Cases Of Postoperative Infection Research Articles

Two cases of postoperative infection with Mycoplasma hominis after abdominal radical hysterectomy

Two cases of postoperative infection with Mycoplasma hominis after abdominal radical hysterectomy

Translated article] Tarsal tunnel syndrome: Clinical-imaging analysis of a case series

BackgroundRetrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. MethodsRetrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. ResultsWe included 8 men and 2 women with an average age of 47 years (range 34−67) and an average follow-up of 62.2 months (range 2–149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The posterior tibial nerve was the most affected (50%) and 30% the medial plantar branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. ConclusionsTTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.

Comparison between Ceftriaxone with Ceftriaxone and Metronidazole Combination in Maxillofacial Fracture (at KSM Reconstruction and Aesthetic Plastic Surgery, RSUD Dr. Soetomo)

The purpose of the research is to evaluate infection rate on maxillofacial fracture in Plastic Surgery and Aesthetic at Dr.Soetomo General Hospital Surabaya, Indonesia, from January 2015 to December 2019. The research is an analytic descriptive study with retrospective cohort design. The affordable population were maxillofacial fracture patients with reconstructive treatment who were given therapeutic antibiotics, namely ceftriaxone at a dose of 2 x 1 g and metronidazole 3 x 500 mg intravenously. The collected data is then transferred to IBM Statistical Package for Social Sciences (SPSS) 20 software for statistical analysis with non-parametric statistics. Descriptive and analytical data will be presented in a series of texts and tables. A total of 621 patients medical record were obtained with a characteristic distribution based on gender, age, and history of trauma from 2015 to 2019 where total cases of postoperative infection after facial bone fracture reconstruction were 10 patients (1.61%), the incidence of infection with a single antibiotic ceftriaxone were 6 patients (0.97%) and cases in the administration of combination of antibiotics ceftriaxone, metronidazole were 4 patients (0.64%). The incidence of post-operative infection for facial fracture reconstruction given single ceftriaxone antibiotics was higher than that given the combination of ceftriaxone, metronidazole at KSM Reconstructive and Aesthetic Plastic Surgery, Dr. Soetomo General Hospital, Surabaya, Indonesia from 2015 until 2019. Keywords: ceftriaxone-metronidazole, infection, maxillofacial fracture DOI: 10.7176/JHMN/97-03 Publication date: January 31 st 2022

Keyhole Approach for Clipping Anterior Circulation Aneurysms: Clinical Outcomes and Technical Note.

Purpose: Keyhole craniotomy is a minimally invasive approach for the treatment of anterior circulation aneurysm. In this study, we evaluated the benefits and value of the keyhole approach by analyzing the surgical results in 235 patients with anterior circulation aneurysm treated by the keyhole approach and identifying lessons learned from addressing various complications in this approach.Patients and Methods: This was a retrospective study in a single institution of 235 surgical patients with 248 anterior circulation aneurysms who had the supraorbital keyhole approach (SKA) or pterional keyhole approach (PKA) between January 2016 and January 2021. The modified Rankin Scale (mRS) was used to measure long-term results during follow up.Results: All 235 patients' aneurysms were fully clamped and have not recurred. Among them, 31 (13.2%) had intraoperative aneurysm rupture, 8 (3.4%) had cerebral vascular spasm, and 4 (1.7%) had intraoperative brain edema. There were seven (3.0%) cases of postoperative infection, eight (3.4%) cases of postoperative cerebral infarction, one (0.4%) case of postoperative hematoma, and two (0.8%) patients had some form of cognitive impairment after surgery. Follow up after surgery demonstrated that 189 out of the 235 patients (80.4%) had favorable outcomes (mRS score 0–2), and 43 (18.3%) had poor outcomes (mRS from 3–5). There were three deaths (1.28%).Conclusions: The keyhole approach has a quick postoperative recovery, a mild postoperative response, and a good surgical outcome. Our findings indicate that the keyhole approach is a safe and effective surgical method for the treatment of anterior circulation aneurysm.

Abstract 14017: Use of Cephalothin Prophylaxis in Artificial Cardiac Stimulation Procedures

Introduction: Antibiotic prophylaxis for artificial cardiac stimulation procedures is already established in clinical studies, however, it can be used in different prophylactic schemes and with different costs. Objective: To evaluate the effectiveness of cephalothin as a prophylactic antibiotic in artificial cardiac stimulation procedures. Secondly, to compare the cost of cephalothin with other well-established prophylaxis antibiotics in these procedures. Material and Methods: We assigned patients between 18 to 103 years old who had clinical recommendations for pacemaker implantation. In this retrospective study, we included all permanent artificial cardiac stimulation procedures with cephalothin prophylaxis realized between January 2011 and December 2020 at Hospital do Coração in Natal, Brazil. The prophylactic scheme was an intravenous infusion of cephalothin 2g administered 30 minutes before single-chamber, double-chamber implantation, and replacement pacemakers. Results: We performed 2,162 procedures and registered seven cases of postoperative infections (0.32%) after procedures. Besides, cephalothin is less expensive (U$1.35/1g - total U$5,887.81), compared to other well-established and commonly used antibiotics prophylaxis as cefazolin (U$2.91/1g - total U$12,596.00) or cefuroxime (U$7.24/750mg - total U$31,310.54). Conclusion: Cephalothin is effective in preventing postoperative infections in artificial cardiac stimulation procedures and has a better cost/dose than other well-established prophylaxis antibiotics.

Twist drill aspiration of chronic subdural hematoma at the Ignace Deen hospital of Conakry

Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.

