Abdominal Surgery Patients Research Articles

Incidence of postoperative delirium according to cognitive status, improved responsiveness and inflammatory response at elderly patients in urgent abdominal surgery

Background. Postoperative delirium (POD) is a clinical syndrome that is manifested in impaired consciousness and attention, perception, memory, thinking and psychomotor behavior after surgery. Methods. After passing the Bioethics Commission at Zaporizhzhya State Medical University and obtaining informed consent from patients, 30 elderly patients who underwent surgical interventions on the abdominal organs under urgent procedure were sequentially included in a single-center prospective study. Patients with a history of traumatic brain injury or stroke with neurological impairments in the form of sensory-motor aphasia and plegia were excluded from the study.Results .The study involved 30 patients (16 (53%) women and 14 (47%) men), aged 62 years to 92 years, grade III-IV ASA, who underwent urgent surgery for bowel tumors (n = 8), gallstone disease (n = 7), entrained inguinal and postoperative ventral hernias (n = 10), gastric or intestinal perforation (n = 5). Postoperative delirium occurred in 33% of patients. On the first day after surgery, the cognitive status of patients in the first group decreased by 1 point relative to the primary assessment (p = 0.88), when on the second postoperative day the indicator returned to baseline. Patients in the second group showed a sharp impairment of cognitive abilities in the postoperative period, associated with POD and a significant decrease in cognitive status at day 5 (p <0.05) compared with preoperative assessment. The level of inflammatory response of the body in the preoperative period is 1.5 times higher in patients with POD (p = 0.01). The correlation between leukocytosis level and POD revealed a moderately significant relationship between these indicators (rs = 0.45 at p <0.05).Conclusions. In 33% of urgent patients, abdominal surgery revealed postoperative delirium, which is reliably dependent on cognitive deficits for surgery and the level of systemic inflammation (p = 0.01). The level of patient wear does not significantly affect the incidence of POD.

PROtective Ventilation with a low versus high Inspiratory Oxygen fraction (PROVIO) and its effects on postoperative pulmonary complications: protocol for a randomized controlled trial

BackgroundPostoperative pulmonary complications (PPCs) are the most common perioperative complications following surgical site infection (SSI). They prolong the hospital stay and increase health care costs. A lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. However, the role of the inspiratory oxygen fraction (FiO2) in the strategy remains disputed. Previous trials have focused on reducing SSI by increasing the inhaled oxygen concentration but higher FiO2 (80%) was found to be associated with a greater incidence of atelectasis and mortality in recent research. The trial aims at evaluating the effect of different FiO2 added to the lung-protective ventilation strategy on the incidence of PPCs during general anesthesia for abdominal surgery.Methods and designPROtective Ventilation with a low versus high Inspiratory Oxygen fraction trial (PROVIO) is a single-center, prospective, randomized controlled trial planning to recruit 252 patients undergoing abdominal surgery lasting for at least 2 h. The patients will be randomly assigned to (1) a low-FiO2 (30% FiO2) group and (2) a high-FiO2 (80% FiO2) group in the lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the postoperative 7 days. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the postoperative 7 and 30 days.DiscussionThe PROVIO trial assesses the effect of low versus high FiO2 added to a lung-protective ventilation strategy on PPCs for abdominal surgery patients and the results should provide practical approaches to intraoperative oxygen management.Trial registrationwww.ChiCTR.org.cn, identifier: ChiCTR18 00014901. Registered on 13 February 2018.

The Comparison of High Flow Nasal Cannula Oxygen and Conventional Oxygen Therapy on Early Effect Hemodynamic Indicators in Post – Upper Abdominal Surgery Patients

Background
 The effect of high-flow nasal cannula (HFNC) on hemodynamic data of the patients is still unknown. This was a pilot study to evaluate the effect of HFNC and conventional oxygen therapy (COT) on post-upper abdominal surgery.
 
