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[PMID]:29458952
[Au] Autor:Yen P; Dumas S; Albert A; Gordon P
[Ad] Endereço:Department of Diagnostic Radiology, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada. Electronic address: peggy_yen@live.com.
[Ti] Título:Post-Vacuum-Assisted Stereotactic Core Biopsy Clip Displacement: A Comparison Between Commercially Available Clips and Surgical Clip.
[So] Source:Can Assoc Radiol J;69(1):10-15, 2018 Feb.
[Is] ISSN:1488-2361
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The placement of localization clips following percutaneous biopsy is a standard practice for a variety of situations. Subsequent clip displacement creates challenges for imaging surveillance and surgical planning, and may cause confusion amongst radiologists and between surgeons and radiologists. Many causes have been attributed for this phenomenon including the commonly accepted "accordion effect." Herein, we investigate the performance of a low cost surgical clip system against 4 commercially available clips. METHODS: We retrospectively reviewed 2112 patients who underwent stereotactic vacuum-assisted core biopsy followed by clip placement between January 2013 and June 2016. The primary performance parameter compared was displacement >10 mm following vacuum-assisted stereotactic core biopsy. Within the group of clips that had displaced, the magnitude of displacement was compared. RESULTS: There was a significant difference in displacement among the clip types (P < .0001) with significant pairwise comparisons between pediatric surgical clips and SecureMark (38% vs 28%; P = .001) and SenoMark (38% vs 27%; P = .0001) in the proportion displaced. The surgical clips showed a significant magnitude of displacement of approximately 25% greater average distance displaced. CONCLUSIONS: As a whole, the commercial clips performed better than the surgical clip after stereotactic vacuum-assisted core biopsy suggesting the surrounding outer component acts to anchor the central clip and minimizes clip displacement. The same should apply to tomosynthesis-guided biopsy.
[Mh] Termos MeSH primário: Mama/diagnóstico por imagem
Mama/patologia
Migração de Corpo Estranho/diagnóstico por imagem
Biópsia Guiada por Imagem
Mamografia
Instrumentos Cirúrgicos
[Mh] Termos MeSH secundário: Biópsia por Agulha
Feminino
Seres Humanos
Estudos Retrospectivos
Técnicas Estereotáxicas
Vácuo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE


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[PMID]:29437070
[Au] Autor:Kim W; Lee JS; Chung HW
[Ad] Endereço:Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
[Ti] Título:Outcomes after extensive manual curettage and limited burring for atypical cartilaginous tumour of long bone.
[So] Source:Bone Joint J;100-B(2):256-261, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Adjuvant treatment after intralesional curettage for atypical cartilaginous tumours (ACTs) of long bones is widely accepted for extending surgical margins. However, evaluating the isolated effect of adjuvant treatment is difficult, and it is unclear whether not using such adjuvants provides poor oncological outcomes. Hence, we analyzed whether intralesional curettage without cryosurgery or chemical adjuvants provides poor oncological outcomes in patients with an ACT. PATIENTS AND METHODS: A total of 24 patients (nine men, 15 women) (mean age 45 years; 18 to 62) were treated for ACTs of long bones and followed up for a median of 66 months (interquartile range 50 to 84). All patients were treated with extensive manual curettage and limited burring. Bone cement and grafts were used to fill bone defects in 16 and eight patients, respectively. No chemical adjuvants or cryosurgery were used. RESULTS: No local recurrence was detectable on plain radiographs and MRI or CT images. At the last follow-up, there were no distant metastases or disease-specific deaths. No procedure-related complications or postoperative fractures developed. CONCLUSION: Intralesional curettage without cryosurgery or chemical adjuvants may provide excellent oncological outcomes for patients with ACTs of long bones, without the risk of complications related to adjuvant use. Our investigation suggests thorough curettage alone is a reasonable treatment option for ACT. However, we acknowledge the limited size of our investigation warrants a multicentre collaborative study to confirm our findings. Cite this article: 2018;100-B:256-61.
[Mh] Termos MeSH primário: Neoplasias Ósseas/cirurgia
Condrossarcoma/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Ossos do Braço/diagnóstico por imagem
Ossos do Braço/patologia
Ossos do Braço/cirurgia
Biópsia
Cimentos para Ossos
Neoplasias Ósseas/diagnóstico por imagem
Neoplasias Ósseas/patologia
Transplante Ósseo
Condrossarcoma/diagnóstico por imagem
Condrossarcoma/patologia
Curetagem
Feminino
Seres Humanos
Ossos da Perna/diagnóstico por imagem
Ossos da Perna/patologia
Ossos da Perna/cirurgia
Masculino
Meia-Idade
Estudos Prospectivos
Instrumentos Cirúrgicos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Cements)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0707.R1


