Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse ...Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.展开更多
Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and...Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.展开更多
Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and manag...Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and managed by FTS principles. Setting: Tertiary hospital, University based subspecialty gynaecological oncology practice. Population or Sample: Consecutive patients with uterine corpus cancer. There were no exclusions. Methods: Three year audit of FTS Database. Main Outcome Measures: Ability to tolerate early oral feeding (EOF), length of stay (LOS), perioperative complication rate and readmission rate. Results: Sixty six patients were operated upon whose median age was 59.5 years. Forty six (70%) had stage I disease, 7 (11%) stage II, 9 (14%) stage III and 4 (6%) had stage IV disease. Twenty seven (41%) had lymph node sampling performed. Median operating time was 2.5 hours. Mean BMI was 30 kg/m2 (Range: 18 - 47). Fifty patients (76%) were classified as over-weight or obese. Twenty four patients (36%) had a “non-zero” performance status. Mean intraoperative EBL was 227 ml. Median LOS was 3.0 days. There were 3 (5%) intraoperative complications. There were no intraoperative ureteric, bowel or vascular injuries. Postoperatively, 13 (20%) patients experienced a total of 24 adverse events. Only 2 (3%) patients experienced complications greater than grade 2. Conclusion: This audit shows that in an unselected group of patients undergoing laparotomy as management for their uterine malignancy and managed by a FTS protocol, overall excellent results can be achieved.展开更多
Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotom...Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.展开更多
Background:The epidemiological investigation of Hodgkin’s lymphoma(HL)among the genetically peculiar population of the Italian island of Sardinia might provide interesting etiological clues.Methods:We used the databa...Background:The epidemiological investigation of Hodgkin’s lymphoma(HL)among the genetically peculiar population of the Italian island of Sardinia might provide interesting etiological clues.Methods:We used the database of 1974-2003 incident cases of hematological malignancies in Sardinia and Bayesian methods to explore the time trend and geographic spread of HL incidence by sex,and age whether≤44 or≥45 years.We also tested its association with several socio-economic and environmental risk factors.Results:The age-and sex-standardized(world population)incidence rate of HL was 2.6 per 100,000(95%CI,2.5-2.8).Over the study period,HL incidence increased linearly in both sexes and among those aged≤44 years but not above that age.Cases clustered among young women in a central-western area covering four bordering administrative units(13 cases vs.5.7 expected,P=0.002).The posterior probability of excess HL cases aged≤44 years was elevated only in a commune in the suburban area of the region’s capital.Cases aged≥45 years were uniformly spread over the region.Among the risk factors we explored,urban residence was associated with an elevated and goat farming with a decreased risk of HL occurrence.We did not observe a link with socio-economic deprivation,environmental exposures,or multiple sclerosis.The geographic spread of COVID-19 was also unrelated to past HL incidence.Conclusions:Our results prompt further in-depth investigation into the previously undetected cluster and the nature of the observed associations.展开更多
文摘Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.
文摘Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.
文摘Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and managed by FTS principles. Setting: Tertiary hospital, University based subspecialty gynaecological oncology practice. Population or Sample: Consecutive patients with uterine corpus cancer. There were no exclusions. Methods: Three year audit of FTS Database. Main Outcome Measures: Ability to tolerate early oral feeding (EOF), length of stay (LOS), perioperative complication rate and readmission rate. Results: Sixty six patients were operated upon whose median age was 59.5 years. Forty six (70%) had stage I disease, 7 (11%) stage II, 9 (14%) stage III and 4 (6%) had stage IV disease. Twenty seven (41%) had lymph node sampling performed. Median operating time was 2.5 hours. Mean BMI was 30 kg/m2 (Range: 18 - 47). Fifty patients (76%) were classified as over-weight or obese. Twenty four patients (36%) had a “non-zero” performance status. Mean intraoperative EBL was 227 ml. Median LOS was 3.0 days. There were 3 (5%) intraoperative complications. There were no intraoperative ureteric, bowel or vascular injuries. Postoperatively, 13 (20%) patients experienced a total of 24 adverse events. Only 2 (3%) patients experienced complications greater than grade 2. Conclusion: This audit shows that in an unselected group of patients undergoing laparotomy as management for their uterine malignancy and managed by a FTS protocol, overall excellent results can be achieved.
文摘Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.
文摘Background:The epidemiological investigation of Hodgkin’s lymphoma(HL)among the genetically peculiar population of the Italian island of Sardinia might provide interesting etiological clues.Methods:We used the database of 1974-2003 incident cases of hematological malignancies in Sardinia and Bayesian methods to explore the time trend and geographic spread of HL incidence by sex,and age whether≤44 or≥45 years.We also tested its association with several socio-economic and environmental risk factors.Results:The age-and sex-standardized(world population)incidence rate of HL was 2.6 per 100,000(95%CI,2.5-2.8).Over the study period,HL incidence increased linearly in both sexes and among those aged≤44 years but not above that age.Cases clustered among young women in a central-western area covering four bordering administrative units(13 cases vs.5.7 expected,P=0.002).The posterior probability of excess HL cases aged≤44 years was elevated only in a commune in the suburban area of the region’s capital.Cases aged≥45 years were uniformly spread over the region.Among the risk factors we explored,urban residence was associated with an elevated and goat farming with a decreased risk of HL occurrence.We did not observe a link with socio-economic deprivation,environmental exposures,or multiple sclerosis.The geographic spread of COVID-19 was also unrelated to past HL incidence.Conclusions:Our results prompt further in-depth investigation into the previously undetected cluster and the nature of the observed associations.
