ASA Scale Research Articles

Retrospective paired cohort study comparing internal fixation for undisplaced versus hemiarthroplasty for displaced femoral neck fracture in the elderly

IntroductionThe debate continues regarding the best treatment for elderly patients with non-displaced femoral neck fractures (FNFs): internal fixation (IF) vs hemiarthroplasty (HA). The Aim of the present study is to compare surgical insult, mortality, complications, and walking recovery after one year in patients older than 65 treated with cannulated screws or HA for FNFs. Patients and methodsMatch-paired comparison of retrospective cohorts: 220 non-displaced FNFs treated with cannulated screws vs 220 displaced FNFs treated with bipolar HA from 2013 to 2021. No differences were observed in age (82.1 ± 7.5 IF vs 83±6.8 HA) (p = 0.172), sex (74.6 % IF females vs 74.6 % HA females) (p = 0.912), year of intervention (p = 0.638) and ASA scale (III in 55.5 % IF vs 55.9 % HA) (IV in 21.8 % IF vs 18.2 % HA) (p = 0.726). Medical complications analyzed included respiratory and urinary infections, heart failure, myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, acute digestive bleeding. ResultsLower surgical aggression in IF: surgical time (p < 0.001), hemoglobin and hematocrit decrease (p < 0.001), need for transfusion (p < 0.001), hospital stay (p < 0.001). Mortalityhigher in-hospital for hemiarthroplasties: 12 deaths (5.5 %) vs 1 (0.5 %) (p = 0.004) (RR=12, 1.5–91.5). No differences after 1 month (13 (6 %) in HA vs 9 (4.1 %) in cannulated screws) and 1 year (33 (15 %) in HA vs 35 (16 %) in IF).Medical complications showed no significant differences (p = 0.055). Surgical complicationsNo differences in surgical infections (5 HA (2.3 %) vs 2 IF (0.9 %);p = 0,253) or neurovascular injuries (3 HA (1,4 %) vs 2 IF (0.9 %); p = 1). HA: 10 dislocations (4.5 %), 11 periprosthetic fractures (5 %). Cannulated screws: 10 fixation failures (4.6 %), 9 non-unions (4.1 %), 16 ischemic necrosis of femoral head (7.3 %). Reoperation rate: 15/220 IF (6.8 %) and 8/220 HA (3.6 %) (p = 0.134).Functional results: No differences were detected (p = 0.285): 111 osteosynthesis patients (50.45 %) and 99 HA (45 %) returned to their pre-fracture walking ability (p = 0.322). There were also no differences between groups in those patients with worsening of walking status: 108 (49 %) osteosynthesis and 118 (53,6 %) prosthesis (p = 0.412). ConclusionsCannulated screws in patients over 65 with non-displaced femoral neck fractures results in less surgical insult, lower in-hospital mortality, comparable medical and surgical complications, a similar re-operation rate, and functional outcomes equivalent to hemiarthroplasty. Level of evidenceLevel III (retrospective comparison of matched cohorts)

[Translated article] Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway

IntroductionThere is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. ObjectiveTo determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). MethodsA retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017–2020 using the ERAS protocol, during which 957 surgeries were performed. ResultsAverage age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASA II. The significantly associated factors to an increased length of stay are: age (p=.001), ASA scale (p=.04), day of surgery (p<.001), blood transfusion (p<.001), postoperative haemoglobin level at 48–72h (p<.001), the time of first postoperative mobilisation to ambulate and climb stairs (p<.001), the need for analgesic rescues (p=.003), and the presence of postoperative nausea and vomiting (p=.008). ConclusionsThere are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimise the quality of care and available health resources.

