Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification.
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ABSTRACT:
SUBMITTER: Radosa MP
PROVIDER: S-EPMC4153816 | biostudies-other | 2014 Aug
REPOSITORIES: biostudies-other
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Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification.
Radosa M P MP Meyberg-Solomayer G G Radosa J J Vorwergk J J Oettler K K Mothes A A Baum S S Juhasz-Boess I I Petri E E Solomayer E F EF Runnebaum I B IB
Geburtshilfe und Frauenheilkunde 20140801 8
<b>Introduction:</b> The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. <b>Material and Methods:</b> Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups we ...[more]
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Project description:ObjectiveTo present our experience with laparoscopic tube-preserving surgery for ectopic tubal pregnancy and evaluate its feasibility and efficacy.MethodsThis was a prospective study of 57 consecutive patients with ectopic tubal pregnancies undergoing laparoscopic tube-preserving procedures including salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking. The outcome measures were treatment success rates and homolateral patency rates.ResultsOf the 57 surgical procedures, 55 (96.4%) were performed successfully without any additional intervention. The number of patients receiving salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking were 24 (42.1%), 25 (43.9%), 4 (7.0%), and 2 (3.5%), respectively. Two case was switched to salpingectomy because excessive bipolar coagulation was required to obtain hemostasis at the tubal bleeding bed. Over a mean β-human chorionic gonadotropin resolution time of 18.3±5.9 days, no persistent trophoblast or postoperative complications occurred. A tubal patency test using hysterosalpingography was performed in 15 cases at 3 months postoperatively. Among these, the homolateral tubal patency rate was 75% (11 of 15) and the contralateral patency rate was 80% (12 of 15).ConclusionTube-preserving surgery is a feasible and safe treatment option for ectopic tubal pregnancy. However, considering that the optimal goal of tube-preserving surgical procedures is not the treatment success, some caution is warranted in interpreting results of this study.
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Project description:ImportanceThe association of the nasal microbiome with outcomes in surgical patients is poorly understood.ObjectiveTo characterize the composition of nasal microbiota in patients undergoing clean elective surgical procedures and to examine the association between characteristics of preoperative nasal microbiota and occurrence of postoperative infection.Design, setting, and participantsUsing a nested matched case-control design, 53 individuals who developed postoperative infection were matched (approximately 3:1 by age, sex, and surgical procedure) with 144 individuals who were not infected (ie, the control group). The 2 groups were selected from a prospective cohort of patients undergoing surgical procedures at 2 tertiary care university hospitals in Baltimore, Maryland, who were at high risk for postoperative infectious complications. Included individuals were aged 40 years or older; had no history of autoimmune disease, immunocompromised state, immune-modulating medication, or active infection; and were scheduled to undergo elective cardiac, vascular, spinal, or intracranial surgical procedure. Data were analyzed from October 2015 through September 2020.ExposuresNasal microbiome cluster class served as the main exposure. An unsupervised clustering method (ie, grades of membership modeling) was used to classify nasal microbial samples into 2 groups based on features derived from 16S ribosomal RNA gene sequencing. The microbiome cluster groups were derived independently and agnostic of baseline clinical characteristics and infection status.Main outcomes and measuresComposite of surgical site infection, bacteremia, and pneumonia occurring within 6 months after surgical procedure.ResultsAmong 197 participants (mean [SD] age, 64.1 [10.6] years; 63 [37.7%] women), 553 bacterial taxa were identified from preoperative nasal swab samples. A 2-cluster model (with 167 patients in cluster 1 and 30 patients in cluster 2) accounted for the largest proportion of variance in microbial profiles using grades of membership modeling and was most parsimonious. After adjusting for potential confounders, the probability of assignment to cluster 2 was associated with 6-fold higher odds of infection after surgical procedure (odds ratio [OR], 6.18; 95% CI, 3.33-11.7; P < .001) independent of baseline clinical characteristics, including nasal carriage of Staphylococcus aureus. Intrasample (ie, α) diversity was inversely associated with infectious outcome in both clusters (OR, 0.57; 95% CI, 0.42-0.75; P < .001); however, probability of assignment to cluster 2 was associated with higher odds of infection independent of α diversity (OR, 4.61; 95% CI, 2.78-7.86; P < .001).Conclusions and relevanceThese findings suggest that the nasal microbiome was an independent risk factor associated with infectious outcomes among individuals who underwent elective surgical procedures and may serve as a biomarker associated with infection susceptibility in this population.
