Impact of a World Health Organization (WHO) Surgical Safety Checklist Implementation During Urgent Operations on Compliance with Basic Standards of Care and Occurrence of Complications

Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths. A 19-item surgical safety checklist was implemented  to  reduce complications and deaths associated with surgery as well as increase the compliance with basic standards of care .The aim of this study is to assess the effect of implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent operations on compliance with basic standards of care as indicated by adherence to 6 selected safety measures and rates of complications at National Bank Hospital for the integrated care affiliated to the Egyptian Ministry of Health and Population. To fulfill this aim a prospective pre- and post intervention study design was used.  A total of 60 adult male & female patients undergoing urgent operations are recruited to this study divided into two equal and matched groups (study& control). Three tools were utilized for data collections; 1) Socio-demographic and operative data sheet, 2) Complications monitoring sheet and 3) Performance of the 6 specified safety measures check list. More information can be found in the full paper

Conservative Management of a Splenic Artery Aneurysm in Pregnancy: A Case Report

Splenic artery aneurysms (SAA) are a rare and life-threatening pathology. Ruptured SAA has a mortality rate of up to 25%, with increased rates of rupture in pregnancy, pseudoaneurysm, liver transplantation, portal hypertension, symptomatic SAA and diameter >2 cm. Management of SAA in pregnant women is poorly described in the literature, making treatment of these patients difficult. Furthermore, careful consideration of complications for both the mother and the foetus need to be taken into account. This case report demonstrates that conservative management with monthly surveillance MRI can be used as viable treatment option of an asymptomatic 17 mm splenic artery aneurysm in a pregnant woman

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Zenith Cook limb type IIIB endoleak causing aneurysm rupture five years after EVAR

Type III endoleaks are rare late complications of endovascular abdominal aortic aneurysm repair. The aneurysm sac is pressurised either through disconnection of modular components (type IIIA) or a defect in the graft fabric (type IIIB). We report the endovascular treatment of a ruptured infrarenal aortic aneurysm five years after elective endovascular abdominal aortic aneurysm repair caused by a type IIIB endoleak secondary to probable graft material erosion of the contralateral limb. This is the first report of a late aneurysm rupture caused by fabric defect in a Cook Zenith limb. The case highlights the potential serious consequences of minimal migration of the device and the importance of landing the proximal fixation in healthy aorta. </jats:p