The impact of operative time and hypothermia in acute burn surgery

Ziolkowski, Natalia; Rogers, Alan D; Xiong, Wei; Hong, Bosun; Patel, Sanjiv; Trull, Brent; Jeschke, Marc G.

doi:10.1016/j.burns.2017.10.001

Cited by 40 publications

(18 citation statements)

References 31 publications

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“… 53 , 54 Specifically, hypercapnia, anemia, and hypothermia all contribute to diminished autoregulation and are exacerbated by prolonged surgery. 53 , 55 , 56 Surgical duration is affected by many factors, including the complexity of the injury, the difficulty of the procedure, and the technical expertise of the surgical team. This lends further support to the notion that hip fractures should ideally be managed expeditiously, by experienced surgeons and anesthetists who are able to complete the surgery safely and quickly.…”

Section: Discussionmentioning

confidence: 99%

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

et al. 2019

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Key Points Question Is surgery duration associated with postoperative delirium in patients receiving hip fracture repair? Findings In this population-based cohort study of 68 131 adults, increasing surgery duration was associated with a higher risk-adjusted likelihood of postoperative delirium (6% increase in delirium risk per additional half hour of surgery). This risk was higher in patients who received a general anesthetic. Meaning The findings suggest that prolonged surgery is associated with increased postoperative delirium, particularly when the patient has received a general anesthetic.

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Section: Discussionmentioning

confidence: 99%

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

et al. 2019

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“…We included burn injuries of different degrees and stratified based on age, that were treated in both inpatient and outpatient settings. Albeit the %TBSA was not specified in the ACS-NSQIP database, a large body of evidence indicates that the vast majority of our patient cohort suffered minor burns with <10% TBSA: Namely, (i) the average operation time of less than one hour, (ii) the comparatively low mortality and morbidity, (iii) the relatively short LOS, and (iv) the nearly equal number of in-and outpatient care support the hypothesis of predominantly minor burn injuries (8,15,(22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 69%

Association of age with perioperative morbidity among patients undergoing surgical management of minor burns

et al. 2023

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IntroductionBurn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database.MethodsWe reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery.ResultsWe found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n = 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p = 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p = 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns.DiscussionIn conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.

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“…Disruption of cerebral autoregulation might also occur during surgery [ 39 , 40 ]. In particular, hypercapnia, anaemia, and hypothermia all affect autoregulation and can be exacerbated by a prolonged surgery [ 41 , 42 ]. Furthermore, previous studies reported that in the case of surgery for cardiac disease, a prolonged surgical duration was associated with an impaired cognitive function [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Contributing to Cognitive Function in the Acute Stage after Treatment of Intracranial Aneurysms: A Cross-Sectional Study

Kim

Lee²,

Jeon³

et al. 2022

JCM

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Background: The factors affecting cognitive function after treatment of subarachnoid haemorrhage (SAH) can be categorised into aneurysmal factors, procedural factors, and complications. The aim of this study was to investigate which of these factors has greater influence on the cognitive function. Methods: We retrospectively identified 14 patients with unruptured intracranial aneurysms (UIAs) and 34 patients with SAH with mild symptoms at disease onset (Hunt and Hess grade: >3). All patients underwent neuropsychological tests within 35 days of discharge from hospitalisation for treatment. The relationship between the clinical factors and each neuropsychological test score was evaluated using multiple linear regression analysis after controlling for age and years of education. Results: Patients with UIA showed greater cognitive impairment in visual memory and the frontal/executive domains. Hypertension was associated with cognitive impairment. Patients with SAH showed greater cognitive impairment in the visuospatial, verbal memory, and frontal/executive domains. The dome-to-neck ratio, aneurysms located in the posterior circulation, microsurgical clipping, procedure time, anaesthesia duration, and complications were associated with cognitive impairment. Conclusions: Underlying diseases, procedural factors, and complications contributed to cognitive impairment after treatment of intracranial aneurysms. Since the effect of each factor on each cognitive domain was slightly different, a more in-depth study of these effects is needed.

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The impact of operative time and hypothermia in acute burn surgery

Cited by 40 publications

References 31 publications

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

Association of age with perioperative morbidity among patients undergoing surgical management of minor burns

Clinical Factors Contributing to Cognitive Function in the Acute Stage after Treatment of Intracranial Aneurysms: A Cross-Sectional Study

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