Results of the use of an integrated risk scale for postoperative complications in patients with colorectal cancer

Inroduction. Polymorbidity significantly increases the risk of complications in the early postoperative period, especially in patients with colorectal cancer, taking into account the initial nutritional status disorder. At present, several scales of postoperative complications risk assessment (POSSUM, RCRI, MUST) are used, but they do not fully meet the needs of modern oncosurgery, so we consider it necessary to compare their effectiveness and propose a new integrated scale.Aim. To establish the most significant factors influencing the outcome of surgical treatment and length of hospitalization in comorbid patients with colon cancer with the development of a surgical risk assessment scale that is most adapted for this group of patients.Materials and methods. We analyzed the data of hospital charts of patients undergo surgery for colorectal cancer in the oncoproctologic department of the S. P. Botkin State Clinical Hospital of the Moscow Healthcare Department in the period from 2019 to 2022. Inclusion criteria: histologically verified colorectal adenocarcinoma; colorectal cancer in stage cT4, cN0, cM0 or cT1–4, cN1–2, cM0; presence of one or more concomitant diseases in the patient. Exclusion criteria: presence of distant metastases of colorectal cancer; absence of confirmed comorbidities; early forms of colorectal cancer (cT1–2, cN0). All patients were assessed for risk of perioperative complications using ASA, POSSUM, MUST, and RCRI scales. The study endpoints were number of days in intensive care, number of days of hospitalization, and 30-day mortality. An Excel database with POSSUM, RCRI, and MUST scale calculators was created for the study. The evaluation of parameters influencing the outcome of hospitalization was performed using ROC analysis and correlation analysis using Pearson’s criterion. To identify the most sensitive parameters affecting the outcome of hospitalization, commonly used calculators were studied in detail.Results. 200 patient records were analyzed. The results of treatment were compared with the data obtained using the postoperative risk scales POSSUM, MUST, RCRI. A comparative analysis of the scales presented above with our proposed integral scale of postoperative complications risk assessment was carried out. It was found that the parameters of our proposed integral scale showed the highest sensitivity (Se &gt;70 %) and specificity (Sp &gt;70 %) to the risk of postoperative complications. Our proposed integral scale showed a moderate correlation with the age of patients (r = 0.475, p = 0.01) and preoperative weight loss (r = 0.592, p = 0.01), as well as a high correlation with POSSUM (r = 0.649, p = 0.01; r = 0.852, p = 0.01) and MUST (r = 0.655, p = 0.01).Conclusion. The developed scale for assessment of surgical risk in comorbid patients with colorectal cancer showed a higher correlation with the outcome of surgical treatment than similar known scales, which indicates its effectiveness and possibility of application in clinical practice after its validation in prospective studies.

Adhesiolysis during reconstructive interventions in patients after Hartmann’s procedure (interim results of a randomized trial)

The purpose of this work was to evaluate the preliminary results of Hartmann reversal procedures with total and partial adhesiolysis in the abdominal cavity. 64 patients with end colostomies were included in the randomized study from November 2021 to December 2022; 37 patients underwent partial adhesiolysis (main group) during the intervention, and 27 patients underwent complete adhesiolysis (control group). The study groups were comparable in gender, BMI, and status on the ASA scale. During the study, postoperative complications developed in 13 (35 %) cases in the group of partial adhesiolysis and in 6 (22 %) cases in the group of complete adhesiolysis (p = 0.4). In both groups, complications of classes I and II on the Clavien-Dindo scale prevailed. Complications requiring repeated surgical interventions developed in 3 patients of the main group: an anastomotic leak was detected in 2 (5 %) patients, and colon perforation was detected in 1 (3 %) patient, however, the groups were comparable in this parameter (p = 0.6). There was no statistically significant difference in the frequency and structure of postoperative complications or the duration of the postoperative inpatient days between the groups. The volume of adhesiolysis did not affect the duration of surgical interventions, which accounted for 224 minutes in the main group and 200 minutes in the control group. According to the results of regression analysis, the presence of previous peritonitis turned out to be the only predictor that increases the likelihood of postoperative complications (OR = 0.33; 95 % CI: 0.1–1; p = 0.049). Thus, the preliminary results of the randomized study showed no impact of the volume of adhesiolysis on the duration of the intervention and the nature and frequency of postoperative complications.Further research is necessary.