 Methods
 This was an open-label randomized controlled trial (RCT) at tertiary hospital between February-June 2019. Inclusion criteria were ASA III, aged 18-65 years, BMI 18,5-29 kg/m2. Exclusion criteria were patients with unstable hemodynamic with vasopressors, general oedema, and uncooperative. Thirty patients were recruited and divided into HFNC group (n=15) and COT group (n=15). Hemodynamic parameters were recorded using the bedside monitor (heart rate, respiratory rate, and mean arterial pressure) as well as the electrical cardiometry using ICON® measurements (stroke volume index, cardiac index and systemic vascular resistance index); laboratory parameters were ScVO2 and lactate serum. Data were collected at 0, 30 and 60 minutes post-extubation.
 Results
 The General Linear Model (GLM) tests on clinical parameters (HR, RR and MAP) were P= 0.20; P=0.72; P = 0.18, ICON® parameters (SVI, CI and SVRI) were P= 0.02;P =0.64; P =0.64 meanwhile ScVO2 and lactate were P = 0.35 and P = 0.22. Despite those results, at some period of measurements there were a tendency of a better outcomes of most parameters for the HFNC group.
 Conclusion
 According to the results, the only statistically significant outcome was SVI (P =0.02) after the analysis between those two groups. However, the HFNC group showed a clinically improvement of the other outcomes among post-upper abdominal surgery patients.
 Keywords 
 High flow nasal cannula, conventional oxygen therapy, haemodynamic, abdominal surgery

A study of surgical site infections in a general practice hospital

Background: Surgical site infections (SSI), major contributor to increased morbidity, mortality and healthcare costs among surgical patients worldwide. This study evaluates the incidence of surgical site infections in abdominal surgeries.Methods: This prospective observational study was conducted at Siri hospital, Khammam after obtaining permission from the hospital ethics committee. A total of 250 patients of elective and emergency abdominal surgery were included and studied about surgical site infections and factors influencing it.Results: This study includes 250 patients with abdominal abnormalities. In this 48(19.2%) patients were recorded with surgical site infection. As the age increases SSI was also increases. ASA scores of III (5.6%) & IV (8.0%) were associated with the increased SSI. These SSI were more common in intestinal obstruction with gangrene cases 7 (2.8%) and also in accidental trauma/injury cases 7 (2.8%). SSI can be noticed after 48 hour of infection and recorded up to 10 days of postoperative period. The surgical wound incidence was clean (14.6%), clean contaminated (29.2%), contaminated (20.8%) and dirty (35.4%) respectively. Major factors that influence the SSI were diabetes, obesity, pre-operative anti biotic usage, duration of surgery, emergency surgery and level of haemoglobin and albumin levels. The organisms isolated from SSI were E.coli (22.9%), Methicillin Resistant Staphylococcus aureus (18.7%), Proteus species (16.6%), Klebsiella species (16.6%), Pseudomonas aeruginosa (8.3%), Staphylococcus aureus (6.2%) and mixed bacterial infections (10.4%).Conclusions: Surgical site infections were more commonly seen in abdominal surgeries. SSI was higher in older people. Control of factors influencing and bacterial contamination decreases the incidence of SSI in abdominal surgeries.

How Sweet Is This? A Review and Evaluation of Preoperative Carbohydrate Loading in the Enhanced Recovery After Surgery Model.

Preoperative carbohydrate loading is a contemporary element of the enhanced recovery after surgery (ERAS) paradigm. In addition to intraoperative surgical and anesthetic modifications and postoperative care practices, preoperative optimization is essential to good postsurgical outcomes. What was long held as dogma, a period of prolonged fasting prior to the administration of anesthesia, was later re-examined and challenged. Along with the proposed physiologic effects of decreasing the surgical stress response and insulin resistance, preoperative carbohydrate loading was also demonstrated to improve patient satisfaction and well-being, without an increase in perioperative complications. The benefits are most strongly observed in abdominal and cardiac surgery patients, but there has also been data which support its use in other specialties and surgeries. Barriers to the adoption of perioperative carbohydrate loading are few, but importantly include overcoming the inertia to modify older and more restrictive fasting guidelines and achieving the multidisciplinary consensus necessary to implement such changes. Despite these challenges, and with an existing body of evidence supporting its benefits, preoperative carbohydrate loading presents a significant contribution to the ERAS programs.

