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[PMID]:28911932
[Au] Autor:Samplaski MK; Lo KC; Grober ED; Zini A; Jarvi KA
[Ad] Endereço:Institute of Urology, University of Southern California, Los Angeles, California. Electronic address: mary.samplaski@med.usc.edu.
[Ti] Título:Varicocelectomy to "upgrade" semen quality to allow couples to use less invasive forms of assisted reproductive technology.
[So] Source:Fertil Steril;108(4):609-612, 2017 Oct.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the magnitude of improvement in semen parameters after a varicocelectomy and the fraction that have improvements such that couples needing IVF or IUI are "upgraded" to needing less invasive assisted reproductive technology (ART). DESIGN: Retrospective review of prospectively collected data. SETTING: Academic medical centers. PATIENT(S): Men presenting for a fertility evaluation with a clinical varicocele. INTERVENTION(S): Varicocele repair (surgical or embolization). MAIN OUTCOME MEASURE(S): Total motile sperm count (TMSC) before and after repair, and the proportion of men considered candidates for: natural pregnancy (NP) >9 million, IUI 5-9 million, or IVF < 5 million. RESULT(S): A total of 373 men underwent varicocele repair. The TMSC increased from 18.22 ± 38.32 to 46.72 ± 210.92 (P=.007). The most pronounced increase was with baseline TMSC <5 million, from 2.32 ± 1.50 to 15.97 ± 32.92 (P=.0000002); 58.8% of men were upgraded from IVF candidacy to IUI or NP. For baseline TMSC 5-9 million, the mean TMSC increased from 6.96 ± 1.16 to 24.29 ± 37.17 (P=.0004), allowing 64.9% of men to become candidates for NP. For baseline TMSC of >9 million, TMSC increased from 36.26 ± 52.08 to 81.80 ± 310.83 (P=.05). CONCLUSION(S): Varicocele repair has an important role in the treatment of infertility. Even for low TMSCs, a varicocelectomy may reduce the need for IVF. Varicocele repair (by embolization or microsurgery) potentially reduces the need for IVF and IUI.
[Mh] Termos MeSH primário: Infertilidade Masculina/cirurgia
Técnicas de Reprodução Assistida
Análise do Sêmen
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Adulto
Características da Família
Feminino
Seres Humanos
Infertilidade Masculina/epidemiologia
Infertilidade Masculina/etiologia
Masculino
Microcirurgia/métodos
Meia-Idade
Gravidez
Taxa de Gravidez
Estudos Retrospectivos
Contagem de Espermatozoides
Varicocele/complicações
Varicocele/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28865536
[Au] Autor:Kohn TP; Kohn JR; Pastuszak AW
[Ad] Endereço:Baylor College of Medicine, Houston, Texas.
[Ti] Título:Varicocelectomy before assisted reproductive technology: are outcomes improved?
[So] Source:Fertil Steril;108(3):385-391, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Clinical varicoceles have been associated with impaired semen parameters and male-factor infertility. Varicocele repair can improve live birth rates for men with clinical varicocele. Varicocelectomy is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Here we review the literature examining varicocelectomy before ART to evaluate whether improved pregnancy outcomes are realized. Although insufficient evidence exists to determine if correcting a varicocele improves IUI outcomes, a clinical benefit is observed when correcting a clinical varicocele in oligospermic and nonobstructed azoospermic men before IVF/ICSI. In couples seeking fertility with the use of ART, varicocele repair may offer improvement in semen parameters and may decrease the level of ART needed to achieve successful pregnancy.
[Mh] Termos MeSH primário: Infertilidade Masculina/epidemiologia
Infertilidade Masculina/terapia
Resultado da Gravidez/epidemiologia
Injeções de Esperma Intracitoplásmicas/utilização
Varicocele/epidemiologia
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Sítios de Ligação
Comorbidade
Medicina Baseada em Evidências
Feminino
Seres Humanos
Masculino
Gravidez
Prevalência
Melhoria de Qualidade
Técnicas de Reprodução Assistida
Fatores de Risco
Resultado do Tratamento
Procedimentos Cirúrgicos Urogenitais
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28865535
[Au] Autor:Johnson D; Sandlow J
[Ad] Endereço:Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin.
[Ti] Título:Treatment of varicoceles: techniques and outcomes.
[So] Source:Fertil Steril;108(3):378-384, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.
