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At least 19 recordsLinked to original sources
PubMed1999

[Demand for and use of blood supply for elective surgical procedures].

UNLABELLED: In elective surgical operations on thyroid gland and breast gland, in cholecystectomy, axillary or inguinal dissections and hernioplasties blood units are usually ordered for the operation. The aim of the study was to analyse the real requirement of transfusions during several years and to show that in the above-mentioned operations only in exceptional cases blood units must stand by. METHODS: At the Surgical Hospital I of the University Leipzig, a retrospective analysis of the anaesthetic records and patient documentations from 1994 to 1997 was performed with regard to intraoperative blood transfusions. RESULTS: There were 1122 operations on the thyroid gland (119 of it as total thyroidectomy), 465 operations on the breast gland, 413 cholecystectomies, 70 axillary and 60 inguinal dissections and 445 hernioplasties. Intraoperative transfusions were necessary in nine operations on the thyroid gland (0.8%), in six operations on the breast gland 1.3%), twice in cholecystectomy (0.5%) and only once in an axillary dissection (1.4%). The analysis of the patients' records showed in almost all of these cases special risk factors such as disorders of blood coagulation or thyroidal function, anaemia, serious other diseases or a necessary extension of the operation. CONCLUSION: It is justified to perform the above-mentioned operations without a routine order of blood units. This would lead to enormous financial savings. Because the optimal care for the patients has priority, it is necessary to estimate the individual risk of a required transfusion preoperatively and to keep low the blood loss by the surgeon during the operation.

Blood Loss, Surgical↗
PubMed1996

[Evaluating elective surgical procedures in ulcer surgery].

Elective surgical treatment of peptic ulcers is less important after the introduction of effective conservative treatment. However, in a chronic recurrent disease all options of treatment have a place. In duodenal ulcer highly selective vagotomy is the procedure of choice despite the high recurrence rate, since it has a low operative risk and a low rate of early postoperative morbidity or late sequelae. In gastric ulcer distal partial gastrectomy (Billroth I) must be recommended using the same criteria. Laparoscopic techniques will not alter the indication for surgery; these procedures are still hampered by technical problems and the main problem of high recurrence rate after vagotomy is not solved by choosing a different approach to the abdomen. Surgical treatment of peptic ulcers must be revalidated in respect to health care reform.

Gastrectomy↗
PubMed1979

Effective use of blood in elective surgical procedures.

The preoperative requests for crossmatching of blood in elective surgical procedures were studied at the Flinders Medical Centre, South Australia. The study revealed that surgeons order crossmatched blood on the basis of habit. This led to considerable time-expiry of blood, and to unnecessary use of laboratory personnel's time and reagents. The statistical information collected during the study was used to educate the surgeons to change their blood-ordering practice. In procedures where excessive blood loss is unlikely to occur, as a stand-by, a "group-and-screen" procedure was substituted for crossmatching. A firm recommendation for maximum blood order in elective surgical procedures was also made. It is estimated that this approach would save approximately $80,000 per year per 350-bed general hospital in Australia.

Australia↗
PubMed2000

Transfusion thresholds in common elective surgical procedures in Finland.

BACKGROUND AND OBJECTIVES: Transfusion practices and thresholds in common elective surgical procedures were investigated in a nationwide multicenter survey in Finland. MATERIALS AND METHODS: The records of 764 total hip replacement (THR), 397 total knee replacement (TKR) and 343 transurethral resection of the prostate (TURP) patients were reviewed by four anesthesiologists. RESULTS: The allogeneic red cell (RBC) transfusion rates in THR, TKR and TURP operations were 92, 84 and 18%, respectively. In THR and TKR, 74% of patients who lost 20% or less of their blood volume during hospitalization were transfused with RBCs. Postoperatively, the median pretransfusion hemoglobin values were 9.6 g/dl in orthopedic operations and 10.7 g/dl in TURP. In some hospitals, the median transfusion threshold in TURP patients was as high as 11.2 g/dl. CONCLUSION: The transfusion thresholds in all operations were liberal compared to recent international recommendations. Inappropriate thresholds were reflected in the high transfusion rates. This study accentuates the need for continuous discussion and educational measures to find optimal indications for transfusion in surgery, and to rationalize the transfusion policy in Finland.