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[PMID]:29319945
[Au] Autor:Food and Drug Administration, HHS.
[Ti] Título:Medical Devices; General and Plastic Surgery Devices; Classification of the Irrigating Wound Retractor Device. Final order.
[So] Source:Fed Regist;83(1):22-4, 2018 Jan 02.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Food and Drug Administration (FDA or we) is classifying the irrigating wound retractor device into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the irrigating wound retractor device's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.
[Mh] Termos MeSH primário: Segurança de Equipamentos/classificação
Instrumentos Cirúrgicos/classificação
Irrigação Terapêutica/classificação
Irrigação Terapêutica/instrumentação
[Mh] Termos MeSH secundário: Seres Humanos
Cirurgia Plástica/classificação
Cirurgia Plástica/instrumentação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


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[PMID]:29190038
[Au] Autor:Mannu GS; Sudul MK; Bettencourt-Silva JH; Cumber E; Li F; Clark AB; Loke YK
[Ad] Endereço:Nuffield Department of Population Health, University of Oxford, CTSU, Richard Doll Building, Old Road Campus, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF.
[Ti] Título:Closure methods of the appendix stump for complications during laparoscopic appendectomy.
[So] Source:Cochrane Database Syst Rev;11:CD006437, 2017 11 13.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Laparoscopic appendectomy is amongst the most common general surgical procedures performed in the developed world. Arguably, the most critical part of this procedure is effective closure of the appendix stump to prevent catastrophic intra-abdominal complications from a faecal leak into the abdominal cavity. A variety of methods to close the appendix stump are used worldwide; these can be broadly divided into traditional ligatures (such as intracorporeal or extracorporeal ligatures or Roeder loops) and mechanical devices (such as stapling devices, clips, or electrothermal devices). However, the optimal method remains unclear. OBJECTIVES: To compare all surgical techniques now used for appendix stump closure during laparoscopic appendectomy. SEARCH METHODS: In June 2017, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6) in the Cochrane Library, MEDLINE Ovid (1946 to 14 June 2017), Embase Ovid (1974 to 14 June 2017), Science Citation Index - Expanded (14 June 2017), China Biological Medicine Database (CBM), the World Health Organization International Trials Registry Platform search portal, ClinicalTrials.gov, Current Controlled Trials, the Chinese Clinical Trials Register, and the EU Clinical Trials Register (all in June 2017). We searched the reference lists of relevant publications as well as meeting abstracts and Conference Proceedings Citation Index to look for additional relevant clinical trials. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared mechanical appendix stump closure (stapler, clips, or electrothermal devices) versus ligation (Endoloop, Roeder loop, or intracorporeal knot techniques) for uncomplicated appendicitis. DATA COLLECTION AND ANALYSIS: Two review authors identified trials for inclusion, collected data, and assessed risk of bias independently. We performed the meta-analysis using Review Manager 5. We calculated the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). MAIN RESULTS: We included eight randomised studies encompassing 850 participants. Five studies compared titanium clips versus ligature, two studies compared an endoscopic stapler device versus ligature, and one study compared an endoscopic stapler device, titanium clips, and ligature. In our analyses of primary outcomes, we found no differences in total complications (OR 0.97, 95% CI 0.27 to 3.50, 8 RCTs, very low-quality evidence), intraoperative complications (OR 0.93, 95% CI 0.34 to 2.55, 8 RCTs, very low-quality evidence), or postoperative complications (OR 0.80, 95% CI 0.21 to 3.13, 8 RCTs, very low-quality evidence) between ligature and all types of mechanical devices. However, our analyses of secondary outcomes revealed that use of mechanical devices saved approximately nine minutes of total operating time when compared with use of a ligature (mean difference (MD) -9.04 minutes, 95% CI -12.97 to -5.11 minutes, 8 RCTs, very low-quality evidence). However, this finding did not translate into a clinically or statistically significant reduction in inpatient hospital stay (MD 0.02 days, 95% CI -0.12 to 0.17 days, 8 RCTs, very low-quality evidence). Available information was insufficient for reliable comparison of total hospital costs and postoperative pain/quality of life between the two approaches. Overall, evidence across all analyses was of very low quality, with substantial potential for confounding factors. Given the limitations of all studies in terms of bias and the low quality of available evidence, a clear conclusion regarding superiority of any one particular type of mechanical device over another is not possible. AUTHORS' CONCLUSIONS: Evidence is insufficient at present to advocate omission of conventional ligature-based appendix stump closure in favour of any single type of mechanical device over another in uncomplicated appendicitis.
[Mh] Termos MeSH primário: Técnicas de Fechamento de Ferimentos Abdominais
Apendicectomia/efeitos adversos
Apêndice/cirurgia
[Mh] Termos MeSH secundário: Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação
Seres Humanos
Complicações Intraoperatórias/epidemiologia
Complicações Intraoperatórias/prevenção & controle
Laparoscopia
Tempo de Internação
Duração da Cirurgia
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Ensaios Clínicos Controlados Aleatórios como Assunto
Instrumentos Cirúrgicos/efeitos adversos
Grampeadores Cirúrgicos/efeitos adversos
Suturas/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006437.pub3


