Endovascular stent grafting versus open surgical repair of descending thoracic-aortic aneurysms in low-risk patients; a multicenter comparative trial

Abstract

Conclusion:Needle-stick injuries among surgical residents are common, and many are not reported even if the injury involved a high-risk patient.Summary: Between 600,000 and 800,000 needle-stick or percutaneous injuries are reported annually in United States health care workers (National Institute for Occupational Safety and Health, 1999; 2000-2108. The authors of this study postulate surgical residents, given their exposure to sharp instruments and blood-borne pathogens and relative unfamiliarity with surgical techniques, would be at high risk for needle-stick injury. Proper reporting of needle-stick injuries is obviously crucial to initiating early prophylaxis or treatment. Given that 20% to 38% of all procedures in some general surgical residencies may involve exposure to high-risk patients, it is crucial to understand the prevalence of needle-stick injuries among surgical trainees as well as reporting patterns of these injuries (Ann Surg 2005;251:803).The authors surveyed surgical residents for needle-stick injuries in 17 medical centers. The survey asked about the most recent injury, whether it was reported to an employee health service, and whether the injury involved a high-risk patient, defined as a patient with known HIV, hepatitis B, or hepatitis C infection, or a history of injectable drug use. Residents were also asked about the circumstances of the injury and the perceived cause of the injury.A total of 699 residents responded, for a 95% rate, and 83% had a needle-stick injury during training. The number of needle-stick injuries increased according to years of training. There was a mean of 1.5 injuries in postgraduate year 1 (PGY1) trainees, 3.7 injuries in PGY2 trainees, 4.1 injuries in PGY3 trainees, 5.3 injuries in PGY4 trainees, and 7.7 injuries in PGY5 trainees. By the final year of their training, 99% of residents reported a needle-stick injury. A high-risk patient was involved in 53% of the injuries, and 16% of the injuries (15 of 91) involving high-risk patients were not reported. A total of 51% injuries were not reported to an employee health service. Lack of time was the reason 42% (126 of 297) said they did not report the injury. The most frequent person knowing about an unreported injury was the attending surgeon and the least frequent was a significant other. The injuries were self-inflicted in 67%, and another member of the operating team inflicted 33%. Fifty-two percent of injuries occurred during suturing, and the perceived cause of the injury was being in a hurry in 57% of cases.Comment: Needle-stick injury is a major occupational problem of surgeons, and many surgeons underestimate seroconversion rates after needle-stick injury (Ann Surg 1998;228:266-72). Clearly, systems-based approaches to reduce needle-stick injury need to be intensified. In the meantime, informing surgical trainees of the importance of reporting injuries and of the underlying causes of the injuries is something that can be implemented immediately in any surgical training program.

Propensity Adjusted Analysis of Open and Endovascular Thoracic Aortic Repair for Chronic Type B Dissection: A Twenty-Year Evaluation

“…In contrast, the alternative treatment strategy of conventional open descending aortic repair (OAR) may be associated with increased early morbidity and recovery time when compared with TEVAR [6]. Unlike TEVAR however, open surgery will effectively treat CBAD with only aorta at adjacent or remote sites subsequently remaining at risk for aneurysm formation.…”

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

“…A markedly lower incidence of spinal cord ischemia after endovascular stent-grafting stimulated the controversy as well as a search for insights regarding the etiologies of spinal cord ischemia. 84 In 1994, Acher and Wynn reported their clinical experience with thoracoabdominal aorta repair using naloxone and CSF drainage without attaching the intercostal artery or using distal perfusion. The early mortality rate was 9.7%, and the postoperative incidence of paraplegia was 3.4%.…”

Tevar

“…Major procedurerelated neurological complications, in- cluding stroke and spinal cord ischemia, were seen in up to 8% of patients. However, compared with standard open surgical repair, endovascular treatment does appear to halve perioperative mortality with similar late survival and almost identical rates of reinterventions and ischemic spinal cord complications [25,26].…”