Is triggering receptor expressed on myeloid cell 1 (TREM-1) protein a new marker of serious infectious complications in colorectal surgery?: case-matched pilot study

PurposeThe purpose of the study was to evaluate the usefulness of the triggering receptor expressed on myeloid cell 1 (TREM-1) protein as a marker for serious infectious complications during laparoscopic colorectal surgery.MethodsSixty-four patients with colon or rectal cancer, who underwent an elective laparoscopic colorectal cancer surgery from November 2018 to February 2020, were included in the analysis. Blood samples of the TREM-1 protein testing were collected four times from each patient: before and on three following postoperative days (PODs). Patients were divided into two groups according to the presence of infectious complications. Subsequently, patients with infectious complications (group 1) were matched 1:1 with patients without complications (group 2). The case-matched analysis was done by selecting patients from the control group by age, ASA scale, cancer stage, and type of surgery.ResultsThere was no significant difference in demographic and operative characteristics between the two groups. The median length of hospital stay was longer in group 1 than in group 2 (11 days vs. 5 days, p < 0.001). Preoperative measurements of TREM-1 protein did not differ between the two groups. There were no significant differences in the measurements on the first and third postoperative days. However, the median TREM-1 measurement was higher in group 1 on the second postoperative day (542 pg/ml vs. 399 pg/ml; p = 0.040). The difference was more apparent when only severe postoperative complications were considered. When compared to the group without any complications, the median TREM-1 level was significantly higher in the group with severe infection complications in POD 1, POD 2, and POD 3 (p < 0.05). The receiver operating characteristic (ROC) curve demonstrated that TREM-1 readings in POD 2 had a sensitivity of 83% and a specificity of 84% for the presence of severe infection complications at a value of 579.3 pg/ml (AUC 0.8, 95%CI 0.65–0.96).ConclusionTREM-1 measurements might become a helpful predictive marker in the early diagnosis of serious infectious complications in patients following laparoscopic colorectal surgery.

The Apraissal of Self-care Agency Scale and its relation to health behaviors and conditions in older adults

The objective of this work was to contribute to the study of the validity of the “Appraisal of Self-care Agency Scale” (ASA scale) in older adults and to analyze its association with health-related behaviors and conditions. A questionnaire was constructed and applied to 165 elderly residents of Michoacán, Mexico. A confirmatory factor analysis of the scale's one-dimensional model was carried out, and also an analysis of internal consistency, as well as an analysis of the relationship with other variables based on group comparisons, exploring the effect of the elimination of inverse items. Overall, the reduced scale performed better although the one-dimensional model maintained a limited fit in the confirmatory factor analysis. Internal consistency was satisfactory in both scales (α coefficient= .806 and .826, respectively). In addition, some important group comparisons were identified with anthropometric measurements. In conclusion, tests were found supporting the validity of the ASA scale in older adults, although more evidence is still needed regarding its construct and criterion validity.

Experience of Dexmedetomidine using for intraoperative analgosedation during ophthalmic operations

Background. The aim of the study is to evaluate the quality and safety of the sedative effect of anesthesia in ambulant ophthalmic surgery by using continuous intravenous infu­sion of Dexmedetomidine. Materials and Methods. Patients were randomized into groups by age (people from 65 to 75 years old, old age 76 years, middle age, young people, children), by gender (men, women). The physical status of patients was assessed using the ASA scale and the dynamics of vegetatic activity by the Kerdo index. Sedation was assessed using the Richmond Sedation Scale RASS.Results. It was found that the difference in the frequency of adverse effects of the appointment of Dexmedetomidine clearly confirms the need to adjust the dose of Dexmede­tomidine, depending on the state of the autonomic nervous system. The use of Dexmedetomidine according to the rec­ommendations made it possible to achieve a safe level of sedation and eliminate side effects in ambulant ophthalmic surgery.Conclusions:&#x0D; &#x0D; Parenteral continuous infusion of Dexmedetomidine pro­vides an effective level of sedation for ambulant ophthalmic surgery and maintaining patient­surgeon contact.&#x0D; Safety is confirmed by a low level of critical incidents, no respiratory depression at the target sedation level.&#x0D; The patency of the upper airways was better compared to previous experience with propofol.&#x0D;

Периоперационная инфузионная терапия разными по объему протоколами у пациентов со средним хирургическим риском, подлежащих неотложной лапаратомии

