المؤلفون: Tarin, Tatum, Feifer, Andrew, Kimm, Simon, Chen, Ling, Sjoberg, Daniel, Coleman, Jonathan, Russo, Paul

المصدر: Journal of Urology; May2014, Vol. 191 Issue 5, p1225-1230, 6p

مصطلحات موضوعية: LAPAROSCOPIC surgery, LENGTH of stay in hospitals, KIDNEY surgery, REGRESSION analysis, NEPHRECTOMY, ACQUISITION of data

الشركة/الكيان: AMERICAN Society of Anesthesiologists

مستخلص: Purpose: Clinical pathways are designed to reduce variability in patient care practices and improve clinical outcomes. We evaluated the effect of implementing a clinical care pathway on length of stay in patients undergoing kidney surgery. Materials and Methods: After receiving institutional review board approval we evaluated prospective data on consecutive cases of partial and radical nephrectomy performed at our institution from 2000 to 2011. We identified 1,775 partial nephrectomies (1,449 open and 326 minimally invasive) and 1,025 radical nephrectomies (857 open and 168 minimally invasive). We used multivariate linear regression to test for an interaction between procedure type and surgery before vs after the clinical pathway was begun. Results: Median length of stay decreased 40% (from 5 to 3 days) for open surgery and 33% (from 3 to 2 days) for minimally invasive surgery after clinical pathway implementation. Length of stay in patients treated with minimally invasive or open partial nephrectomy and open radical nephrectomy decreased while it remained stable in those who underwent minimally invasive radical nephrectomy. The difference in length of stay between open and minimally invasive partial nephrectomy before and after implementing the clinical pathway decreased by 1.5 days (95% CI 0.56–2.5, p = 0.002). At 30 days postoperatively major complication rates remained similar. Conclusions: The clinical pathway resulted in a significantly shorter length of stay in patients treated with partial and radical nephrectomy without a discernible impact on safety or quality of care. Clinical pathways for kidney surgery should be used and continually optimized to enhance efficiency, patient safety and outcomes. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Urology is the property of Wolters Kluwer UK and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Silberstein, Jonathan L., Sprenkle, Preston C., Su, Daniel, Power, Nicholas E., Tarin, Tatum V., Ezell, Paula, Sjoberg, Daniel D., Feifer, Andrew, Fleisher, Martin, Russo, Paul, Touijer, Karim A.

المصدر: BJU International; Aug2013, Vol. 112 Issue 4, p517-525, 9p, 1 Color Photograph, 1 Diagram, 4 Charts, 2 Graphs

مصطلحات موضوعية: NEUTROPHILS, LIPOCALINS, ISCHEMIA, KIDNEY injuries, LABORATORY swine, LAPAROSCOPIC surgery, PNEUMOPERITONEUM, SURGICAL complications

مستخلص: Objectives To test a novel porcine two-kidney model for evaluating the effect of controlled acute kidney injury ( AKI) related to induced unilateral ischaemia on both renal units ( RUs), To use neutrophil gelatinase-associated lipocalin ( NGAL) and physiological serum and urinary markers to assess AKI and renal function., Methods Twelve female Yorkshire pigs had bilateral cutaneous ureterostomies placed laparoscopically with identical duration of pneumoperitoneum for all cases., An experimental group ( n = 9) underwent induced unilateral renal ischaemia with left hilar clamping of timed duration (15, 30, 60 min) and a control group ( n = 3) had no induced renal ischaemia., Urine was collected and analysed from each RU to assess creatinine and NGAL concentration preoperatively and at multiple postoperative time points. Serum was collected and analysed daily for creatinine and NGAL levels., Statistical comparisons were made using the rank-sum and sign-rank tests., Results Three pigs were excluded because of intra-operative and postoperative complications., In the RUs that experienced renal ischaemia ( n = 7),the median urine volume was lower ( P = 0.04) at 6, 12, 24 and 48 h and the median NGAL concentration was higher ( P = 0.04) at 12 and 48 h compared with the RUs of control pigs that experienced no renal ischaemia ( n = 2)., When comparing the ischaemic (left) RU of the pigs in the experimental group with their contralateral non-ischaemic (right) RU, ischaemic RUs had a lower median cumulative urine volume at 6, 12, 24 and 48 h ( P = 0.05) and a higher median NGAL concentration at 12, 24 and 48 h ( P < 0.05)., At 48 h, no significant increase was found in serum NGAL in pigs in the experimental group compared with controls ( P = 0.2)., Creatinine clearance ( CC) was lower in ischaemic RUs compared with non-ischaemic RUs 1 day after surgery ( P = 0.04) with decreasing CC as the duration of ischaemia increased., Conclusions We have developed a promising novel small-scale pilot surgical model that allowed the evaluation of bilateral RU function separately during and after unilateral renal ischaemia., The induction of unilateral renal ischaemia corresponds with physiological changes in both the ischaemic and contralateral RU., AKI as measured by increases in NGAL and decreased renal function as measured by decreases in CC, are specific to the RU exposed to ischaemia. [ABSTRACT FROM AUTHOR]

: Copyright of BJU International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Bergman, Simon¹, Feifer, Andrew¹, Feldman, Liane S.¹ liane.feldman@muhc.mcgill.ca, Bell, Lorraine², Flageole, Helene¹, Tchervenkov, Jean¹, Anidjar, Maurice¹, Stanbridge, Donna¹, Fried, Gerald M.¹

المصدر: Pediatric Transplantation. Jun2007, Vol. 11 Issue 4, p429-452. 24p. 2 Charts.

مصطلحات موضوعية: *PEDIATRICS, *OPERATING rooms, *ISCHEMIA, *LAPAROSCOPIC surgery, *ORGAN donors, *TRANSPLANTATION of organs, tissues, etc.

مستخلص: Background: At our institution, laparoscopic live donor nephrectomy (LLDN) is done at a different hospital site than pediatric recipient transplantation, whereas open donor nephrectomy (OLDN) is done in the adjacent operating room. The purpose of this study was to evalute the safety of a dual-site renal transplantation program by comparing the outcomes of pediatric recipients of LLDN vs. OLDN. Methods: This is a retrospective study of consective pediatric recipients (n = 10) of LLDN (June 2002 to June 2005) compared to the 10 most recent pediatric recipients of OLDN (March 2001 to June 2005). Renal function was assessed with calculated creatinine clearance using the Schwartz formula and the following outcomes were assessed: delayed graft function, ureteral complications, acute rejection and patient and graft survival. Results are expressed as median (IQR). Results: When comparing the laparoscopic vs. open group, there were no significant differences in recipient age, height, weight, preoperative calculated creatinine clearance and warm ischemia time. Twelve month postoperative creatinine clearance was 88 ml/min/1.73 m2 (57–99) in the laparoscopic group (n = 8) and 66 ml/min/1.73 m2 (60–86) in the open group (n = 9), p = 0.2. In the LLDN group vs. the OLDN group, delayed graft function was 0% vs. 10% (p = 1.0), ureteral complications were 20% vs. 30% (p = 1.0), and acute rejection was 20% vs. 40% (p = 0.6). In the laparoscopic group, one-yr patient and graft survival were both 100%, as compared to 100% and 89%, respectively, in the open group. Conclusion: A dual-site laparoscopic donor nephrectomy program is not associated with adverse pediatric recipicent outcomes when compared to a same-site open donor approach. [ABSTRACT FROM AUTHOR]