Coronary artery bypass graft(CABG)is associated with a high risk of mortality and morbidity;thus,assessment of surgery quality is necessary.In this perspective,we will focus on the structure,process,and outcomes measu...Coronary artery bypass graft(CABG)is associated with a high risk of mortality and morbidity;thus,assessment of surgery quality is necessary.In this perspective,we will focus on the structure,process,and outcomes measured as quality assessment.A set of 21 evidence-based structure,process,and outcome measures were selected as National Quality Forum.Of these,the Society of Thoracic Surgeons ultimately chose 11 individual quality measures grouped them into four domains used to assess the quality of CABGs.These four domains consisted of perioperative medical care,operative care,risk-adjusted operative mortality and postoperative risk-adjusted major morbidity.These measures have been useful as quality improvement tools in assessing the quality of CABG surgery.展开更多
Autologous free tissue transfer is a safe and effective option for breast reconstruction.It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life.Microvascular ...Autologous free tissue transfer is a safe and effective option for breast reconstruction.It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life.Microvascular thrombosis is a rare but significant complication of microsurgical breast reconstruction,often resulting in flap failure.Proper diagnosis and timely management of this complication are essential to free flap salvage.While microvascular thrombosis poses a threat to flap survival,several methods may be employed to mitigate its more devastating effects.Here,we present a comprehensive review of arterial and venous thrombotic complications in both the intraoperative and postoperative settings.We discuss preoperative risk assessment,methods for flap monitoring,and operative and medical management of thrombotic complications.We present an updated algorithm for the intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our novel algorithm for the postoperative management of microvascular thrombosis.展开更多
基金supported by the Departments of Anesthesiology and Pain Medicine of University of California Davis Health and NIH grant UL1 TR001860 of the University of California Davis Health
文摘Coronary artery bypass graft(CABG)is associated with a high risk of mortality and morbidity;thus,assessment of surgery quality is necessary.In this perspective,we will focus on the structure,process,and outcomes measured as quality assessment.A set of 21 evidence-based structure,process,and outcome measures were selected as National Quality Forum.Of these,the Society of Thoracic Surgeons ultimately chose 11 individual quality measures grouped them into four domains used to assess the quality of CABGs.These four domains consisted of perioperative medical care,operative care,risk-adjusted operative mortality and postoperative risk-adjusted major morbidity.These measures have been useful as quality improvement tools in assessing the quality of CABG surgery.
文摘Autologous free tissue transfer is a safe and effective option for breast reconstruction.It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life.Microvascular thrombosis is a rare but significant complication of microsurgical breast reconstruction,often resulting in flap failure.Proper diagnosis and timely management of this complication are essential to free flap salvage.While microvascular thrombosis poses a threat to flap survival,several methods may be employed to mitigate its more devastating effects.Here,we present a comprehensive review of arterial and venous thrombotic complications in both the intraoperative and postoperative settings.We discuss preoperative risk assessment,methods for flap monitoring,and operative and medical management of thrombotic complications.We present an updated algorithm for the intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our novel algorithm for the postoperative management of microvascular thrombosis.
