Suchergebnisse

Abstract
Background Surgery for intra-/extraforaminal disk herniations (IEDH) is technically demanding due to the hidden location of the compressed nerve root section. Ipsilateral approaches (medial and lateral) are accompanied by extended resection of the facet joint and inadequate visualization of the pathology, especially at the L5–S1 level.
Methods We describe a microsurgical interlaminar contralateral approach (MICA) suitable for IEDH at the lumbosacral junction that can also be used at L4–L5 and L3–L4.
Conclusion The MICA provides access and sufficient intraforaminal visualization for IEDH in the lumbosacral region without resection of stability-relevant structures or manipulation of the nerve root ganglion.

Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. The World Bank in 2002 reported that an estimated 164 million disability-adjusted life years, representing 11% of the entire disease burden, were attributable to surgically treatable conditions. To study the prevalence of various surgical operations undergone by individuals in their life time, in an urbanized community of Delhi. Cross-sectional study, conducted from October 2008 to April 2009 in Vivek Vihar—an urban affluent colony in Delhi. A total of 3,043 individuals residing in 622 households were interviewed as part of the study. Total number of households with some member having ever undergone surgery was 306 (49.2%). 12.3% of our study population (375 out of 3,043) had undergone one or the other form of major surgical operation in their life time. Caesarean section was found to be the most common surgical procedure performed. 61.7% surgeries were elective in nature and 81.9% were performed in a private hospital. The lifetime prevalence of surgical procedures was 1.77% among children, 12.6% among adult males and 15.8% among adult females (p < 0.001). It was observed that the expense of surgeries conducted in private hospitals was more compared to government. Our findings suggest that surgery occurs at a substantial rate, at least among the urban affluent, with most of the patients choosing to refer to a private hospital for their surgery.

IMPORTANCE: The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. OBJECTIVE: To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19–related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. EXPOSURES: 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. MAIN OUTCOMES AND MEASURES: Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. RESULTS: A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures ...

Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy, myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic- and computer-assisted surgery in the specialty of gynecologic oncology.

This cohort study uses data from the Department of Defense Military Health System Data Repository to describe patterns of opioid pain medication prescriptions after common surgical procedures and determine the appropriateness of the prescription as indicated by the rate of refills.

With increasing demands for greater cost-effectiveness and the recognition of the importance of health self-care behaviors, social work interventions need to be developed that reach more individuals and reach medical treatment arenas where, previously, traditional medical care was the only option. This article describes an example of intervention research (codeveloped by a social worker) designed to improve urologic self-care for women presenting to a urology clinic with frequency-urgency syndrome. Five women kept daily diary data on their urinary frequency and then received a pamphlet of behavioral recommendations developedfrom the Health Belief Model, Self-Efficacy Theory, the Theory of Reasoned Action and other compliance-enhancement strategies. Three women showed improvement in their frequency of urination, one showed improvement in her unpleasant urges, and one showed no change in either self-care behaviors or clinical outcome. Implications for future research are discussed.

A significant percentage (43%) of medical errors is caused by errors in communication between healthcare professionals or between them and the patient. Today the surgeon has a multiple role (leader of the surgical team, member of the medical team, scientific role, management role).The surgical team has the duty to ensure and promote a positive work environment that improves team performance and maximizes outcomes for patient's safety.

PURPOSE: We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. MATERIALS AND METHODS: We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. RESULTS: We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). CONCLUSIONS: This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.

Background: This study assessed the lower limb reconstruction outcome so that it will provide a baseline evidence to enable data-driven decision making to improve outcome in the future.Methods: In this study, hospital records from 1st January to 31st December 2019 were collected retrospectively. Complete data of all patients' records treated for lower limb defects at Kirtipur Hospital were included and incomplete data were excluded. Univariate and Bivariate analyses were performedResults: In total 110 patients were included in this study with a male predominance of 66.4% (n=73). The mean age of the patients was 38.7 years (+/- 20). The majority of the patients were from outside Kathmandu valley 79.1% (n=87) and referred 55.5% (n=61). The commonest cause of lower limb defects was trauma 69.1% (n=76), the procedure performed was skin graft 48.5% (n=72), and complication was wound infections, 43% (n=13) of total complications. The hospital stay of more than two weeks was more common among the referred patients 63.9% (n=39) as compared to non-referred patients 30.6% (n=15) and trauma etiology 34.2% (n=26) had more complications than other etiology. The mean age of patients with complications (32.4 years) was lower than those without complications (41.1 years). More number of referred patients (n=43) required multiple surgeries than non-referred patients (n=21).Conclusions: Referred cases were more likely to have multiple surgeries and a longer hospital stay than non-referred cases. Infection was the commonest complication and the majority of complications were seen in trauma and younger age group. Keywords: Lower limb defect; plastic surgery; reconstruction

Traumatic anterior shoulder dislocations are the most common dislocations of the shoulder, and the recurrence rate is high when they are treated nonoperatively in young patients (<30 years old). This has led to a trend toward early surgical stabilization. Originally open Bankart repair was considered the standard of care, with good clinical outcomes and a low recurrence rate. However, the majority of Bankart repairs are now performed with newer arthroscopic techniques because of their potential advantages and similar results. Both open and arthroscopic repairs have been shown to decrease the recurrence rate to 6% to 23%. Although arthroscopic Bankart repair is now more common, open repair should be considered for younger patients participating in contact sports or military activity, osseous Bankart lesions, revision cases, shoulder instability with "subcritical" (20% to 25%) glenoid bone loss, ligamentous laxity, or cases not considered repairable with arthroscopic techniques. Therefore, knowing how to perform an open Bankart repair is essential. The major steps of the procedure are (1) preoperative planning, (2) induction of anesthesia, (3) patient positioning and setup, (4) examination under anesthesia, (5) possible arthroscopic examination of the shoulder, (6) incision along the anterior axillary fold, (7) exposure using the deltopectoral interval, (8) clavipectoral fascia incision, (9) vertical tenotomy of the subscapularis tendon, (10) dissection of the capsule from the subscapularis, (11) assessment of the quality of the capsule, (12) "T" capsulotomy, (13) repair of the Bankart lesion, (14) anterior capsulorrhaphy, (15) subscapularis repair, (16) possible closure of the rotator interval, (17) wound closure, and (18) postoperative rehabilitation. Studies have shown that surgical stabilization after traumatic anterior shoulder instability decreases the recurrence rate, and open and arthroscopic techniques have similar clinical outcomes.

Abstract
Background Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH.
Methods Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery).
Results Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05).
Conclusion According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.