A Concurrent Pseudoaneurysm and an Arteriovenous Fistula ...
Artery Forceps Removed From Abdomen Of Woman Four Months After Surgery
Artery Forceps left in Abdomen.
Vijayawada: An artery forceps measuring two to three inches length was removed from the abdomen of a woman when it was forgotten by a team of doctors while performing delivery through C-section four months ago and the woman is under stable condition at government hospital in Vijayawada.
A 25 year old pregnant woman was admitted at government hospital at Eluru in April and the doctors delivered a baby through C-section and forgot an artery forceps in her abdomen.
Though she suffered mild stomach pain, she and her family members considered it due to delivery through C-section.
However, when she developed severe stomach pain, her family members rushed her to government hospital at Eluru and the doctors referred her to government hospital in Vijayawada based on an emergency situation.
On Aug. 10, the doctors found an artery forceps in her abdomen when they carried out an X-ray and carried out an operation immediately and removed it. They also found some parts of intestines were damaged and are providing treatment to her. The artery forceps is used to clamp blood vessels to stop bleeding during surgery and though the staff nurse is supposed to count the number of tools used after surgery to find out anyone is missing and report to the concerned doctors who performed surgery, she failed to do so.
Vijayawada government hospital general surgery department head Dr Appa Rao said, "Our team of doctors removed the artery forceps found in her abdomen and also noticed some parts of intestines damaged. Her health condition is stable now and is under medical observation."
Meanwhile, Eluru Collector V. Prasanna ordered for an inquiry on the issue.
Pulmonary Artery Catheter Use In Cardiac Surgery Patients: Study Reveals Varied Impact On Hospital Stay And Mortality Rates
In a recent study published in Scientific Reports, researchers investigated the relationship between pulmonary artery catheter (PAC) use and clinical outcomes in cardiac surgery patients, focusing on in-hospital deaths and hospital stay durations both generally and within specific subgroups.
Study: Association of pulmonary artery catheter with in-hospital outcomes after cardiac surgery in the United States: National Inpatient Sample 1999–2019. Image Credit: J-THE PHOTOHOLIC/Shutterstock.Com
PACs provide specialized hemodynamic data essential for cardiac surgery decisions, yet while they may lead to more intensive treatments, improved outcomes are not always guaranteed.
Despite their potential utility, the absence of randomized trial data has led global guidelines to somewhat discourage PACs' routine use, highlighting the balance between its potential benefits and the scarcity of evidence in certain scenarios.
This stance is further complicated by inconsistent usage across nations, fueling the ongoing debate surrounding PACs.
PACs deliver direct and indirect hemodynamic measurements, assisting in treatment selection and monitoring chronic conditions. Some doubt their precision, especially concerning cardiac output (CO) estimations.
Limited studies have examined differences in outcomes, like in-hospital mortality and intensive care unit (ICU) admission, between PAC users and non-users. A knowledge gap persists regarding PAC's utility for certain patient subgroups. This highlights the need for further study investigating PAC's impact on cardiac surgery outcomes.
About the studyIn the present study, analyses were conducted on data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) between 1999–2019, which holds hospital discharge records from the United States (US) community hospitals.
The data encompasses patient demographics, diagnoses, procedures, and hospital outcomes. The Fort Belvoir Community Hospital deemed the study exempt from human subject considerations.
The study focused on patients 18 years and older with a record indicating cardiac surgery. Records from hospitals with fewer than 50 cardiac surgeries from 1999 to 2019 and those with zero PACs yearly were excluded, after which 969,034 records remained.
Patients were categorized by age, sex, race/ethnicity, Charlson comorbidity index, elective admissions, admission quarter, weekend admission status, and primary payer. Comorbidities relevant to cardiovascular surgery patients were also taken into account. Hospitals were categorized by region, control, location, teaching status, and bed size.
Specific subgroups were identified using diagnostic and procedure codes: "heart failure," "pulmonary hypertension," "mitral or tricuspid valve disease," and "combined surgery."
Hospital discharge records were labeled based on whether the patient received a PAC or not. Outcomes considered were in-hospital mortality and length of stay (LOS).
Using Stata version 17, analyses were conducted incorporating descriptive statistics, bivariate associations, linear and logistic regression models, risk adjustment, and targeted maximum likelihood estimation (TMLE).
Sensitivity analyses were conducted based on hospital-level PAC rates. A significance level of P < 0.05 was adopted. The Fort Belvoir Community Hospital Institutional Review Board waived the study due to its non-human subject nature, adhering to the Declaration of Helsinki.
Study resultsThe study results reported that fewer disparities were noticed concerning PAC receipt between patients with selected subgroup characteristics than those without.
Among cardiac surgery patients, the PAC receipt rate was 9.49%. However, this was higher for patients with subgroup characteristics (10.01%) than those without (9.23%, significant at P=0.007).
The in-hospital mortality rate in the cardiac surgery group stood at 4.05%. Remarkably, there was a difference based on subgroup characteristics: 3.05% for patients without any and 6.06% for those with any of the characteristics (significant at P<0.0001).
The average hospital stay was 11.40 days, with patients having subgroup characteristics staying longer (13.37 days) than those without (10.41 days, significant difference at P<0.0001).
When comparing PAC recipients and non-recipients, there were noticeable variations in hospital stay lengths, but in-hospital death rates remained relatively consistent.
After accounting for various factors, the chances of in-hospital death did not show a significant difference between PAC recipients and non-recipients. Interestingly, in certain risk-adjusted models, PAC recipients had shorter hospital stays than non-recipients.