Aged↗
PubMed1995

Functioning and well-being of patients before and after elective surgical procedures.

BACKGROUND: Recent changes in health care delivery and financing have prompted interest in medical outcomes research. This study was performed to assess the effect of general surgical procedures on the health status of patients over time. STUDY DESIGN: The functional health status of patients undergoing elective surgical procedures was measured preoperatively, in the immediate postoperative period, and three and six months after surgery. Complete data were collected for 82 patients presenting to the general surgery service at the Ohio State University Medical Center for symptoms related to gallbladder disease (21), hemorrhoids (10), inguinal and incisional hernias (37), and clinically severe obesity (14). The Short Form-36 health status questionnaire was administered before the surgical procedure, at the first postoperative visit, and by telephone three months and six months following surgery. Hospital records were reviewed following the procedures, and preoperative anesthesiologist's risk status, American Society of Anesthesiologists scores, and complications were noted. Patient satisfaction was assessed using a questionnaire developed by Ohio State University. RESULTS: For all four elective procedures, a significant improvement in health status was demonstrated when preoperative function was compared to measurements three and six months postoperatively. Improvement was significant in all eight categories assessed, encompassing physical, social, mental, emotional, and general health, and pain relief. Dramatic improvement was reported by patients undergoing Roux-en-Y gastric bypass for clinically severe obesity. CONCLUSIONS: The Short Form-36 health status questionnaire proved to be a useful tool in assessing patient outcomes following elective surgical procedures. The general health status assessment will be especially useful for documenting the effectiveness of routine and innovative therapies.

Activities of Daily Living↗
PubMedDate not supplied

Potentially unintended discontinuation of long-term medication use after elective surgical procedures.

BACKGROUND: Transitions between health care settings represent vulnerable periods for medical error. Discontinuation of long-term medication use may occur during discharge from the hospital to the community. METHODS: We performed a population-based, cohort study using administrative records from Ontario, Canada, between April 1, 1997, and September 30, 2002. We studied all residents 66 years and older with continuous use of warfarin, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), or beta-blocker ophthalmic drops for 1 or more years. Those who had an overnight hospitalization for selected elective surgical procedures were compared with 2 control groups: one that had an ambulatory procedure and one that had no procedures. All groups were assessed for the outcome of failure to renew the prescription within 6 months. RESULTS: Rates of drug treatment discontinuation after overnight hospitalizations, after ambulatory procedures, and after no procedures were 11.4%, 7.5%, and 4.8%, respectively, in the warfarin group; 4.0%, 3.9%, and 3.9%, respectively, in the statin group; and 8.4%, 8.9%, and 7.9%, respectively, in the ophthalmic drops group. The adjusted odds ratio (OR) was 2.6 (95% confidence interval [CI], 2.0-3.4) for discontinuation of warfarin therapy after overnight hospitalizations and 1.6 (95% CI, 1.4-1.7) after ambulatory procedures. In contrast, there was no increased risk of discontinuing treatment with either statins (OR for overnight hospitalization, 1.0 [95% CI, 0.9-1.2]; OR for ambulatory procedure, 1.0 [95% CI 1.0-1.1]) or ophthalmic drops (OR for overnight hospitalization, 1.0 [95% CI, 0.8-1.5]; OR for ambulatory procedure, 1.1 [95% CI, 1.0-1.2]). CONCLUSIONS: Patients prescribed long-term therapy with warfarin were at risk for potentially unintended medication discontinuation after elective procedures. Patients prescribed statins or beta-blocker ophthalmic drops were not at increased risk.

Aged↗
PubMed1979

A guideline for anticipated blood usage during elective surgical procedures.

A realistic guideline for transfusion therapy was prepared, with the cooperation of the departments of anesthesiology and surgery, in order to reduce excessive crossmatching. The guideline recommends an ABO-Rh type and an antibody screen, instead of the ""routine'' two-unit crossmatch, for elective surgical procedures where blood is seldom used. For those operations normally necessitating hemotherapy, the number of units suggested for the preoperative crossmatch was determined by examination of the average number of units transfused in the past for that particular procedure. The guideline provides the anesthesiologic and surgical staff with the knowledge of how much blood was usually used during a particular elective surgical procedure and therefore how much blood should be preoperatively crossmatched for that procedure. Implementation of this guideline allows the blood bank to distribute its limited blood resources more efficiently and also decreases patient and laboratory costs.