С целью оценки эффективности либерального и рестриктивного протоколов периоперационной инфузионной терапии при неотложной лапаратомии нами было обследовано 100 больных. Степень операционно-анестезиологического риска соответствовала IIЕ классу по шкале АSA, хирургического риска по шкале POSSUM — 1–5 % (средний риск). Всем больным проведена предоперационная подготовка на протяжении 2 часов в условиях отделения интенсивной терапии в объеме 2870 ± 540 мл в 1-й группе и 1733 ± 340 мл во 2-й, при расчетной инфузионной нагрузке 80–120 мл и 40–60 мл/кг/сут соответственно. Больные были обследованы клинически, инструментально и лабораторно. В исследовании доказано, что острая хирургическая патология у пациентов со средним хирургическим риском сопровождается исходным сохранением нормального общего объема жидкости на фоне дефицита объема плазмы с развитием гиповолемии, внутриклеточной дегидратации и интерстициального оте­ка. Это приводит к относительной гипердинамии путем увеличения общего периферического сопротивления и частоты сердечных сокращений. Применение рестриктивной стратегии периоперационной инфузионной терапии позволяет восстановить физиологические объемы водных секторов организма и сформировать нормодинамический тип кровообращения с 3-х суток послеоперационного периода.

COMPLICATIONS AFTER PARTIAL, TOTAL OR EXTENDED SACRECTOMY: A CASE SERIES

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.

Quality of life after extended lymph node dissection for colon cancer

Aim: to evaluate the effect of the lymphadenectomy (LD) level on the quality of life (QoL) in patients who underwent laparoscopic colon resection for colon cancer.Patients and methods: the study included 86 patients who underwent surgery for colon cancer from January 2018 to August 2020. The patients were randomized in 2 groups: the main group — with D3 lymphadenectomy — 41 patients and the control group — with D2 — 45 patients. Two validated QoL questionnaires (QLQ-C30 v. 3.0, QLQ-CR29 v. 2.1) of the European Organization for Research and Treatment of Cancer (EORTC) were applied by the patients on the day before the surgery and on the 30th day after the surgery and were used for the further analysis.Results: there were no significant differences between the groups in gender, age, weight, height, BMI, assessment of functional and physical status according to the ASA and ECOG scales, incidence of comorbidities, tumor site, type and volume surgical of procedures. Regardless of the level of lymphadenectomy, the significant improvement in QoL after surgery was obtained (pQoLD3 = 0.005, pQoLD2 = 0.023) in both groups. The significant increase in the incidence of diarrhea by 2.65 times was detected after laparoscopic right hemicolectomies with extended lymphadenectomy (p = 0.042). Also, there was a significant 2.45 fold increase in the risk of developing erectile dysfunction (ED) after D3 lymphadenectomy in the patients who underwent laparoscopic resections of the left colon in the early postoperative period (p = 0.031).Conclusion: the analysis of physical, social functioning and symptomatic scales has established that in patients who underwent colon resection for cancer of the left colon erectile dysfunction occurred to a greater extent after D3 LD, whereas diarrhea was more likely to develop after resection of the right colon with D3 LD than with D2 LD.

Postoperative complications in patients infected with covid-19 (review of literature)

The article provides an analysis of the literature on the frequency and nature of postoperative complications in patients infected with a new coronavirus infection – COVID-19. Risk factors for the development of postoperative complications and mortality are considered; the presence of SARS-CoV-2 is a leading risk factor for these complications and mortality, significant risk factors are also patients age ≥70 years, male gender, cancer surgery, severity of the patient’s condition before surgery (3–5 points on the ASA scale), performance emergency operations, a significant amount of surgical interventions. Postoperative complications in patients with COVID-19 develop in 50 %, the mortality rate is 2 times higher compared with patients without coronavirus infection.

