Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diag...Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.展开更多
Background Subarachnoid haemorrhage(SAH)and intraventricular haemorrhage(IVH)are associated with poor patient outcomes.Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neur...Background Subarachnoid haemorrhage(SAH)and intraventricular haemorrhage(IVH)are associated with poor patient outcomes.Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome.By similar rationale,cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH.We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators.We extracted ORs from the individual studies and aggregated these using a random effects model.The quality of evidence was evaluated using Grading of Recommendations,Assessment,Development and Evaluations assessment and ROBINS-I or RoB-2.Results 24 articles were included.In SAH,we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality(OR:0.68,95%CI 0.46 to 1.00),higher probability of favourable functional outcome(OR:1.80,95%CI 1.30 to 2.51),and reduced risks of DCI(OR:0.28,95%CI 0.18 to 0.42)and cerebral vasospasm(OR:0.28,95%CI 0.18 to 0.42),compared with conventional therapy.Cisternal irrigation with vasodilatory agents was associated with lower mortality(OR:0.32,95%CI 0.13 to 0.79)and reduced risk of cerebral vasospasm(OR:0.37,95%CI 0.17 to 0.79).The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.Conclusion In this study,we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy.There is no evidence to support cisternal irrigation treatment of IVH.展开更多
文摘Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.
基金supported by grants from the Danish Cancer Society(R304-A17698-B5570 and R295-A16770)the Lundbeck Foundation(R325-2019-1490)+2 种基金the Independent Research Fund Denmark(903900307B)unrelated to this studysupported by a grant from The Health Research Fund of Central Denmark Region unrelated to this studysupported by grants from The Health Research Fund of Central Region Denmark and the Novo Nordisk Foundation unrelated to this study.
文摘Background Subarachnoid haemorrhage(SAH)and intraventricular haemorrhage(IVH)are associated with poor patient outcomes.Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome.By similar rationale,cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH.We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators.We extracted ORs from the individual studies and aggregated these using a random effects model.The quality of evidence was evaluated using Grading of Recommendations,Assessment,Development and Evaluations assessment and ROBINS-I or RoB-2.Results 24 articles were included.In SAH,we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality(OR:0.68,95%CI 0.46 to 1.00),higher probability of favourable functional outcome(OR:1.80,95%CI 1.30 to 2.51),and reduced risks of DCI(OR:0.28,95%CI 0.18 to 0.42)and cerebral vasospasm(OR:0.28,95%CI 0.18 to 0.42),compared with conventional therapy.Cisternal irrigation with vasodilatory agents was associated with lower mortality(OR:0.32,95%CI 0.13 to 0.79)and reduced risk of cerebral vasospasm(OR:0.37,95%CI 0.17 to 0.79).The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.Conclusion In this study,we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy.There is no evidence to support cisternal irrigation treatment of IVH.