The results mirrored those from risk-adjusted models when looking at causal relationships between PAC receipt, in-hospital deaths, and hospital stays. PAC receipt was significantly associated with in-hospital death due to congestive heart failure patients. Moreover, PAC recipients were generally less likely to have hospital stays exceeding seven days.
In-depth stratified analyses based on subgroup status showed no major difference in the relationship between PAC and clinical outcomes. Sensitivity tests, when sorted by hospital PAC rates, showed distinct trends.
In particular, hospitals with PAC rates in the first to third quartiles had more in-hospital deaths, either no difference or longer stays for PAC recipients than non-recipients. In contrast, hospitals in the fourth quartile showed fewer deaths and shorter stays for PAC recipients.
Lastly, PAC use was not linked to in-hospital death upon excluding combined surgeries and focusing on specific cardiac surgeries. However, it was associated with shorter stays for mitral valve repairs and longer stays for tricuspid valve repairs.
Colchicine Does Not Reduce Perioperative AF Or MINS In Major Non-cardiac Thoracic Surgery
Colchicine does not significantly reduce perioperative atrial fibrillation (AF) or myocardial injury after non-cardiac surgery (MINS) in patients undergoing major non-cardiac thoracic surgery, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.
Perioperative AF occurs in approximately 10% of patients after major thoracic surgery, while MINS has an incidence of about 20% in the same patient population. Patients with perioperative AF and MINS have a poor prognosis. High levels of inflammatory biomarkers have been associated with an increased risk of perioperative AF and MINS. Anti-inflammatory treatment therefore has the potential to reduce the incidence of these two prognostically important complications. Colchicine is an inexpensive drug with anti-inflammatory effects. Small randomized trials have suggested that in patients undergoing cardiac surgery, low-dose colchicine reduces the risk of perioperative AF. Two large randomized trials found that low-dose colchicine significantly reduced the incidence of major cardiovascular outcomes in patients with coronary artery disease.
The COP-AF trial tested the hypothesis that colchicine reduces the incidence of clinically important perioperative AF and MINS in patients undergoing major non-cardiac thoracic surgery. The trial enrolled patients aged 55 years or older who were undergoing major non-cardiac thoracic surgery. Participants were randomly assigned in a 1:1 ratio to receive oral colchicine 0.5mg twice daily or matching placebo, starting within four hours before surgery and for a total duration of 10 days. Two co-primary outcomes were assessed during 14 days of follow up: 1) clinically important perioperative AF (i.E., AF needing medical treatment or AF leading to heart failure, hypotension or angina) and 2) MINS (i.E., myocardial infarction or any postoperative troponin elevation deemed to be of ischaemic origin).
The study included 3,209 patients from 45 sites in 11 countries. The mean age was 68 years and 48.4% were women. Clinically important AF developed in 103 of 1,608 (6.4%) patients assigned to colchicine and 120 of 1,601 (7.5%) patients assigned to placebo, for a hazard ratio (HR) of 0.85 (95% confidence interval [CI] 0.65 to 1.10) and absolute risk reduction (ARR) of 1.1% (95% CI -0.7 to 2.8, p=0.22). MINS occurred in 295 (18.3%) patients assigned to colchicine and 325 (20.3%) patients assigned to placebo, HR 0.89 (95% CI 0.76 to 1.05) and ARR 2.0% (95% CI -0.8 to 4.7, p=0.16).
There were no significant differences between treatment groups in key secondary outcomes, including the composite of all-cause mortality, nonfatal MINS and nonfatal stroke, HR 0.88 (95% CI 0.75 to 1.03); the composite of all-cause mortality, nonfatal myocardial infarction (MI) and nonfatal stroke, HR 0.67 (95% CI 0.39 to 1.17); MINS not fulfilling the fourth universal definition of MI, HR 0.90 (95% CI 0.76 to 1.06); and MI, HR 0.86 (95% CI 0.41 to 1.81).
In post-hoc analyses, the composite outcome of clinically important perioperative AF or MINS occurred in 360 (22.4%) patients in the colchicine group and in 415 (25.9%) patients in the placebo group (HR 0.84; 95% CI 0.73 to 0.97). The composite outcome of vascular mortality, nonfatal MINS, nonfatal stroke or clinically important perioperative AF occurred in 364 (22.6%) patients in the colchicine group versus 422 (26.4%) in the placebo group (HR 0.83; 95% CI, 0.72 to 0.96). Six patients had a stroke, 1 (0.1%) in the colchicine group and 5 (0.3%) in the placebo group (p=0.12).
From a safety perspective, the composite outcome of sepsis or infection occurred in 103 (6.4%) patients in the colchicine group and 83 (5.2%) patients in the placebo group (HR 1.24; 95% CI 0.93 to 1.66). Colchicine increased the incidence of non-infectious diarrhea, 134 (8.3%) versus 38 (2.4%) patients, HR 3.64 (95% CI 2.54 to 5.22). No treatment was required in 66 (38.4%) cases of diarrhea, 15 (8.7%) patients needed intravenous hydration, 2 (1.2%) received antibiotics, and 1 (0.7%) patient required readmission for diarrhea. In the colchicine group, the median (interquartile range) length of stay was 5 (4-7) days in patients with diarrhea and 5 (3-7) days in those without diarrhea.
Colchicine did not significantly reduce the incidence of the co-primary outcomes of clinically important perioperative AF or MINS. Colchicine increased the risk of non-infectious diarrhea, but our data suggest that these episodes were temporary and benign. Despite these findings, several results provide an encouraging signal of benefit for colchicine to reduce the incidence of adverse cardiovascular outcomes in patients undergoing major non-cardiac thoracic surgery. Future trials should further investigate the role of colchicine in the prevention of these events in patients undergoing surgery."
Dr. David Conen, Population Health Research Institute, Hamilton, Canada
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