Propofol sedation administered by cardiologists in echocardiography studies

Introduction and objectivesThe advantages of sedation in patients undergoing transesophageal echocardiography (TEE) are well established, but the increasing number of TEE studies may limit the capacity of anesthesiology services. In this study we analyze the effectiveness and safety of a moderate sedation program carried out by non-anesthesiology professionals (NAP). MethodsDescriptive and prospective study that included all consecutive patients undergoing a TEE procedure under moderate sedation by NAP and by anesthesiology professionals (AP) from September 2018 to September 2019. Patients were selected according to a specific algorithm agreed upon with the Anesthesiology Department. We analyze current indications for TEE, complication rates, and recovery times associated with sedation. ResultsWe performed 267 procedures in 252 patients (54% male, 69 years). Main indications were screening or monitoring of surgical and percutaneous cardiac interventions (47.9%), endocarditis (28.5%) and stroke (20.6%). Patients in the NAP group were younger (59 vs 71 years), less hypertensive (43% vs 61%), with less lung disease (4% vs 24%), lower risk of difficult airway (1% vs 22%) and lower comorbidity (ASA scale≥III 13% vs 77%). Complications were more frequent in the AP group (26% vs 9%), mainly mild respiratory (19% vs 9%). Events were associated with the presence of lung disease and higher ASA degree. Recovery time was longer in the AP sedation group (20min vs 15min). ConclusionsTEE indications are changing and involve larger and more complex studies. Moderate sedation with propofol performed by NAP is safe in selected patients, with adequate recovery times.

Total hip replacement for displaced intracapsular neck of femur fracture. Are current guidelines appropriate for all patients? Five-year retrospective analysis of 315 cases

BackgroundAccording to the National Hip Fracture Database (NHFD), in 2018 31.4% of patients with displaced intracapsular neck of femur (NOF) fracture who, National Institute for Health and Care Excellence (NICE) viewed eligible for total hip replacement (THR), received this operation.We aimed to identify the compliance of performing THR for those patients in our unit and identify the reasons for proceeding with the alternative type of surgery. MethodsA five-year retrospective review of eligible patients was conducted between January 2014 and Dec 2018. Statistical analysis was performed between groups who did or didn't receive THR. Reasons for not performing THR were identified from pre-operative ward rounds notes. ResultsIn 2018 our unit performed THR for 44% of eligible cases. This was the highest result over five-years and higher than the national average.Out of the 348 eligible cases, pathological or undisplaced intracapsular fractures were excluded. Reminder received THR (138), hip hemiarthroplasty (166) or internal fixation (11).The average age was 77. Younger patients were more likely to receive THR than 80 years or older (p<0.05). THR group scored 0.4 points higher on AMTS and 0.2 lower on ASA scale then non-THR group (9.8 vs. 9.4 and 2.7 vs. 2.5 respectively). Mean time to surgery was 1.24 days with no significant difference between THR and non-THR group (1.6 vs. 1.1) but a slight delay to surgery during the weekends was noted (1.3 vs 1.8 days).Reasons for not performing THR were well documented as a combination of mobility restrictions and serious medical comorbidities. Retrospectively we judged the surgical decision making to be correct in 95% of cases. ConclusionsAnnual NHFD report comments on poor national and individual hospital's compliance with NICE guidelines without allowing surgeons to justify their choice of the procedure undertaken.Surgical decisions are made in a highly specialised multi-disciplinary environment taking into consideration individual patient's frailty and potential morbidity. Details of those discussions should be collected in NHFD to allow further analysis of reasons why surgeons decide not to offer THR to a patient NHFD views as eligible for this procedure. This could help in understanding the complex factors impacting on decision making in those cases.Level of evidence:Level III

Acute purulent widespread peritonitis: conceptual aspects of modern surgical tactics

