↗