Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity an...Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.展开更多
Aim:To evaluate the effectiveness of lymphovenular anastomosis(LVA)under local anesthesia for patients with high American Society of Anesthesiologists Physical Status(ASA PS)score.Methods:From January 2019 to January ...Aim:To evaluate the effectiveness of lymphovenular anastomosis(LVA)under local anesthesia for patients with high American Society of Anesthesiologists Physical Status(ASA PS)score.Methods:From January 2019 to January 2021,we collected a total of 29 patients with lymphedema stage III and IV,operated upon with LVA by a single surgeon in a medical center.These patients had poor responses to compression therapies.After surgery,the patients underwent complex decongestive therapy consisting of the continuous wearing of an elastic stocking.To examine the effect of LVA,all data were collected,and differences in preoperative and postoperative means were analyzed.Results:Twenty-nine patients with high ASA PS score(>3)were followed after lymphovenular anastomosis and postoperative compression therapies.Twenty-one of 29 patients were survivors of oncological diseases and continued oncological therapies.The average duration of edema of these patients before LVA was 25±5.0 years.The average number of anastomosis for each patient was 6.8±2.2;the methods of anesthesia had no significant influence on these numbers.The average follow-up period was 7.8±0.85 months,and the result was considered effective(26/29 patients;89.7%).The average reduction of the circumference in affected limbs was 4.40%±3.67%of the preoperative excess length.There were no perioperative complications in this study.Conclusion:Lymphovenular anastomosis can be performed under local anesthesia,especially in patients with high risks of general anesthesia(ASA PS score>3).By this way,we could achieve adequate anastomosis and effective treatment of lymphedema in advanced cancer patients as well.展开更多
Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with...Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed.Based on KPS and ASA scores,patients were categorized into high KPS(>70)or low KPS(≤70)and high ASA(3~4)or low ASA(1~2)groups.Differences in intraoperative risk factors and perioperative complications among the groups were analyzed.Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage(31.8%)and intracranial infection(27.0%);30-day mortality was 5.2%.The incidence rates of severe complications,central nervous system complications,and total complications were comparable in the low and high KPS groups and in the low and high ASA groups(all p>0.05).Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.展开更多
文摘Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.
文摘Aim:To evaluate the effectiveness of lymphovenular anastomosis(LVA)under local anesthesia for patients with high American Society of Anesthesiologists Physical Status(ASA PS)score.Methods:From January 2019 to January 2021,we collected a total of 29 patients with lymphedema stage III and IV,operated upon with LVA by a single surgeon in a medical center.These patients had poor responses to compression therapies.After surgery,the patients underwent complex decongestive therapy consisting of the continuous wearing of an elastic stocking.To examine the effect of LVA,all data were collected,and differences in preoperative and postoperative means were analyzed.Results:Twenty-nine patients with high ASA PS score(>3)were followed after lymphovenular anastomosis and postoperative compression therapies.Twenty-one of 29 patients were survivors of oncological diseases and continued oncological therapies.The average duration of edema of these patients before LVA was 25±5.0 years.The average number of anastomosis for each patient was 6.8±2.2;the methods of anesthesia had no significant influence on these numbers.The average follow-up period was 7.8±0.85 months,and the result was considered effective(26/29 patients;89.7%).The average reduction of the circumference in affected limbs was 4.40%±3.67%of the preoperative excess length.There were no perioperative complications in this study.Conclusion:Lymphovenular anastomosis can be performed under local anesthesia,especially in patients with high risks of general anesthesia(ASA PS score>3).By this way,we could achieve adequate anastomosis and effective treatment of lymphedema in advanced cancer patients as well.
基金supported by National Natural Science Foundation of China(grant no.81802502)the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University,China(No.XJTU1AF-2016-018).
文摘Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed.Based on KPS and ASA scores,patients were categorized into high KPS(>70)or low KPS(≤70)and high ASA(3~4)or low ASA(1~2)groups.Differences in intraoperative risk factors and perioperative complications among the groups were analyzed.Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage(31.8%)and intracranial infection(27.0%);30-day mortality was 5.2%.The incidence rates of severe complications,central nervous system complications,and total complications were comparable in the low and high KPS groups and in the low and high ASA groups(all p>0.05).Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.