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[PMID]:28452822
[Au] Autor:Covotta M; Claroni C; Torregiani G; Naccarato A; Tribuzi S; Zinilli A; Forastiere E
[Ad] Endereço:From the *Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy; and †Research Institute on Sustainable Economic Growth of the National Research Council of Italy, Italy.
[Ti] Título:A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study.
[So] Source:Anesth Analg;124(6):1794-1801, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Prolonged pneumoperitoneum and Trendelenburg positioning for robot-assisted radical cystectomy (RARC) are essential for optimizing visualization of the operative field, although they worsen hemodynamic and respiratory function. Our hypothesis is that the use of a valveless trocar (VT) may improve respiratory mechanics. METHODS: In this prospective, 2-arm parallel trial, patients ASA II to III undergoing RARC were randomly assigned into 2 groups: in the VT group, the capnoperitoneum was maintained with a VT; in the control group, the capnoperitoneum was maintained with a standard trocar (ST group). Inspiratory plateau pressure (Pplat), static compliance (Cstat), minute volume (MV), tidal volume (Vt), and carbon dioxide (CO2) elimination rate were recorded at these times: 15 minutes after anesthesia induction (T0), 10 minutes (T1) and 60 minutes (T2) after first robot docking, 10 minutes before first undocking (T3), 10 minutes (T4) and 60 minutes (T5) after second docking, 10 minutes before second undocking (T6), and 10 minutes before extubation (T7). The primary end point of the study was the assessment of Pplat mean value from T1 to T6. RESULTS: A total of 56 patients were evaluated: 28 patients in the VT group and 28 in the ST group. VT group had lower Pplat (means and standard error, VT group 30 [0.66] versus ST group 34 [0.66] cm H2O, with estimated mean difference and 95% confidence interval, -4.1 [-5.9 to -2.2], P < .01), lower MV (means and standard error, VT group 8.2 [0.22] versus ST group 9.8 [0.21] L min, P < .01), lower CO2 elimination rate (means and standard error, VT group 4.2 [0.25] versus ST group 5.4 [0.24] mL kg min, P < .01), lower end-tidal CO2 (ETCO2) (means and standard error, VT group 28.8 [0.48] versus ST group 31.3 [0.46] mm Hg, P < .01), and higher Cstat (means and standard error, VT group 26 [0.9] versus ST group 22.1 [0.9] mL cm H2O, P < .01). Both groups had similar Vt (P = .24). CONCLUSIONS: During RARC, use of a VT was associated with a significantly lower Pplat and improvement in other respiratory parameters.
[Mh] Termos MeSH primário: Cistectomia/instrumentação
Pulmão/fisiopatologia
Monitorização Intraoperatória/métodos
Pneumoperitônio Artificial/instrumentação
Mecânica Respiratória
Procedimentos Cirúrgicos Robóticos/instrumentação
Instrumentos Cirúrgicos
[Mh] Termos MeSH secundário: Idoso
Cistectomia/efeitos adversos
Desenho de Equipamento
Feminino
Decúbito Inclinado com Rebaixamento da Cabeça
Hemodinâmica
Seres Humanos
Masculino
Meia-Idade
Posicionamento do Paciente/métodos
Projetos Piloto
Pneumoperitônio Artificial/efeitos adversos
Estudos Prospectivos
Procedimentos Cirúrgicos Robóticos/efeitos adversos
Cidade de Roma
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002027


