Thursday December 12, 2019

Deadliest Time for Many Surgery Patients isn’t When They’re on Operating Table

Researchers monitored patients for complications and deaths within 30 days of surgery

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FILE - A medical team performs hernia surgery in an operating room near Riohacha, Colombia, Nov. 27, 2018. VOA

The deadliest time for many surgery patients isn’t when they’re on the operating table, it’s while they’re recovering in the hospital and after they go home, a new study suggests.

For the study, researchers examined outcomes for more than 40,000 patients age 45 and older who underwent non-cardiac surgery at 28 hospitals in 14 countries. Researchers monitored patients for complications and deaths within 30 days of surgery.

Overall, five people, or less than 1% of patients, died on the operating table, and another 500 patients, or 70%, died in the hospital. Another 210 deaths, or 29%, didn’t happen until after patients were sent home.

Nearly half of all the deaths were associated with three complications: major bleeding, heart damage, and bloodstream infections.

Deadliest, Surgery, Patients
The deadliest time for many surgery patients isn’t when they’re on the operating table, it’s while they’re recovering in the hospital and after they go home, a new study suggests. Pixabay

“Many families anxiously wait to hear from the surgeon whether their loved one survived the operation, but our research demonstrates that very few of the deaths occur in the operating room,” said Dr. P.J. Devereaux, senior author of the study and director of the Division of Perioperative Care at McMaster University in Canada.

“Our research now demonstrates that there is a need to focus on postoperative care and transitional care into the home setting to improve outcomes,” Devereaux said by email.

Worldwide, 100 million patients age 45 and older undergo inpatient surgery unrelated to cardiac issues every year, researchers note in CMAJ.

Study details

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A wide range of technological and medical advances have made surgery safer and less invasive in recent years, the study team notes. But at the same time, patients also are coming to the hospital sicker and being sent home with complex care needs that once would have meant a lengthy hospital stay.

In the study, roughly half of the patients had high blood pressure, one in five had diabetes, and 13% had coronary artery disease.

More than one-third of them came in only for low-risk procedures that were not emergencies. Many of the rest had major general, orthopedic, urological, gynecological, vascular or neurological operations.

Patients who experienced major bleeding after surgery were more than twice as likely to die within 30 days as people who didn’t have this complication.

 

Deadliest, Surgery, Patients
For the study, researchers examined outcomes for more than 40,000 patients age 45 and older who underwent non-cardiac surgery at 28 hospitals in 14 countries. Pixabay

And patients who developed heart injuries even though they didn’t have heart surgery were also more than twice as likely to die.

Patients who got sepsis, a serious bloodstream infection, were more than five times more likely to die within 30 days than people who didn’t get these infections.

Inflammation 

The study wasn’t a controlled experiment designed to identify which if any complications actually caused any deaths. Inflammation may be a common denominator in the complications that were most responsible for deaths, said Barnaby Charles Reeves of the University of Bristol in the U.K., author of an editorial accompanying the study.

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“Surgery causes a body-wide inflammatory reaction,” Reeves said by email. “This can lead to single or multi-organ failure (kidney, heart, lungs, sepsis etc.) which leads to death.”

Patients may also not recognize that something is wrong when they’re coming off anesthesia or taking narcotic painkillers after surgery, Devereaux said.

“This makes patients after surgery vulnerable to delays in recognizing complications and hence delays in treatment,” Devereaux said.

Surgery also activates patients’ inflammatory, stress, and coagulation systems. The activation of these systems can also predispose patients to major complications. Patients should advocate and support research into enhanced monitoring techniques after surgery, which can help sort out identifying ways to lower the risk of death after surgery. (VOA)

Next Story

Resistance to Antibiotics Rise Among Indian Patients in Pace

There is increase in resistance to antibiotics including clarithromycin which is undoubtedly a worrisome situation in the country

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Antibiotics
In India, a huge population prefers to consume over-the-counter (OTC) drugs without even consulting a doctor. In the long run, this may make them resistant to most of the Antibiotics including clarithromycin. Pixabay

Resistance to commonly-used Antibiotics like clarithromycin is rising among Indian patients and that too at quite a fast pace, health experts have warned.

Clarithromycin is used to treat a wide variety of bacterial infections. This medication can also be used in combination with anti-ulcer medications to treat certain types of stomach ulcers.

According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health, food security and development today.

Sunil Sofat, Additional Director, Department of Interventional Cardiology (Adult) at Jaypee Hospital in Noida, said that every antibiotic medicine has its own mechanism to treat diseases.

“Yes, this is true that the resistance to clarithromycin is rising among the Indian patients and that too at quite a fast pace. There are multiple factors for the same but one of the major reasons behind it is self-medication,” Sofat told IANS.

“In India, a huge population prefers to consume over-the-counter (OTC) drugs without even consulting a doctor. In the long run, this may make them resistant to most of the antibiotics including clarithromycin,” Sofat added.

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Resistance to commonly-used Antibiotics like clarithromycin is rising among Indian patients and that too at quite a fast pace, health experts have warned. Pixabay

In a recent study presented at United European Gastroenterology (UEG) Week Barcelona 2019, researchers have found that resistance to clarithromycin, one of the most established antimicrobials used to eradicate Helicobacter pylori (H. pylori), had increased from 9.9 per cent in 1998 to 21.6 per cent last year, with increases in resistance also seen for levofloxacin and metronidazole.

The study, which analysed 1,232 patients from 18 countries across Europe, investigated resistance to antibiotics regularly taken for Helicobacter pylori infection, a harmful bacterium associated with gastric ulcers, lymphoma and gastric cancer.

According to Gaurav Jain, Senior Consultant, Internal Medicine at Dharamshila Narayana Superspeciality Hospital, New Delhi, antibiotic resistance is a major concern.

“In India the consumption of antibiotics without consulting a qualified physician is quite common which is leading to its resistance,” Jain told IANS.

“There is increase in resistance to antibiotics including clarithromycin which is undoubtedly a worrisome situation in the country,” Jain said.

However, Deepak Verma of Internal Medicine at Columbia Asia Hospital, Ghaziabad said: “Most of the cases that we see in India are connected to gram-negative bacteria such as e.coli that causes urinary tract infection (UTI).”

He added that the main causes for antibiotic resistance in India are its rampant misuse where people indulge in self-doctoring as well as taking medicines prescribed by unregistered medical practitioners, including quacks who suggest antibiotics quite indiscriminately.

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According to the World Health Organization (WHO), resistance to Antibiotics is one of the biggest threats to global health, food security and development today. Wikimedia Commons

“They primarily use antibiotics symptomatically which is not a correct method for all ailments — without blood and urine culture. Antibiotics can force the pathogen to develop resistance,” Verma explained.

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“Since the clinical culture in India is different from that of the western countries, the lack of awareness of the right process to prescribe antibiotics increases the chances of people using antibiotics without questioning,” he stressed. (IANS)