[Mh] Termos MeSH primário: Embolização Terapêutica/métodos
Infertilidade Masculina/prevenção & controle
Laparoscopia/métodos
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/diagnóstico
Varicocele/terapia
Procedimentos Cirúrgicos Vasculares/métodos
[Mh] Termos MeSH secundário: Terapia Combinada/métodos
Medicina Baseada em Evidências
Seres Humanos
Infertilidade Masculina/diagnóstico
Infertilidade Masculina/etiologia
Masculino
Resultado do Tratamento
Varicocele/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28865533
[Au] Autor:Brannigan RE
[Ad] Endereço:Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: r-brannigan@northwestern.edu.
[Ti] Título:Introduction: Varicoceles: a contemporary perspective.
[So] Source:Fertil Steril;108(3):361-363, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In this Views and Reviews section, four groups of authors address the timely and highly relevant issue of varicoceles across the male life spectrum. Varicoceles are very prevalent among men presenting for an infertility workup. While reduction in bulk semen parameters (including sperm concentration, motility, and morphology) has long been recognized as a deficit caused by varicoceles, in recent years a number of investigators have shown that varicoceles can have broader, multi-faceted effects on male reproductive health. Sperm DNA integrity and other aspects of sperm function appear to be impacted by the presence of varicoceles, and varicocele correction can result in significant improvement in not only semen parameters, but also fertilization and pregnancy rates.
[Mh] Termos MeSH primário: Embolização Terapêutica/métodos
Infertilidade Masculina/diagnóstico
Infertilidade Masculina/prevenção & controle
Varicocele/diagnóstico
Varicocele/terapia
Procedimentos Cirúrgicos Vasculares/métodos
[Mh] Termos MeSH secundário: Terapia Combinada/métodos
Medicina Baseada em Evidências
Seres Humanos
Infertilidade Masculina/etiologia
Masculino
Resultado do Tratamento
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/complicações
[Pt] Tipo de publicação:INTRODUCTORY JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28727390
[Au] Autor:Cho CL; Ho KL; Chan WK; Chu RW; Law IC
[Ad] Endereço:Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong.
[Ti] Título:Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience.
[So] Source:Int Braz J Urol;43(5):974-979, 2017 Sep-Oct.
[Is] ISSN:1677-6119
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.
[Mh] Termos MeSH primário: Angiografia/métodos
Verde de Indocianina/administração & dosagem
Canal Inguinal/cirurgia
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Canal Inguinal/diagnóstico por imagem
Período Intraoperatório
Masculino
Microscopia de Fluorescência
Microcirurgia
Índice de Gravidade de Doença
Varicocele/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
IX6J1063HV (Indocyanine Green)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1590/S1677-5538.IBJU.2017.0107


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[PMID]:28681369
[Au] Autor:Hirabayashi T; Ueno S; Hirakawa H; Tei E; Mori M
[Ti] Título:Surgical Treatment of Inguinal Hernia with Prolapsed Ovary in Young Girls: Emergency Surgery or Elective Surgery.
[So] Source:Tokai J Exp Clin Med;42(2):89-95, 2017 Jul 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Inguinal ovarian hernias are common in young girls. Many articles in medical literature recommend early surgery for inguinal ovarian hernia because of the risk of torsion of the prolapsed ovary. However, since many irreducible herniated ovaries in newborn infants and during early infancy undergo spontaneous reduction by the age of 9 months, the policy at our institute is to obtain informed consent from the patient's family and then wait to perform surgery until after 9 months of age. In the present study, we assessed the indications for surgery for inguinal ovarian hernia in newborn infants and during early infancy. METHODS: Between 2003 and 2011, a total of 673 girls with inguinal hernias (age at the time of onset of symptoms: mean, 42.5 months; median, 39 months) were brought to our outpatient clinic for consultation. We reviewed their age at the time of the onset of hernia symptoms and their age at the time of surgery, their history of surgery, and their history of inguinal ovarian hernia using information obtained from their medical records. RESULTS: Among the 673 outpatients, 71 patients (mean/median age at the time of onset of symptoms: 11.2/1.5 months) were diagnosed as having an inguinal ovarian hernia at the time of diagnosis. Among these patients, surgery was performed for 58 patients (mean/median age at the time of surgery: 21.3/11 months). Of these patients, the ovary had