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[PMID]:29208812
[Au] Autor:Malyugin B
[Ad] Endereço:S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia.
[Ti] Título:Cataract surgery in small pupils.
[So] Source:Indian J Ophthalmol;65(12):1323-1328, 2017 Dec.
[Is] ISSN:1998-3689
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:This paper presents the review of historical aspects and the current state-of-the-art in various pupil dilatation methods to be used in cataract surgery. The surgical algorithm in managing small pupil cases should include topical and intraocular mydriatics, appropriately selected viscosurgical device and mechanical dilatation with instruments, iris hooks, and/or pupil expanders.
[Mh] Termos MeSH primário: Extração de Catarata/instrumentação
Catarata/complicações
Miose/complicações
Instrumentos Cirúrgicos
[Mh] Termos MeSH secundário: Desenho de Equipamento
Seres Humanos
Miose/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180103
[Lr] Data última revisão:
180103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.4103/ijo.IJO_800_17


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[PMID]:29037433
[Au] Autor:Hettlich BF
[Ad] Endereço:Department of Small Animal Surgery, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, Bern 3012, Switzerland. Electronic address: bianca.hettlich@vetsuisse.unibe.ch.
[Ti] Título:Minimally Invasive Spine Surgery in Small Animals.
[So] Source:Vet Clin North Am Small Anim Pract;48(1):153-168, 2018 Jan.
[Is] ISSN:1878-1306
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Minimally invasive spine surgery (MISS) seems to have many benefits for human patients and is currently used for various minor and major spine procedures. For MISS, a change in access strategy to the target location is necessary and it requires intraoperative imaging, special instrumentation, and magnification. Few veterinary studies have evaluated MISS for canine patients for spinal decompression procedures. This article discusses the general requirements for MISS and how these can be applied to veterinary spinal surgery. The current veterinary MISS literature is reviewed and suggestions are made on how to apply MISS to different spinal locations.
[Mh] Termos MeSH primário: Doenças do Gato/cirurgia
Doenças do Cão/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos/veterinária
Procedimentos Neurocirúrgicos/veterinária
Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Animais
Gatos
Cães
Seres Humanos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Procedimentos Neurocirúrgicos/métodos
Instrumentos Cirúrgicos/veterinária
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171018
[St] Status:MEDLINE


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[PMID]:29229142
[Au] Autor:Atrchian S; Sadeghi P; Cwajna W; Helyer L; Rheaume D; Nolan M; Sadeghi P; Robar J
[Ad] Endereço:Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: siavash.atrchian@bccancer.bc.ca.
[Ti] Título:Improvement of consistency in delineating breast lumpectomy cavity using surgical clips.
[So] Source:J Surg Res;221:30-34, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delineation of lumpectomy cavity for whole breast radiation therapy after breast conserving surgery can be challenging because of poor visualization of the cavity. The use of surgical clips on lumpectomy cavity walls has been suggested as an effective and low-cost method to improve the accuracy and consistency of lumpectomy cavity delineation. MATERIALS AND METHODS: Twenty-three eligible female breast cancer patients who were treated with lumpectomy and adjuvant radiation therapy were recruited for this study. During breast conserving surgery, four surgical clips were placed on the superior, inferior, lateral, and medial walls of the lumpectomy cavity. Patients were imaged prior and during radiation treatment. Software was developed to anonymize the image sets and digitally remove the clips from the computed tomography images. Three radiation oncologists contoured the lumpectomy cavity volume, with and without presence of clips. Contoured image sets were analyzed with regard to cavity volume, dimensions, and concordance index. Statistical analysis was performed using a paired t-test. RESULTS: The presence of clips significantly increased the average lumpectomy cavity volumes from 23.50 cc to 26.42 cc (P < 0.0001). The presence of clips also significantly increased the mean craniocaudal, anteroposterior, and mediolateral dimensions by 6.8, 2.3, and 2.9 mm, respectively (all P < 0.01). In addition, the presence of surgical clips improved the consistency in delineation in CC dimension by significantly decreasing the standard deviation (P < 0.006). CONCLUSIONS: The presence of surgical clips improves the accuracy of lumpectomy cavity delineation. However, consistency is only improved in CC dimension.
[Mh] Termos MeSH primário: Mama/diagnóstico por imagem
Mastectomia Segmentar/instrumentação
Radioterapia Adjuvante/instrumentação
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Instrumentos Cirúrgicos
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:28459316
[Au] Autor:Klooster K; Hartman JE; Ten Hacken NHT; Slebos DJ
[Ad] Endereço:1 University Medical Center Groningen Groningen, the Netherlands.
[Ti] Título:Improved Predictors of Survival after Endobronchial Valve Treatment in Patients with Severe Emphysema.
[So] Source:Am J Respir Crit Care Med;195(9):1272-1274, 2017 05 01.
[Is] ISSN:1535-4970
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Broncoscopia/métodos
Pneumonectomia/métodos
Enfisema Pulmonar/cirurgia
Instrumentos Cirúrgicos
[Mh] Termos MeSH secundário: Tolerância ao Exercício
Feminino
Volume Expiratório Forçado
Seres Humanos
Masculino
Meia-Idade
Enfisema Pulmonar/mortalidade
Enfisema Pulmonar/fisiopatologia
Índice de Gravidade de Doença
Taxa de Sobrevida
Resultado do Tratamento
Teste de Caminhada
[Pt] Tipo de publicação:LETTER; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1164/rccm.201610-1993LE


