文献简介

出版社:Langenbecks Arch Surg

作  者:Emanuel C. A. Bauer & Nicolina Koch & Christoph J. Erichsen & Tobias Juettner & Daniel Rein & Wolfgang Janni & Hans G. Bender & Markus C. Fleisch

编  号:10.1007/s00423-014-1172-z

关键字:Compartment syndrome| Gynecological surgery| Incidence| Prevention| Lithotomy position

年  份:2014   点击量:370

文献摘要

Purpose

This study was aimed to investigate incidence, cir- cumstances and consequences of acute compartment syn- drome (CS) of the lower extremity after gynecological oper- ations in lithotomy position by collecting data from depart- ments of Obstetrics and Gynecology in Germany.

Design

Retrospective observational study. Setting Departments of Obstetrics and Gynecologyinthearea of North Rhine (Germany)

Methods A 24-item questionnaire was sentto 168 gynecolog- ical departments. In addition, cases anonymously reported to the Expert Committee for Medical Malpractice Claims of the Medical Association of North Rhine between 2002 and 2012 were analyzed. Main outcome measure Incidence of acute CS after gyneco- logical operations.

Results

A total of 59 questionnaires (35 %) were returned for analysis, reporting 21 cases of CS. Based on the collected data, we calculated an incidence of postoperative CS ranging between 0.067 % and 0.28 %. All reported cases of postoper- ative CS occurred after surgeries in lithotomy position, 57.1% of cases occurred after laparoscopic procedures and 76.2 % after procedures longer than 4 h. Overall, 61.0 % of depart- ments do not routinely inform about the risk of this compli- cation when they get patients’ informed consent. Reported prevention strategies were inconsistent and ranged from none to multiple measures.

Conclusion

CS is a complication clearly associated with long lasting gynecological operations in Lithotomy position. De- spite a relatively high incidence, so far no guidelines on perioperative management and medicolegal aspects exist and preventive measures are heterogeneous among institutions. The need for guidelines and recommendations by an expert committee has been identified.