Background. The priority areas of the problem of acute widespread peritonitis (AWP) include the standardization of terminology and classification, assessment of the severity of the process, control of the infection source and correction of pathological intra-abdominal syndromes.&#x0D; Objective. To outline the conceptual aspects of AWP surgical treatment based on consensus guidelines and own research.&#x0D; Materials and methods. The study involved 371 patients with AWP. Patients underwent the necessary clinical, laboratory, biochemical, bacteriological, radiological, instrumental and pathomorphological studies.&#x0D; Results and discussion. To assess the severity of the disease one should assess the general clinical condition of the patient, the source and the site of infection, the presence or absence of organ or multiorgan dysfunction, the characteristics of the pathogen. The assessment of the clinical condition takes into account the patient’s age, physiological status and comorbid diseases, the general scales ASA, SOFA, APACHE, Marshall and peritonitis-specific scales (Mannheim Peritonitis Index, Peritonitis Index Altona). When determining the infection source, it is advisable to determine whether the process is provoked by damage to the upper or lower segment of the gastrointestinal tract. The most common causes of AWP in the own study were acute appendicitis (23 %), perforated gastric ulcer (21 %), acute pancreatitis and pancreatic necrosis (18 %). Acute cholecystitis, intestinal perforation, and anastomosis failure were somewhat less common. Suboperative measures during AWP surgery include detection and assessment of the source of the pathological process, elimination of the detected changes, lavage and adequate drainage of the abdominal cavity, correction of intra-abdominal pathological syndromes, clarification of the feasibility of programmed relaparotomy. Dekasan (“Yuria-Pharm”) is used for lavage. It is a local antiseptic, effective against gram-positive and gram-negative bacteria, viruses, and fungi. Dekasan is a surfactant that removes fibrin, pus, colonies of microorganisms and blood clots. According to V.V. Boiko et al. (2012), abdominal lavage with the help of Dekasan reduces postoperative mortality by almost 9 %, and the frequency of secondary purulent complications – by 16.5 %. Pathological intra-abdominal syndromes that need correction include abdominal compartment syndrome (ACS), intestinal insufficiency, and the excessive colonization of the proximal small intestine by pathological microflora. Prolonged tubal decompression of the small intestine, hyperbaric oxygenation, VAC-therapy, and application of negative pressure are used to decrease intra-abdominal hypertension in ACS. Tube techniques used in AWP include enteral lavage, enterosorption, selective pharmacological decontamination, and intraluminal transtubal electrophoresis. It is advisable to introduce enteral nutrition early. For additional detoxification and correction of water-electrolyte balance, low-volume infusion therapy with hyperosmolar solutions (Reosorbilact, “Yuria-Pharm”) is used. Reosorbilact contains sorbitol, sodium lactate and the necessary ions.&#x0D; Conclusions. 1. Modern approaches to solving the problem of AWP should be based on modern terminological and classification principles and provide an understanding of the content of surgery and the validity of antibiotic therapy. 2. Control of the source of peritonitis includes its complete elimination, lavage and drainage of the abdominal cavity, ensuring the decompression of the digestive tract with the implementation of a tubal program of measures. 3. Antibiotic therapy and infusion therapy are the important components of treatment. 4. The implementation of these statements will increase the effectiveness of AWP treatment.

Effect of perioperative infusion therapy on the functional state of the hemostatic system in patients with concomitant coronary heart disease

Background. The choice of the infusion therapy regimen in the perioperative period remains a complex and controversial issue of modern anesthesiology. This is especially true for elderly patients with concomitant cardiovascular diseases, primarily coronary heart disease (CHD). Excessive fluid restriction in the perioperative period during the intervention can contribute to the development of arterial hypotension and hypoperfusion of vital organs. At the same time, excessive fluid intake in these patients is dangerous in terms of developing complications such as decompensation of heart activity, ischemic myocardial damage. There are many factors of the perioperative period that affect the processes of fluid metabolism in the body, the state of hemodynamics and other vital functions. Among them, the most significant factors are operational stress, features of the underlying disease and surgical intervention, the influence of anesthetics, the functional state of the cardiovascular system, kidneys, etc. One of the insufficiently considered factors that may influence the choice of infusion therapy, in our opinion, is the functional state of the hemostatic system in the preoperative period.&#x0D; Objective. To investigate the effect of perioperative infusion therapy on the functional state of the hemostatic system in patients with concomitant CHD.&#x0D; Materials and methods. A total of 92 patients who underwent abdominal surgery under combined general anesthesia with a ventilator were examined. The average age of patients was 61±12 years; risk on the ASA scale – II-III; risk of cardiac complications on the RCRI – 1-3; risk of thrombosis on the Caprini scale – 6.5±0.1. The functional state of platelets was assessed using the platelet aggregation analyzer AR 2110 (Belarus); the state of plasma hemostasis was assessed using standard coagulogram indicators.&#x0D; Results and discussion. When studying platelet aggregation in the initial state, significant fluctuations in the studied parameters were found from significant hypoaggregation to significant platelet hyperaggregation. For further analysis and differential correction, patients were divided into three groups depending on the degree of platelet aggregation. Group 1 included 22 patients with established hypoaggregation, 2nd group – 38 patients with established normal platelet aggregation, and 3rd group – 32 patients with platelet hyperaggregation. The coagulogram in the majority of patients in the initial state characterized normocoagulation or a tendency to hypercoagulation. Correction of changes in primary hemostasis was performed using infusion therapy, depending on the initial data of platelet aggregation. In the group with greegreece platelets was conducted infusion therapy with the liberal type – 5-10 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with hoareau for restrictive type an average of 3-5 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with normoergic the relatively restrictive type that was 5-7 ml/kg/h intraoperatively; 25 ml/kg/day after surgery. For specific correction of platelet-vascular hemostasis, etamzilate 12.5 % 4.0 ml was used in group 1 patients before surgery and later 4.0 ml three times a day; in group 3 patients, pentoxifylline 2 % 5.0 ml twice a day. Thromboprophylaxis with low-molecular-weight heparins in the perioperative period was performed in all patients according to current recommendations. As a result of this approach to the correction of established disorders of platelet-vascular hemostasis, a clear trend towards normalization of the studied parameters was established already at the intraoperative stage, this trend persisted a day after the operation. Thus, the indicators of platelet aggregation in group 1 patients at the intraoperative and early postoperative stages were 68.2 (59.5; 78.1) and 63.6 (60; 72.6); in group 3 patients – 79.7 (75.3; 94.2) and 74.6 (59.2; 83.4), respectively.&#x0D; Conclusions. Individualized infusion and pharmacological therapy allows correction of disorders of platelet-vascular hemostasis in patients with concomitant CHD, which may be useful for reducing the risk of thrombotic complications.

