Major and minor surgery: Terms used for hundreds of years that have yet to be defined.
TL;DR: The lack of an established distinction between major and minor surgery has major implications on the interpretation of research, clinical practices, and outcomes as mentioned in this paper, and physicians must weigh this utility against the complications caused by unsuitable use in scientific literature and medical education.
Abstract: •The terms major and minor surgery are commonly used in scientific literature. The lack of an established distinction between the two terms has major implications on the interpretation of research, clinical practices, and outcomes.•Researchers should be cautious when using major and minor surgery to describe procedures unless accompanied by a thorough evidence-based explanation of each category.•The terminology may be useful for setting the tone of expectations when communicating with patients and their families, but physicians must weigh this utility against the complications caused by unsuitable use in scientific literature and medical education.
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TL;DR: In this article , the authors evaluated a five-step complication grading system (Clavien-Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide.
Abstract: The postsurgical Clavien–Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien–Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures.
1 citations
TL;DR: In this paper , the authors investigated whether anterior bone loss (ABL) in cervical discarthroplasty (CDA) in 2-level hybrid surgery (HS) is affected by adjacent fusion in vivo compared with 1-level CDA alone.
TL;DR: In this paper , the authors conducted a cross-sectional study among surgical patients by means of interviewer-administered structured questionnaire, which incorporated both the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and numeric rating scale for anxiety instruments, with the patients' demographic and clinical details.
Abstract: Background: High preoperative anxiety in surgical patients impacts anesthetic management, postoperative pain scores, patient satisfaction, and postoperative morbidity. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) offers an attractive option for the assessment of preoperative anxiety on account of its brevity and validity. Aim: Our aim was to determine the prevalence and predictors of preoperative anxiety in our surgical patients. Materials and Methods: We conducted a cross-sectional study among surgical patients by means of interviewer-administered structured questionnaire. The questionnaire incorporated both the APAIS and numeric rating scale for anxiety instruments, with the patients’ demographic and clinical details. The data collection was carried out from January 2021 to October 2022. Data entry and analysis were done using IBM Statistical Product and Service Solutions, statistical software version 25. Continuous variables were summarized using mean and standard deviation, while categorical variables were presented using frequencies and proportions. Chi square test, Student t test, correlation analysis, and multivariate analysis using binary logistic regression were used in the analysis. Statistical significance was determined by a P value of <0.05. Results: A total of 451 patients participated in the study, with a mean age of 39.4 ± 14.4 years. The prevalence of clinically significant anxiety was 24.4% (110/451). The predictors of high preoperative anxiety in our cohort were female gender, tertiary education attainment, lack of previous surgical experience, ASA grade 3, and patients scheduled for major surgery. Conclusion: A substantial proportion of the surgical patients experienced clinically significant preoperative anxiety.
TL;DR: In this article , the authors used data from a large population-based case-control study (Multiple Environment and Genetic Assessment study) into causes of venous thromboembolism (VTE), and linked these to the Dutch Hospital Data Registry to identify exposure to surgical procedures.
TL;DR: Especially in the urology clinic, evaluating the cognitive functions of elderly patients, reviewing the drugs they use and minimizing the length of stay in this patient group will contribute significantly to their quality of life.
Abstract: Introduction: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. The aim of this exploratory study were to examine the effect and coexistence of geriatric syndromes, admission type and surgical severity on UI-related QoL in patients hospitalized in the urology clinic. Materials and methods: This study was conducted among 250 older inpatients (aged 65 years and older between October 2019 and March 2020) at Zonguldak Bulent Ecevit University department of Urology, Zonguldak, Turkey. After ethical approval and patient consent, we examined geriatric syndromes and related factors including cognitive impairment, delirium, depression, decreased mobility, multiple drug use, malnutrition, pain and fecal incontinence as well as hospitalization patterns and surgical severity of the patients. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. Results: Geriatric syndromes and related factors were associated with UI. Moderate cognitive decline (odds ratio [OR], 3.764; 95% confidence interval [CI], 1.621- 8.742), Charlson Comorbidity Index (CCI) (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.24–5.05) and the number of medication used (odds ratio [OR], 1,33; 95% confidence interval [CI], 1.11–1.58) were associated with increased probability of having UI. Cognitive impairment, length of hospital stay had an inverse and age of patients had a direct effect on patients UI-related QoL. Conclusions: UI-related quality of life was associated with some factors. Especially in the urology clinic, evaluating the cognitive functions of elderly patients, reviewing the drugs they use and minimizing the length of stay in this patient group will contribute significantly to their quality of life.