already spontaneously reduced into the abdomen in 35 cases (mean/median age at the time of surgery: 24.1/12months), whereas the ovaries were on the wall of the hernia sac in 22 cases (mean/median age at the time of surgery: 17.3/10 months). In one case, a testis instead of an ovary was observed in the hernia sac at the time of surgery. Surgeries were performed in 611 of the 673 patients (mean/median age at the time of surgery: 54/50 months). In 35 cases (mean/median age at the time of surgery: 21.6/10 months), the ovary was still on the hernia sac wall at the time of surgery, but an inguinal ovarian hernia had not been diagnosed before surgery in 13 of these cases. A severe complication occurred in only one case, in which a hernia sac that contained a fallopian tube and ovary was ligated. None of the cases exhibited torsion of the ovary within the inguinal canal. CONCLUSION: Since the ovary can be expected to undergo spontaneous reduction into the abdomen by late infancy in many young patients with inguinal ovarian hernias, patients with inguinal ovarian hernias can be treated by elective surgery at the most convenient age, after 9 months of age.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Eletivos
Hérnia Inguinal/cirurgia
Doenças Ovarianas/cirurgia
Ovário/cirurgia
Prolapso de Órgão Pélvico/cirurgia
Procedimentos Cirúrgicos Urogenitais/métodos
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Criança
Pré-Escolar
Emergências
Feminino
Seres Humanos
Lactente
Recém-Nascido
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


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[PMID]:28631901
[Au] Autor:Filimonov VB; Vasin RV; Vasina IV; Kaprin AD; Kostin AA
[Ad] Endereço:Department of Surgery and Obstetrics-Gynecology, FPE of Ryazan SMU of Minzdrav of Russia, Ryazan.
[Ti] Título:[Female genital prolapse surgery using ultra lightweight polypropylene mesh].
[So] Source:Urologiia;(2):14-23, 2017 Jun.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To compare the results of female genital prolapse (FGP) surgery via vaginal access using lightweight and ultra-lightweight polypropylene mesh. MATERIALS AND METHODS: From 2007 to 2011, 93 women aged from 46 to 71 years with II-IV stage FGP (POP-Q classification) were examined and underwent the vaginal extra-peritoneal colpopexy using polypropylene implants in the Department of Urology. Patients were divided into 2 groups. In patients of group 1 (n=50) the surgery was performed according to a newly developed technique using perforated ultra-lightweight (surface density 19 g/m2) domestically manufactured polypropylene implant. In group 2, a standard trocar set with light (surface density of 42.7 g/m2) foreign-made polypropylene implants was used. RESULTS AND DISCUSSION: Long-term follow-up was from 1 to 5 years. General surgical complications (urinary bladder injury, blood loss over 300 ml, perineal and vaginal hematomas) were detected in 2 (4%) patients of group 1 and in 7 (16.3%) patients of group 2. The most common specific mesh-related complication was the vaginal wall erosion, which was observed in 4 (9.3%) patients of group 2 and in 1 (2%) patient of group 1. FGP recurrence was diagnosed in 5 (10%) patients of group 1 in the non-treated part and in 8 (18.6%) patients of group 2. Three patients (7%) in group 2 developed recurrent cystocele due to the shrinkage of the mesh implant which was not observed in group 1. At 12 month follow-up, the results of FGP surgical treatment were estimated as good (full functional recovery and no FGP recurrence) in 41 (82%) and 32 (74.4%) patients of groups 1 and 2, respectively. CONCLUSION: We have developed a method of vaginal extra-peritoneal colpopexy using a perforated ultra-lightweight polypropylene implant. This technique has resulted in the absence of recurrence in the treated part of FGP, and 4.1, 4.2 and 4.7 fold reductions in the incidence of general surgical complications, vaginal wall erosions and perineal and vaginal hematomas, respectively, compared with FGP patients undergoing the placement of the lightweight polypropylene implant using the standard trocar set.
[Mh] Termos MeSH primário: Prolapso de Órgão Pélvico/cirurgia
Polipropilenos
Telas Cirúrgicas
Procedimentos Cirúrgicos Urogenitais
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Meia-Idade
Resultado do Tratamento
Vagina/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Polypropylenes)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170621
[St] Status:MEDLINE


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[PMID]:28301253
[Au] Autor:Yuan R; Zhuo H; Cao D; Wei Q
[Ad] Endereço:a Department of Urology, Institute of Urology, West China Hospital , Sichuan University , Chengdu , China.