THE STATE OF THE MOTOR-EVACUATOR FUNCTION OF THE DIGITAL CHANNEL IN PATIENTS AFTER SURGICAL TREATMENT OF ACUTE OBSTRUCTION OF SMALL INTESTINE AND ITS INFLUENCE ON ITS COURSE

Summary. Disruption of the motor-evacuation function of the digestive canal is an integral cause of the adverse course of acute obstruction of the small intestine and as a consequence of high lethality in this pathology.&#x0D; Purpose of the study. To study the motor activity of the gastrointestinal tract in patients with acute obstruction of the small intestine and its effect on the course of the disease in the postoperative period to create effective, sound methods of treatment of these patients.&#x0D; Materials and methods. Complexly after surgery, 221 patients with acute obstruction of the small intestine were examined. Used clinical and instrumental methods for the study of motor-evacuation function of the gastrointestinal tract (electrogastrography, electroenterography, phonoenterography), determined the degree of intoxication syndrome (leukocyte index of intoxication, molecules of medium mass), nonspecific resistance to organism operating-anesthetic index on ASA scale.&#x0D; Results and its discussion. Functional state of the patient with acute obstruction of the small intestine, its comorbidity affects the degree of operativeanesthesiological risk and the state of the motor-evacuation function of the digestive canal. It was found that inhibition of the motor function of the digestive tract in the first three days after surgery led to an increase in the level of intoxication, requiring its mandatory correction.&#x0D; Conclusions. A promising direction in the treatment of patients with acute obstruction of the small intestine is to develop measures that contribute to the preservation, protection and restoration of motility of the digestive tract at all stages of treatment.

Comorbidity in patients with HIV infection and tuberculous spondylitis as a risk factor for infectious complications

Objective . To determine how the presence of comorbidity, including the fact of the presence of HIV infection, affects the risks of developing infectious postoperative complications in patients with tuberculous spondylitis. Material and Methods . A monocenter comparative retrospective analysis of 116 HIV-infected patients and 158 HIV-negative patients operated on for tuberculous spondylitis was carried out, with an analysis of risk factors for postoperative complications – concomitant diseases, the Charlson comorbidity index, the anesthesia-related and operative risk according to the ASA scale. Results . Concomitant pathology and classes 3 and 4 according the ASA criteria were observed in 88.3 % of patients in the general cohort. In class 4 patients, infectious complications occurred 1.5 times more often, primarily due to early complications of immunodeficiency, while in the group of HIV-negative patients, the frequency of complications did not differ significantly between these classes. In HIV-infected patients with a moderately higher operative and anesthesia-related risk (risk increase factor = 1.19), the risk of postoperative complications increased by 1.76 times. Specific postoperative complications in HIV-infected patients were more common than in the control group (2 = 4.53, OR = 2.76). Conclusion . The presence of HIV infection in patients with tuberculous spondylitis in comparison with HIV-negative patients is a risk factor that significantly increases the risk of early (occurring up to 1 year after surgery) postoperative complications, such as postoperative pneumonia, exacerbation (progression) of spondylitis and the development of tuberculous meningitis. At that, the risk of developing late postoperative complications does not depend on the fact of HIV infection.