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TL;DR: Turoctocog alfa was effective in controlling blood loss by obtaining a sufficient haemostatic response in patients with severe haemophilia A undergoing surgery, and no safety issues were identified.
Abstract: Recombinant factor VIII (rFVIII) products provide a safe and efficacious replacement therapy for prevention and treatment of bleeding episodes in patients with haemophilia A. The present investigations from the multinational, open-label guardian(™) clinical trials assessed the haemostatic response of turoctocog alfa (NovoEight(®)), a rFVIII product, in patients with severe haemophilia A (FVIII ≤ 1%) undergoing surgery. All patients had a minimum of 50 exposure days to any FVIII product prior to surgery and no history of inhibitors. A total of 41 procedures (13 orthopaedic, 19 dental and 9 general) were performed in 33 patients aged 4-59 years. Of the 41 procedures, 15 were major surgeries in 13 patients and 26 were minor surgeries in 21 patients. The success rate for haemostatic response was 100% (success was defined as 'excellent' or 'good' haemostatic outcome). Turoctocog alfa consumption on the day of surgery ranged from 27 to 153 IU kg(-1). The mean daily dose declined over time, while retaining adequate FVIII coverage as measured by trough levels. Overall, no safety issues were identified. No thrombotic events were observed and none of the patients developed FVIII inhibitors. In conclusion, the present results show that turoctocog alfa was effective in controlling blood loss by obtaining a sufficient haemostatic response in patients with severe haemophilia A undergoing surgery.
34 citations
TL;DR: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.
Abstract: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.
28 citations
TL;DR: There was considerable variance in the categorization of major and minor surgical procedures and some overlap in surgical nomenclature and the lack of consistent guidance when referring to major or minor surgery in people with hemophilia needs to be addressed.
Abstract: Agents that control bleeding and the usage of bypassing agents have made surgery an option to consider in people with hemophilia. However, the lack of consistent definitions for major or minor surgery may lead to inconsistencies in patient management. This literature review has evaluated how surgical procedures in people with hemophilia were categorized as major or minor surgery and assessed the consistency across publications. After screening 926 potentially relevant articles, 547 were excluded and 379 full-text articles were reviewed. Ninety-five articles categorized major or minor surgical procedures; of these, 35 publications categorized three or more major or minor surgical procedures and were included for analysis. Seven (20%) publications provided varying criteria for defining major or minor surgery, five of which defined surgery according to the level of surgical invasiveness. Across all 35 publications, there was considerable variance in the categorization of major and minor surgical procedures and some overlap in surgical nomenclature (eg, type of synovectomy, arthroscopy, and central venous access device insertion/removals). The lack of consistent guidance when referring to major or minor surgery in people with hemophilia needs to be addressed. Clear and consistent definitions, achieved by consensus and promoted by relevant international hemophilia committees, are desirable, to provide guidance on appropriate treatment, to increase the accuracy of trial data and may confound the interpretation of surgical outcomes.
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26 citations
TL;DR: This paper will attempt to answer the question "Can operative procedures be classified as `major' or `minor' with any degree of accuracy?"
Abstract: This paper will attempt to answer the question "Can operative procedures be classified as `major' or `minor' with any degree of accuracy?" It is often difficult to decide if a given surgical procedure should be listed as major or minor. Because of this difficulty some surgeons feel that these terms should be abandoned. To others, a discussion of major and minor surgery is bound to the question of surgical privileges. The material presented here is not intended for use in determining who should perform major or minor surgery. The use of the terms "major" and "minor surgery," however inaccurate, is firmly established in the medical profession. One needs only to mention the textbooks available on minor or out-patient surgery and the frequent reference to major surgery in various articles. Enumeration of the major operations performed in a hospital is helpful in evaluation of a service for resident training. The experience
17 citations