Interim Analysis: Perioperative Wearable Fitness Devices Accelerate Recovery in Elective Abdominal Colorectal Surgery Patients: A Randomized Clinical Trial

Interim Analysis: Perioperative Wearable Fitness Devices Accelerate Recovery in Elective Abdominal Colorectal Surgery Patients: A Randomized Clinical Trial

Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients

IntroductionNational data suggest that surgical site infection (SSI) complicates 2%–10% of general surgery cases, although the patient-reported incidence is much higher. SSIs cause significant patient morbidity and represent a significant...

Comparison of HFNC and COT to Diaphragm Function of Post-upper Abdominal Surgery Patients

Comparison of HFNC and COT to Diaphragm Function of Post-upper Abdominal Surgery Patients

Effects of Autogenic Drainage in Patients with Abdominal Surgery

AbstractBackground: Surgery has become an important part of global health care, estimated to about 234 million patients operated yearly. Surgery and general anesthesia directly affects the respiratory system. Surgeries alter postoperative pulmonary function causes impairment of lungs volume such as total lung capacity, vital capacity and tidal volume and can develop post pulmonary complications.Aim of Study: Is to study the effect of autogenic drainage (AD) breathing technique in abdominal surgery patients to prevent those complications.Patients and Methods: Thirty participants who underwent abdominal surgeries with age 30-60 years were included in the study for one week of intervention. Total seven sessions was given in a week and pre and post readings were taken by using inch tape at Axillary level, inspiratory capacity was taken with help of incentive spirometer (Helios 401) and peak expiratory flow rate with peak flow meter.Results: It showed significant difference when pre values were compared with outcome post measures like inspiratory capacity with incentive spirometer, peak expiratory flow rate with peak flow meter, and chest expansion using inch tape.Conclusion: The present study concluded that Autogenic drainage of breathing control is effective for improving chest expansion, peak expiratory flow rate and inspiratory capacity in abdominal surgery patients.

Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes

BackgroundEnhanced recovery pathways have been shown to improve clinical outcomes after surgery. Concerns exist about the feasibility of implementing enhanced recovery pathways in frail patients, who are at a greater risk for adverse postoperative outcomes. This study evaluated compliance and outcomes after enhanced recovery pathway implementation in high-risk, abdominal surgery patients. MethodsPatients entered into the American College of Surgeons National Surgical Quality Improvement Program database who underwent abdominal surgery after enhanced recovery pathway implementation at two Johns Hopkins Medical Institutions were included. Risk was assessed using the American College of Surgeons National Surgical Quality Improvement Program validated, modified 5-item frailty index. Primary outcomes included compliance with 14 enhanced recovery pathway standards and postoperative length of stay, major complications (Clavien-Dindo score II–IV), and 30-day readmission. ResultsThis study included 646 patients who participated in our enhanced recovery pathway program and 65 patients with modified 5-item frailty index ≥ 2 before enhanced recovery pathway implementation. Overall, 325 patients (50.3%) were high compliers (>75% compliance) with enhanced recovery pathway standards, with similar proportions of patients with a modified 5-item frailty index ≥ 2 or < 2 achieving high compliance (51.6% vs 50.2%, P = .89, respectively). Examining causality for “low compliers” among patients with a high frailty score (modified 5-item frailty index ≥2) demonstrated significant less use of goal-directed therapy when compared with “high compliers” (43% vs 75%, P = .01). Low compliers were also less likely than high compliers to experience mobilization the day of surgery (43% vs 78%, P = .01), postoperative day 1 (43% vs 88%, P < .01), and postoperative day 2 (60% vs 100%, P < .01). In addition, low compliers were less likely than high compliers to have their diet advanced to solids on postoperative day 1 (17% vs 59%, P < .01) and have their Foley catheter removed on postoperative day 1 (45% vs 97%, P < .01). Comparing our pre-enhanced recovery pathway patients with our enhanced recovery pathway cohort with a high frailty score, enhanced recovery pathway patients had a significantly shorter length of stay (4.5 vs 6 days, P = .04). However, adjusted analysis demonstrated that high compliance, and not just the enhanced recovery pathway intervention among patients with a high frailty score, was independently associated with a decrease in length of stay (odds ratio 0.72, 95% confidence interval 0.63–0.82, P < .01) and a significant reduction in major complications (odds ratio 0.30, 95% confidence interval 0.14–0.65, P < .01. ConclusionThis study demonstrates that frail patients comply well with a robust enhanced recovery pathway protocol and subsequently experience improved outcomes. Targeted interventions that seek to maximize compliance with specific enhanced recovery pathway standards may further improve outcomes in this population.

