Traumatic rupture of the descending thoracic aorta

The management of acute traumatic rupture of the descending thoracic aorta at Groote Schuur Hospital between January 1984 and December 1989 is reviewed. Aortic rupture was diagnosed angiographically in 18 of 150 patients (12%), who underwent aortography because this injury was suspected. However. 3 of these patients had false-positive angiograms. The diagnosis was initially missed in 31% of patients, and this contributed to morbidity and mortality. Simple aortic crossclamping (N = 8) was used before September 1988 and 3 patients died - 1 intra-operatively from cardiac arrhythmia and 2 postoperatively, where major peri-operative haemorrhage had occurred. In contrast, partial heparin-less bypass (N = 5) using a centrifugal vortex pump was used after September 1988, and there were no haemorrhagic or paraplegic complications or mortality in this group. This technique is safe and appears to be superior to simple aortic crossclamping in managing this condition

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P  70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high

Mitral repair best practice: proposed standards

OBJECTIVES: To define best practice standards for mitral valve repair surgery. DESIGN: Development of standards for process and outcome by consensus. SETTING: Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation. MAIN OUTCOME MEASURES: Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care. RESULTS: 19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues. CONCLUSIONS: Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care

Skin Glue Improves Outcome after Excision and Primary Closure of Sacrococcygeal Pilonidal Disease

Evaluating the effect of Histoacryl on the outcome and recurrence rate after excision and primary closure of sacrococcygeal pilonidal disease. Forty patients with sacrococcygeal pilonidal sinus were randomly divided into 2 equal groups through computer randomization program. Group I was operated by complete excision of sinus with wound closure using Histoacryl. Group II was operated with primary wound closure by interrupted inverting sutures. Mean operative time was 31.5 ± 5.6 minutes in group I and 35.9 ± 5.1 minutes in group II. Mean healing time was 13.4 ± 2.7 days in group I and 18.0 ± 8.9 days in group II. Wound infection occurred in 2 patients (10%) in Group II. Delayed wound healing occurred in 3 patients (15%) in group I and 4 patients (20%) in group II. Recurrence occurred in 1 patient (5%) in group I and 3 patients (15%) in group II. Histoacryl improves outcome (significantly decreases operative and healing times and increases patient satisfaction score, insignificantly decreases rates of complications and recurrence) after excision and primary closure of sacrococcygeal pilonidal disease