[Ti] Título:Efficacy and safety of varicocelectomies: A meta-analysis.
[So] Source:Syst Biol Reprod Med;63(2):120-129, 2017 Apr.
[Is] ISSN:1939-6376
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review of the relevant randomized clinical trials was performed. Trials were identified from specialized trials register of the Cochrane UGDP Group, the Cochrane library, additional electronic searches (mainly MEDLINE, EMBSAE, SCI, CBM), and handsearching. Clinical trials comparing microsurgical, laparoscopic and open varicocelectomies were included. Statistical analysis was managed using Review Manager 5.3. Seven clinical trials of 1,781 patients were included. The meta-analysis indicated that compared with open varicocelectomy, microsurgery had a higher pregnancy rate (p=0.002), while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies. Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy (p=0.008 and p=0.001, respectively). Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility (p=0.02). Compared with the other two, microsurgical varicocelectomy had the longest operative time (p=0.01 and p=0.0004 respectively). A nonsignificant difference was found in the hospital stay between the three approaches, whereas microsurgical and laparoscopic varicocelectomies had a shorter time to return to work. Moreover, microsurgical varicocelectomy had a lower incidence of postoperative complications and recurrence compared with the others. Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time, lower incidence of postoperative complications, and recurrence than laparoscopic and open varicocelectomies, and shows a higher pregnancy rate, with a greater increase in postoperative sperm concentration, better improvement in postoperative sperm motility, and shorter time to return to work than open varicocelectomy.
[Mh] Termos MeSH primário: Fertilidade
Infertilidade Masculina/cirurgia
Laparoscopia/métodos
Microcirurgia/métodos
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Adulto
Distribuição de Qui-Quadrado
Feminino
Seres Humanos
Infertilidade Masculina/diagnóstico
Infertilidade Masculina/etiologia
Infertilidade Masculina/fisiopatologia
Laparoscopia/efeitos adversos
Tempo de Internação
Masculino
Microcirurgia/efeitos adversos
Razão de Chances
Complicações Pós-Operatórias/etiologia
Gravidez
Taxa de Gravidez
Recuperação de Função Fisiológica
Retorno ao Trabalho
Fatores de Risco
Contagem de Espermatozoides
Motilidade Espermática
Fatores de Tempo
Resultado do Tratamento
Procedimentos Cirúrgicos Urogenitais/efeitos adversos
Varicocele/complicações
Varicocele/diagnóstico
Varicocele/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170317
[St] Status:MEDLINE
[do] DOI:10.1080/19396368.2016.1265161


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[PMID]:27762470
[Au] Autor:Lo TS; Lin YH; Chu HC; Cortes EF; Pue LB; Tan YL; Uy-Patrimonio MC
[Ad] Endereço:Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.
[Ti] Título:Association of urodynamics and lower urogenital tract nerve growth factor after synthetic vaginal mesh implantation on a rat model.
[So] Source:J Obstet Gynaecol Res;43(1):173-178, 2017 Jan.
[Is] ISSN:1447-0756
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:AIM: By investigating the association of urodynamics and urogenital nerve growth factor (NGF) levels in vaginal mesh surgery, we may be able to associate the likelihood of postoperative lower urinary tract symptoms developing as a result of synthetic mesh implanted for pelvic floor reconstructive surgery. METHODS: Thirty-eight female Sprague-Dawley rats were divided into three groups: mesh, sham (no mesh), and control. Urodynamic study and NGF analysis of the urogenital tissues were done and results were compared among all groups. The urodynamic studies of the mesh and sham groups were further divided into the 4th and 10th days. A P-value < 0.05 was considered statistically significant. RESULTS: All rats survived and no complications were observed during the post-implantation period. Histological evaluation showed intense acute inflammatory reaction on days 4 and 7 in the mesh and sham groups when compared to the control. The mesh group showed a larger area of inflammation as compared to the sham. The NGF levels increased significantly in the mesh and sham groups on the 4th and 10th days when compared to the control (P < 0.001, P < 0.001, respectively). Both the mesh and sham groups had shorter voiding interval and lower voiding volume on days 4 and 10 when compared to the control group (P < 0.001, P < 0.001, respectively). The magnitude on increasing NGF level and decreasing voiding interval and voiding volume was significantly more on the mesh group than the sham group. CONCLUSION: A higher level of NGF in the early days post-transvaginal mesh implantation is associated with a shorter voiding interval and a smaller bladder capacity, which represents abnormal lower urinary tract symptoms following transvaginal mesh implantation.