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria.

Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.

Nurses' Indications for Administration of Perioperative Intravenous Fluid Therapy—A Prospective, Descriptive, Single-Center Cohort Study

To examine whether nurse anesthetists and postanesthesia nurses' administration of intravenous (IV) fluid therapy during surgery and in the postanesthesia care unit is based on evidence. Secondarily to investigate if providing indications for IV fluid administration changed nursing practice. Prospective, descriptive, single-center study in Scandinavia comparing two cohorts. Descriptive, fluid volume, and type data were obtained in both cohorts. Cohort 1 (n=126) was used as baseline data. In cohort 2 (n=130), nurses recorded indications for type and volume of fluid therapy using a validated list. Analysis compared median volumes of crystalloid or colloid fluids of surgical types by cohort. Analysis compared frequency of given indication reasons for each IV fluid by surgical type. Basic static variables were chosen most frequently for indications of IV fluid needed for all surgeries except high-risk abdominal surgery where dynamic variables were more frequent. Signs and symptoms of inadequate tissue perfusion were only sparsely indicated. The volume of intraoperative crystalloid fluids was statistically different for patients with hip fracture surgery in cohort 2. Volumes of both colloid and crystalloid fluids were significantly higher for high-risk abdominal surgery in cohort2. Nurse anesthetists and nurses in the postanesthesia care unit rely more on basic static parameters than signs of inadequate tissue perfusion when they make decisions about fluid administration. The indications cited for fluid administered to high-risk abdominal surgery and hip fracture patients did not always fit guidelines. This indicates the need of a stronger intervention to change practice to follow evidence-based clinical guidelines.

Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery.

Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery.

Tactics to Prevent Intra-Abdominal Infections in General Surgery.

Abdominal infections following surgery have many severe consequences. Several effective, well-evaluated infection prevention and control processes exist to avoid these infections. This manuscript reviews and provides supporting evidence for common management strategies useful to avoid postoperative abdominal infection. Prevention of abdominal infection begins with preparation of the environment using standard infection control practices. Peri-operative use of systemic antibiotics, an antibiotic bowel preparation in colorectal surgery, and effective antiseptic preparation of the surgical site all reduce infection rates. Peri-operative supplemental oxygenation, maintenance of core body temperature, and physiologic euglycemia will reduce both incisional and organ-space infections in the abdominal surgery patient. Strategic use of irrigation and drain placement may be useful in some circumstances. Specific methods of prevention are documented to reduce intra-abdominal infections. Prevention requires a multi-disciplinary team including the surgeon, anesthesiologist, and all operating room personnel.

Effectiveness of Foot Massage on Pain, Heart Rate and Blood Pressure among Abdominal Surgery Patients

Effectiveness of Foot Massage on Pain, Heart Rate and Blood Pressure among Abdominal Surgery Patients

Enhanced recovery pathways in orthopedic surgery.

The enhanced recovery after surgery (ERAS)© concept, sometimes referred to as “fast track”, “accelerated,” or “Rapid Recovery” surgery, was first introduced in 1997. The concept of ERAS targets factors that delay postoperative recovery such as surgical stress and organ dysfunction. ERAS protocols or programs are a care package of evidence-based interventions used in a multimodal and coordinated clinical care pathway. They represent a multidisciplinary approach directed to reducing postoperative complications, shortening length of hospital stay, improving patient satisfaction, and accelerating recovery. ERAS was initially centered on abdominal and colorectal surgery patients; however, ERAS protocols have been widely extended to include other specialties. Orthopedic surgery, particularly elective hip and knee arthroplasty is one of such areas where ERAS principles have been adopted. It has been associated with reduced length of hospital stay, readmission rate, and improved functional recovery. The common interventions used in orthopedic ERAS programs have been divided into those performed in the preoperative, intraoperative, and postoperative phases of care. A PubMed literature search was performed for articles that included the terms enhanced recovery and orthopedic surgery. In this article, we summarized the clinical application of ERAS and highlighted the key elements that characterize an enhanced recovery program.

Premedication effect of melatonin on propofol induction dose for anesthesia, anxiety, orientation and sedation after abdominal surgery: a double-blinded randomized trial.