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Project description:ImportanceDeep learning-based automatic surgical instrument recognition is an indispensable technology for surgical research and development. However, pixel-level recognition with high accuracy is required to make it suitable for surgical automation.ObjectiveTo develop a deep learning model that can simultaneously recognize 8 types of surgical instruments frequently used in laparoscopic colorectal operations and evaluate its recognition performance.Design, setting, and participantsThis quality improvement study was conducted at a single institution with a multi-institutional data set. Laparoscopic colorectal surgical videos recorded between April 1, 2009, and December 31, 2021, were included in the video data set. Deep learning-based instance segmentation, an image recognition approach that recognizes each object individually and pixel by pixel instead of roughly enclosing with a bounding box, was performed for 8 types of surgical instruments.Main outcomes and measuresAverage precision, calculated from the area under the precision-recall curve, was used as an evaluation metric. The average precision represents the number of instances of true-positive, false-positive, and false-negative results, and the mean average precision value for 8 types of surgical instruments was calculated. Five-fold cross-validation was used as the validation method. The annotation data set was split into 5 segments, of which 4 were used for training and the remainder for validation. The data set was split at the per-case level instead of the per-frame level; thus, the images extracted from an intraoperative video in the training set never appeared in the validation set. Validation was performed for all 5 validation sets, and the average mean average precision was calculated.ResultsIn total, 337 laparoscopic colorectal surgical videos were used. Pixel-by-pixel annotation was manually performed for 81 760 labels on 38 628 static images, constituting the annotation data set. The mean average precisions of the instance segmentation for surgical instruments were 90.9% for 3 instruments, 90.3% for 4 instruments, 91.6% for 6 instruments, and 91.8% for 8 instruments.Conclusions and relevanceA deep learning-based instance segmentation model that simultaneously recognizes 8 types of surgical instruments with high accuracy was successfully developed. The accuracy was maintained even when the number of types of surgical instruments increased. This model can be applied to surgical innovations, such as intraoperative navigation and surgical automation.
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2022-05-20 | PXD031241 | Pride
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Project description:The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications.In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Student's t, Fisher's exact and Mann-Whitney U tests.The analysis comprised n?=?57 vs. n?=?60 operations. In the very elderly patients there was often a grade IV prolapse (p?<?0.001), apical fixations were more frequent (p?<?0.001), but the operating times were not different. In the very elderly patients 21?% CD II+III complications were observed, in the control group 6.6?% (p?=?0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (±?1) vs. 4.1 (±?0.8; p?<?0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p?<?0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p?<?0.001), in CIRS-G (4.1?±?2.2 vs. 2.4?±?1.7; p?<?0.01) and in Charlson Index (1.6?±?1.6 vs. 0.5?±?0.7; p?<?0.001).A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.
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Project description:Take Home Message Our review revealed a significantly higher annual volume of surgery per surgeon (AVSS), a higher percentage of low-risk patients, and lower rates of lymphadenectomy and complications for robot-assisted radical prostatectomy (RARP) compared to open and laparoscopic techniques. RARP showed better performance for all the perioperative variables studied except for operative time. Among all the outcomes, only AVSS was significantly correlated with complication rates. The AVSS required to achieve a target complication rate was significantly lower for RARP. Context The advantages of minimally invasive surgery for radical prostatectomy (RP) have been demonstrated in a number of systematic reviews (SRs). However, the rigorous study selection process for SR means that a lot of information can be excluded, leading to a very specific clinical scenario that is often unrepresentative of real life. Our new reverse SR methodology generates a heterogeneous population database that covers a wide range of clinical scenarios. Objective To compare perioperative surgical results and complications for open retropubic RP (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in a reverse SR. Evidence acquisition Eight databases were searched for SRs on RRP, LRP, or RARP between 2000 and 2020 (80 SRs). All references used in these SRs were captured for analysis (1724 articles). Perioperative outcomes and complications were compared among the RRP, LRP, and RARP approaches. Evidence synthesis We identified 559 (32.4%) reports on RRP, 413 (23.9%) on LRP, and 752 (43.7%) on RARP, involving 1 353 485 patients overall. RARP showed a significantly higher annual volume of surgery per surgeon (AVSS) in comparison to RRP and LRP (mean 64.29, 43.26, and 41.47, respectively), a higher percentage of low-risk patients (prostate-specific antigen <10 ng/ml, Gleason <7, stage <cT2), and a lower rate of lymphadenectomy, culminating in a lower complication rate (12.3% for RARP, 16.3% for LRP, 20.2% for RRP). Among all outcomes, only AVSS was significantly correlated with complication rates. An AVSS of 30, 95 and 95 surgeries/yr was required for RARP, LRP, and RRP, respectively, to obtain a complication rate of 12.3% (average for RARP). RARP showed better performance for all perioperative variables studied except for operative time (operative time: 199.8 vs 214.9 vs 169.5 min; estimated blood loss: 228.2 vs 408.0 vs 852.1 ml; blood transfusion rate: 2.8% vs 6.5% vs 19.8%; length of stay: 2.9 vs 5.7 vs 6.1 d; catheter time: 7.8 vs 8.5 vs 11.0 d for RARP vs LRP vs RRP). Conclusions Our reverse SR involved a wide real-life representative sample and reference values established in the literature and revealed that minimally invasive surgery had the best perioperative and complication results, especially RARP, which was associated with less complex cases, higher annual surgeon volume, and greater performance. Patient summary We used a wide sample representative of real-life surgical practice and reference values established in the literature for three techniques for removal of the prostate to guide patients and physicians in deciding the best surgical treatment for prostate cancer according to availability.
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