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Contemporary Analysis of Rhytidectomy Using the Tracking Operations and Outcomes for Plastic Surgeons Database with 13,346 Patients.

使用13,346例患者的整形外科医生数据库跟踪手术和结果对除皱术进行当代分析。

  • 影响因子:1.74
  • DOI:10.1097/PRS.0000000000006813
  • 作者列表:"Chopan M","Samant S","Mast BA
  • 发表时间:2020-06-01
Abstract

BACKGROUND:Rhytidectomy is a popular procedure for facial rejuvenation, but an up-to-date, comprehensive, and broadly representative appraisal is lacking. METHODS:A cohort of patients undergoing rhytidectomy between 2008 and 2016 was identified from the Tracking Outcomes in Plastic Surgery database. Perioperative data and patient characteristics were analyzed with respect to adverse events. Multivariate logistic regression was used to identify association of complications with various risk factors. RESULTS:A total of 13,346 patients with a mean age of 60 years underwent rhytidectomies and a total of 31,206 Current Procedural Terminology procedures. Most were healthy women with an American Society of Anesthesiologists class of 1 or 2 (98 percent). On average, 2.3 procedures were performed in 3.8 hours per patient, and blepharoplasty was the most common adjunctive procedure. Fifty percent of operations were performed in office-based settings, and general anesthesia utilized in 63 percent of cases. The incidence of adverse events was 5.1 percent, with hematomas and infections as the most frequent surgical complications. Male gender, obesity, current smoker, duration, combined procedures, general anesthesia, and office-based surgery were associated with increased odds of adverse events. CONCLUSIONS:This is the largest outcomes analysis of face-lift surgery in a patient population solely representative of board-certified plastic surgeons. Rhytidectomy is a very safe procedure when performed by board-certified plastic surgeons. Nevertheless, risk factors for complications are identified, several of which can be affected by surgeon choice of surgical venue, additive procedures, duration of operation, and type of anesthetic. The study provides a standard reference for professionals when counseling patients and in guiding clinical practices. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.

摘要

背景: 除皱术是一种流行的面部年轻化手术,但缺乏最新的、全面的、具有广泛代表性的评价。 方法: 从整形外科数据库的跟踪结果中确定了2008年至2016年间接受除皱术的患者队列。分析围手术期数据和患者特征的不良事件。采用多因素logistic回归分析各种危险因素与并发症的关系。 结果: 共有13,346例平均年龄为60岁的患者接受除皱术,共有31,206例现行术语程序。大多数是健康女性,美国麻醉医师协会1或2级 (98%)。平均每名患者在2.3小时内完成3.8例手术,重睑成形术是最常见的辅助手术。63% 的手术在办公室进行,的病例使用全身麻醉。不良事件发生率为5.1%,其中血肿和感染是最常见的手术并发症。男性、肥胖、当前吸烟者、持续时间、联合手术、全身麻醉和以办公室为基础的手术与不良事件的风险增加相关。 结论: 这是在仅代表经委员会认证的整形外科医生的患者人群中进行面部提升手术的最大结局分析。当由董事会认证的整形外科医生进行除皱术时,除皱术是一种非常安全的手术。然而,确定了并发症的风险因素,其中一些因素可能受到外科医生选择手术地点、附加程序、手术持续时间和麻醉剂类型的影响。该研究为专业人员咨询患者和指导临床实践提供了标准参考。 临床问题/证据水平: 风险,III.

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发表时间:2020-01-01
DOI:10.1213/ANE.0000000000003975
作者列表:["Uppal V","Retter S","Casey M","Sancheti S","Matheson K","McKeen DM"]

METHODS:BACKGROUND:Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery. METHODS:Key electronic databases (PubMed, Embase, and Cochrane Library) were searched for randomized controlled trials in the cesarean delivery population. The primary outcome was the failure rate of spinal anesthesia, as assessed by the need for either conversion to general anesthesia or intraoperative analgesic supplementation. Two reviewers independently extracted the data using a standardized electronic form. Results are expressed as relative risks or mean differences with 95% CIs. RESULTS:Seventeen randomized controlled clinical trials (most judged as low or unclear risk of bias) with 1064 participants provided data for the meta-analysis. Fentanyl added to intrathecal bupivacaine alone reduced the need for intraoperative supplemental analgesia (relative risk, 0.18; 95% CI, 0.11-0.27; number needed to treat, 4) and the incidence of nausea/vomiting (relative risk, 0.41; 95% CI, 0.24-0.70; number needed to treat, 6.5), with longer time to first postoperative analgesia request (mean difference, 91 minutes; 95% CI, 69-113). No difference was observed regarding the need for conversion to general anesthesia (relative risk, 0.67; 95% CI, 0.12-3.57), the incidence of hypotension, the onset of sensory block, or the duration of motor block. However, the addition of intrathecal fentanyl was associated with higher incidence of intraoperative pruritus (relative risk, 5.89; 95% CI, 2.07-16.79; number needed to harm, 13.5). The inclusion of fentanyl to intrathecal bupivacaine-morphine compared to intrathecal bupivacaine-morphine alone conferred a similar benefit, with a significantly reduced need for intraoperative supplemental analgesia (relative risk, 0.16; 95% CI, 0.03-0.95; number needed to treat, 9). Analysis using a funnel plot indicated a possibility of publication bias in included studies. CONCLUSIONS:Current evidence suggests a benefit of using fentanyl as both an additive to intrathecal bupivacaine alone and to intrathecal bupivacaine combined with morphine for cesarean delivery under spinal anesthesia. The possibility of publication bias, small sample size, and high risk of bias in some of the included studies warrant treating the results with caution.

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影响因子:2.27
发表时间:2020-05-01
DOI:10.1213/ANE.0000000000004012
作者列表:["Jean YK","Kam D","Gayer S","Palte HD","Stein ALS"]

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