The present study addressed the effect of melatonin premedication on propofol induction dose for anesthesia in abdominal surgery. This is a double-blinded clinical trial in which abdominal surgery patients admitted to the Valiasr Hospital, Iran (n = 88) were enrolled and individually randomized into two groups: melatonin and placebo groups sublingually administered 3 mg of melatonin and placebo, respectively, 50 minutes before surgery. Their anxiety, orientation, and sedation were recorded before melatonin administration, anesthesia induction, and recovery, while we also recorded the propofol induction dose required for general anesthesia. Anxiety was seen less in the melatonin group than the placebo group (P < 0.05), whereas orientation was significantly different before anesthesia induction (P = 0.044) and sedation was the same before the induction (P = 0.044) and recovery (P = 0.049) in both groups, with a better efficiency in the melatonin group in which a lower dose of propofol was used (P = 0.002). The sedation, anxiety, and propofol dose used were lower in the melatonin group than the placebo group. The recommended dosage was 3 mg of melatonin once to achieve an anesthetic depth index or a bispectral index of 40. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1395.432 code in July 2016, and the trial was registered in Iranian Registry of Clinical Trials with IRCT20141209020258N98 in September 2016.

Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): protocol for a single-centre, pilot, randomised controlled trial

IntroductionPostoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this...

Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study

ObjectivesTo (1) determine whether short, 30-minute sessions of non-invasive ventilation (NIV) is associated with fewer postoperative pulmonary complications (PPC) following elective high-risk upper abdominal surgery and (2) measure feasibility and safety of this intervention when delivered by physiotherapists. DesignProspective, pre post cohort, observational, single-centre study. SettingPrimary referral hospital in Australia. ParticipantsA total of 182 consecutive high-risk elective upper abdominal surgery patients consisting of 101 pre cohort participants compared to 81 post cohort participants. InterventionsBoth groups received standardised preoperative physiotherapy and early postoperative mobilisation. The post cohort group received five additional 30-minute NIV sessions in the first two postoperative days. Main outcome measurePrimary outcome measure was PPC incidence within the first seven postoperative days. Secondary outcomes included feasibility and safety of physiotherapy-led NIV. ResultsIncidence of PPC (7% vs 18%, adjusted relative risk 0.24; 95% CI 0.10 to 0.59, p=0.002) was less in the NIV group compared to those who received no NIV. Mean time to first NIV session was 18.6 (SD 11.0) hours with 74% of participants receiving NIV within 24-hours of surgery. There were no major adverse events. ConclusionThese findings suggest PPC reduction may be possible with postoperative NIV following high-risk elective upper abdominal surgery. Results should be seen as hypothesis-generating associations only considering the significant limitations to this study. Physiotherapy-led NIV was delivered safely to ICU and ward patients. However, the planned protocol was not feasible and appropriate physiotherapy staffing and/or a multidisciplinary approach may be required to provide this service successfully. Trial registrationLIPPSMAck POP (Lung Infection Prevention Post Surgery – Major Abdominal – with Pre Operative Physiotherapy) ANZCTR-12613000664741 (for pre cohort group only).

Balanced Anesthesia VS General Anesthesia for Upper Abdominal Surgery-A Comparative Study of Outcome

This is a prospective randomized clinical study was done in the dept. of Rajshahi Medical College Hospital &amp; in different Clinics in Rajshahi city from August 2013 to December 2014 to evaluate the outcome of patient undergoing upper abdominal surgery such as cholecystectomy, cholidocholithotomy, Nephrolithotomy, Gastrojejunestomy, Splenectomy, Hysterectomy, LUCS, Appendisectomy etc. by balanced anesthesia. This is also a comparative study of patient undergoing upper abdominal surgery either by balanced anesthesia or by general anesthesia. For this study 80 patients of upper abdominal surgery were randomly selected in two groups (Each group contain 40 patients) Group 'A' Patient received balanced anesthesia &amp; group 'B' Patient received general anesthesia. Then these patient were monitored during per-operative &amp; post operative period to evaluate its outcome. After completion of operation we have seen that those patent received balanced anesthesia had better outcome than general anesthesia undergoing upper abdominal surgery.TAJ 2012; 25: 47-54