Evaluation of the need of perioperative antibiotic prophylaxis at endoscopic operations in bariatric surgery. An observational study

Purpose of the study. To determine the need for perioperative antibiotic prophylaxis in video endoscopic operations in bariatric surgery. Materials and methods. The observational study included 152 patients who underwent sleeve gastrectomy for morbid obesity — 94 (61.84 %), gastric bypass surgery — 21 (13.82 %), mini-gastric bypass surgery — 31 (20.40 %) or gastric banding — 6 (3.94 %) in the absence of PAP. All surgical interventions were performed by one team of surgeons. The average duration of the operation was 140.69 ± 35.57 minutes. The overwhelming majority of patients belonged to the average age — 44.0 ± 8.5 years (from 23 to 64 years). The average body mass index (BMI) of all patients at the time of admission was 46.57 ± 7.12. Results. It was found that the development of infections of the surgical site (SSI) without the use of antibiotics in the perioperative period was absent, the frequency of presumed infections was 4.0 % (6 out of 151). Moreover, only in 1 case, an anastomotic leak was diagnosed, in 6 cases the focus of infection was not established and antibiotics (cefoperazone / sulbactam or cefepime, or ceftriaxone) were prescribed empirically for 2–3 days based on an increase in the number of blood leukocytes and a rise in body temperature above normal values. An increase in body temperature and an increase in the number of blood leukocytes in the initial state was associated with grade 4 on the ASA scale and an operation duration of more than 180 minutes. Conclusion. During endovideoscopic surgeries for morbid obesity, perioperative antibiotic prophylaxis is justified only in patients belonging to the 4th class on the ASA scale and the estimated duration of surgery is more than 3 hours.

Risk Factors for Infectious Complications after Surgical Treatment of Spinal Metastases in Patients with Breast and Kidney Cancer

Relevance. In patients with the most common malignant new growth such as breast, kidney and lung cancer the rate of spinal metastases amounts to 70%. Increasing number of surgical procedures results in growing frequency of postoperative complications including surgical site infection (SSI) which do not only deteriorate the quality of patient’s life but change the timelines for renewal of therapy for the primary disease. Study design — case control study. Purpose of the study — to identify key risk factors as well as impact of tumor therapy on development of infectious complications in patients with breast and kidney cancer after surgical management of metastatic spine lesion. Materials and Methods. The authors collected and compiled the data on 2023 oncological patients who underwent specialized neuroorthopaedic treatment in the period from 2000 until 2017 due to tumor spine lesions. Inclusion criteria: malignant breast and kidney tumors with spine metastases, continued systemic tumor therapy, decompression and stabilization spine surgery irrespective of used implants. Patients that corresponded to inclusion criteria were divided into two groups. The first (main) group included patients (n = 22) with infectious complications after surgery. The second (control) group (n = 23) was formed by propensity score matching. Results. The analysis of obtained data resulted in identification of severe significant factors (р0.05): diabetes mellitus, postoperative liquorrhea, certain classes by ASA (3, 4) and ECOG (2, 3, 4) scales, volume of blood loss, time of surgery and type of tumor therapy. However, the three latter have the highest statistical significance (р0.01): surgical factors (blood loss volume and time of procedure) and type of tumor therapy. Conclusion. Postoperative SSI remains a common severe complication after surgeries due to metastatic spine lesions. The causes of postoperative infection after tumor resection are compromised immune status of the patient; long time of procedure with heavy blood loss and adjuvant tumor therapy.