ABO Blood-Group System↗
PubMed2005

Appropriate antibiotic administration in elective surgical procedures: still missing the message.

OBJECTIVE: The aim of this study was to determine the appropriateness of antibiotic prophylaxis in selected elective surgical procedures in a tertiary referral centre. METHODS: A cross-sectional study using retrospective data from January 2000 to May 2002 was performed pertaining to elective colorectal surgery, cholecystectomy and inguinal hernia repairs. Appropriateness of antibiotic administration was determined based on compliance with national and internationally accepted guidelines on prophylactic antibiotic prescribing policy. A single dose or omission of antibiotic administration was judged appropriate for cholecystectomy and inguinal hernia repair, while up to 24 hours' dosing was considered appropriate practice for colorectal surgery. RESULTS: Of 419 cases, there were 55 (13.1%) colorectal procedures, 97 (23.2%) cholecystectomies and 267 (63.7%) inguinal hernia repairs. Antibiotics were administered in a total of 306 (73%) cases, with single-dose prophylaxis in only 125 (41%) of these. Prophylaxis was inappropriately prolonged in 80%, 52% and 31% of colorectal, cholecystectomy and inguinal hernia cases, respectively. The corresponding mean duration of anti-biotic administration was 2.4+/-2.2, 1.6+/-1.8 and 1.1+/-1.3 days, respectively. CONCLUSION: Antibiotic prophylaxis in elective surgery continues to be administered haphazardly. This study supports close surveillance of antibiotic utilization by a dedicated team, perhaps consisting of microbiologists or pharmacists, to minimize inappropriate administration.

Adult↗
PubMed2005

Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.

BACKGROUND: Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. PROCEDURE: We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications. RESULTS: Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered. CONCLUSIONS: Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.

Adolescent↗
PubMed2005

[Oral anticoagulants in cardiac patients undergoing elective surgical procedures: what attitude to adopt?].

Clinicians are often required to decide how to manage patients receiving long-term anticoagulant therapy, and who need a surgical procedure. The decisions are based on the perceived risk of continuing or stopping the treatment. Generally, warfarin must be stopped before all interventions at high risk of bleeding, but can be maintained unchanged before oral and skin surgery. For patients with a high risk of thromboembolism, heparin should be administered preoperatively, when the INR is <2. The estimation of this risk depends largely on the undelying heart disease. In the postoperative phase, the restarting of anticoagulant therapy must be weighed against both thromboembolic and hemorragic risks.

Administration, Oral↗
PubMed1987

Thermogenesis after major elective surgical procedures.

Sequential changes of body temperature have been measured for 48 h in 147 patients after major elective abdominal, cardiac, orthopaedic and pelvic surgery. Core temperature (aural canal) started to increase immediately after surgery reaching a mean peak value of 37.5 degrees C 14 h (range 8-16) after the end of surgery. Subsequently, a second peak of 37.4 degrees C was shown 18 h (range 16-20) later. The time interval between these two peak temperatures was constant for all types of surgery studied. A close examination of core temperature oscillations during a 72-h postoperative period and a comparison with a pre-operative 24-h cycle in a group of 14 patients who underwent cardiac surgery did not show any circadian rhythm. In the third part of the study, analysis of postoperative body temperature and metabolic rate showed a similar pattern of increase for core and mean skin temperatures, and oxygen consumption.

Adult↗
PubMed1984

Hypokalemia of various etiologies complicating elective surgical procedures.

During a 12-month period, 7933 surgical procedures were performed in a suburban intercommunity hospital. Thirty scheduled procedures were cancelled preoperatively by the anesthesia department because the level of serum potassium was below 3.2 mEq/L. Hypokalemia compromised three patients intraoperatively, and two patients suffered severe and life-threatening complications postoperatively. A preoperative bowel preparation produced severe hypokalemia in one patient, thus bringing the routine use of this time-honored procedure into question. The suggestion is made that all patients who are over 50 years of age, and who are scheduled for elective operation, receive an admission evaluation of the level of serum potassium.

Adult↗