[Mh] Termos MeSH primário: Sintomas do Trato Urinário Inferior/cirurgia
Fator de Crescimento Neural/metabolismo
Prolapso de Órgão Pélvico/cirurgia
Telas Cirúrgicas
Urodinâmica
Procedimentos Cirúrgicos Urogenitais/métodos
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Feminino
Seres Humanos
Inflamação/complicações
Inflamação/metabolismo
Diafragma da Pelve/cirurgia
Complicações Pós-Operatórias
Ratos
Ratos Sprague-Dawley
Procedimentos Cirúrgicos Reconstrutivos
Bexiga Urinária/cirurgia
Vagina/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9061-61-4 (Nerve Growth Factor)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170425
[Lr] Data última revisão:
170425
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161021
[St] Status:MEDLINE
[do] DOI:10.1111/jog.13158


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[PMID]:27653498
[Au] Autor:Massarweh NN; Kougias P; Wilson MA
[Ad] Endereço:Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas2Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
[Ti] Título:Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System.
[So] Source:JAMA Surg;151(12):1157-1165, 2016 Dec 01.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system. Objective: To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years. Design, Setting, and Participants: A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014. Main Outcomes and Measures: Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time. Results: Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P < .001 for all). Although there were no clinically meaningful differences in rates of complications and major complications across hospital risk-adjusted mortality quintiles (any complications: lowest quintile, 20 945 of 147 721 [14.2%] vs highest quintile, 18 938 of 135 557 [14%]; major complications: lowest quintile, 14 044 of 147 721 [9.5%] vs highest quintile, 12 881 of 135 557 [9.5%]), FTR rates (any complications: lowest quintile, 2249 of 20 945 [10.7%] vs highest quintile, 2769 of 18 938 [14.6%]; major complications: lowest quintile, 2161 of 14 044 [15.4%] vs highest quintile, 2663 of 12 881 [20.7%]) were significantly higher with increasing quintile (P < .001). However, across hospital quintiles, there were significant decreases in morbidity (20.6%-29.9% decrease; trend test, P < .001 for all) and FTR (29.2%-50.6% decrease; trend test, P < .001 for all) during the study period. After hierarchical modeling, the odds of postoperative mortality, FTR, and FTR after a major complication were approximately 40% to 50% lower in the most recent study year compared with 15 years ago (P < .001 for all). Conclusions and Relevance: For the past 15 years, morbidity, mortality, and FTR have improved within the VA health system. Other integrated health systems providing a high volume of surgical care for their enrollees may benefit by critically evaluating the system-level approaches of the VA health system to surgical quality improvement.
[Mh] Termos MeSH primário: Falha da Terapia de Resgate/estatística & dados numéricos
Hospitais de Veteranos/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Melhoria de Qualidade/tendências
Procedimentos Cirúrgicos Operatórios/efeitos adversos
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
United States Department of Veterans Affairs/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Feminino
Cirurgia Geral/normas
Cirurgia Geral/estatística & dados numéricos
Hospitalização
Hospitais de Veteranos/normas
Hospitais de Veteranos/tendências
Seres Humanos
Masculino
Meia-Idade
Procedimentos Neurocirúrgicos/efeitos adversos
Procedimentos Neurocirúrgicos/normas
Procedimentos Neurocirúrgicos/estatística & dados numéricos
Procedimentos Ortopédicos/efeitos adversos
Procedimentos Ortopédicos/normas
Procedimentos Ortopédicos/estatística & dados numéricos
Complicações Pós-Operatórias/mortalidade
Estudos Retrospectivos
Coluna Vertebral/cirurgia
Procedimentos Cirúrgicos Operatórios/normas
Procedimentos Cirúrgicos Torácicos/efeitos adversos
Procedimentos Cirúrgicos Torácicos/normas
Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos
Estados Unidos
United States Department of Veterans Affairs/normas
United States Department of Veterans Affairs/tendências
Procedimentos Cirúrgicos Urogenitais/efeitos adversos
Procedimentos Cirúrgicos Urogenitais/normas
Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos
Procedimentos Cirúrgicos Vasculares/efeitos adversos
Procedimentos Cirúrgicos Vasculares/normas
Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170620
[Lr] Data última revisão:
170620
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160923
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2016.2920



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