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[PMID]:29180198
[Au] Autor:Farrelly JS; Clemons C; Witkins S; Hall W; Christison-Lagay ER; Ozgediz DE; Cowles RA; Stitelman DH; Caty MG
[Ad] Endereço:Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: james.farrelly@yale.edu.
[Ti] Título:Surgical tray optimization as a simple means to decrease perioperative costs.
[So] Source:J Surg Res;220:320-326, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Health care spending in the US remains excessively high. Aside from complicated, large-scale efforts at health care cost reduction, there are still relatively simple ways in which individual hospitals can cut unnecessary costs from everyday operations. Inspired by recent publications, our group sought to decrease the costs associated with surgical instrument processing at a large, multihospital academic center. METHODS: This was a single-site observational study conducted at a large academic medical center. At the study start, all attending surgeons within the section of pediatric surgery agreed to standardize the pediatric surgery trays and to eliminate instruments that were deemed unnecessary from each tray. A multidisciplinary start-up meeting was held, and this meeting included stakeholders from central sterile processing, operating room nursing, scrub technicians, and materials management along with all five pediatric surgeons. Each tray was addressed individually. Instruments were eliminated from trays only if there was unanimous agreement among all the surgeons in the group. If no instruments in a given surgical tray were deemed necessary, the entire tray was eliminated from sterile processing rotation. Feedback questionnaires were drafted by the multidisciplinary team that participated in the start-up meeting. Surgeons were allowed to request for certain instruments to be placed back into the trays at any time, and the questionnaires also allowed for free-hand comments. Surgical kit preparation time was obtained from the institutional barcode scanning system. The cost per second of sterile processing labor was calculated using regional median salary for sterile processing technicians in the state of Connecticut. Using the pediatric surgery section as the model unit, this method was then applied to pediatric urology, neurosurgery, spine surgery, and orthopedics. RESULTS: The pediatric surgery section eliminated an average of 59.5% of instruments per tray, resulting in an overall reduction of 1826 (39.5%) instruments from rotation, 45,856 fewer instruments processed per year, and nine trays eliminated completely from regular rotation. Processing time for six commonly used trays was reduced by an average of 28.7%. The urology section eliminated 18 trays from regular rotation and 179 (10.1%) instruments in total. Pediatric orthopedics, neurosurgery, and spine sections eliminated 708 (17.1%), 560 (92.7%), and 31 (32.2%) instruments, respectively, resulting in approximately 18,804 fewer instruments processed per year. Among all five surgical sections, annual instrument cost avoidance after tray optimization was estimated at $53,193 to $531,929 using average instrument life spans ranging from 1-10 y. Negative feedback and requests for instrument replacement were both minimal on feedback questionnaires. CONCLUSIONS: Surgical tray optimization represents a relatively simple microsystem improvement that could result in significant hospital cost reduction. Although difficult to quantify, other gains from surgical kit optimization include decreased weight per tray, decreased materials cost, and decreased labor required to count, decontaminate, and pack surgical trays.
[Mh] Termos MeSH primário: Redução de Custos
Assistência Perioperatória/economia
Instrumentos Cirúrgicos/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE



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