A clinical observation of stage I implant breast reconstruction for mass-like granulomatous lobular mastitis.

Granulomatous lobular mastitis (GLM) is a chronic benign inflammatory breast disease, and mainly mass-like granulomatous lobular mastitis (MGLM) clinically. There are few reports on applications of stage I implant breast reconstruction in GLM. This observational study was conducted to evaluate the safety and efficacy of stage I implant breast reconstruction in the treatment of MGLM. Patients suffering from MGLM who visited at hospital from April 2019 to June 2020 were selected and graded according to the magnetic resonance imaging (MRI) examination. Patients with MGLM were grouped into the prosthesis implantation group and the traditional treatment group according to their preferences. Clinical parameters of the two groups were analyzed before and after surgery, such as postoperative infection, recurrence, and satisfaction with appearance and aesthetics were observed. To evaluate the safety and efficacy of the implant breast reconstruction in MGLM. There were 59 cases of MGLM, 31 cases of grade 3-4 GLM, 11 cases of bilateral metachronous GLM. There were 18 patients in the prosthesis implantation group, including 9 patients with bilateral metachronous GLM, 2 patients with synchronous GLM, and 41 patients in the traditional treatment group. All the patients were followed up with a median of 17.5 months. One patient in the observation group had an infection on the reconstructed side 3 weeks after surgery, and the implant was retained after 2 weeks of conservative treatment such as antibiotics. Two patients in the prosthesis implantation group were not satisfied with size of the reconstructed breast was smaller than the opposite side. In the traditional treatment group, there were 3 cases of postoperative infection or delayed wound healing, and 26 cases of postoperative breast asymmetry. For patients with MGLM, it is safe to select stage I prosthesis implantation after conservative treatment, with exact effect and high patient satisfaction.

Prevention measures of postoperative hemorrhage in children day surgery of tonsils and adenoids

Objective:To investigate the effect of preventive measures in reducing postoperative bleeding, which is made for children day surgery on tonsils and adenoids in our hospital, and to clarify its safety and feasibility. Methods:A retrospective analysis of 649 patients with children day surgery due to obstructive sleep apnea（OSA） caused by adenoid hypertrophy of tonsil was conducted. All of the patients were admitted to Shanghai Children's Hospital from February 2021 to April 2021. According to whether preventive measures were taken or not, they were divided into the control group and the observation group. The postoperative bleeding rate, bleeding time, and bleeding-related factors of the two groups were compared. Results:There were 4 cases（1.22%） in the observation group and 12 cases（3.74%） in the control group, the postoperative bleeding rate of the observation group was lower than that of the control group（χ²=4.28, P=0.039）. The postoperative bleeding in the observation group occurred（8.25±2.75） days after surgery while the control group（7.42±1.98） days, which shows no significant difference in postoperative bleeding time between the two groups（χ²=2.601, P=0.321）. There was no case of postoperative infection in the observation group while 7 cases（58.3%） in the control group（χ²=7.658, P=0.036）. Conclusion:For children with day surgery of tonsils and adenoids, appropriate optimization measures can be taken for hospital admission evaluation, infection prevention, postoperative observation, publicity and education, which can effectively reduce the incidence of postoperative complications and improve the treatment effect of day surgery.

Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws.

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

Síndrome del túnel del tarso: análisis clínico-imagenológico de una serie de casos

BackgroundRetrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. MethodsRetrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. ResultsWe included 8 men and 2 women with an average age of 47 years (range 34-67) and an average follow-up of 62.2 months (range 2-149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The Posterior Tibial Nerve was the most affected (50%) and 30% the Medial Plantar Branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. ConclusionsTTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.

Utilization of a Newly Designed Asymmetric Dorsal Gull Wing Flap for the Treatment of Postoperative Web Creep After Syndactyly Surgery.

Web creep is the most common long-term complication requiring revision after syndactyly surgery; however, few methods have been reported. The aim of this study was to introduce a newly designed asymmetric dorsal gull wing flap to reconstruct web for the postoperative web creep. A retrospective analysis was performed for 20 patients from January 2016 to May 2019. Sex, age, original malformations, original surgical procedure, complications, time between the 2 operations, operation records, preoperative and postoperative photographs, and Withey score were reviewed. Eleven boys and 9 girls with average age of 60.65 ± 44.76 months underwent revision. Twenty-nine web spaces were affected (web creep, 12 cases; web creep and scar contracture, 17 cases). The original surgical procedure consisted of syndactyly separation in 15 cases, syndactyly separation with a full-thickness skin graft in 5 cases. There was 1 case of postoperative infection. All patients received an asymmetric dorsal gull wing flap and a zigzag incision, 15 patients received an additional full-thickness skin graft. The average time interval between the 2 operations was 34.60 ± 35.94 months. The follow-up time was 34.30 ± 20.73 months. No complications were noted, none of the patients redeveloped web creep. The median values for web creep, flexion-extension deformity, total Withey scores in the postoperative period were significantly lower than the preoperative values. The appearance and function of all digits were good. The asymmetric dorsal gull wing flap is a good choice for web reconstruction when web creep is caused by syndactyly surgery.

Cranioplasty with three-dimensional customised mould for polymethylmethacrylate implant: a series of 16 consecutive patients with cost-effectiveness consideration

BackgroundDifferent methods of cranioplasty for the reconstruction of bony skull defects exist. In the absence of the autologous bone flap, a customised manufactured implant may be the optimal choice, but this implant has several limitations regarding its technical standardisation and better cost-effectiveness.MethodsThis study presents a series of 16 consecutive patients who had undergone cranioplasty with customised three-dimensional (3D) template moulds for polymethylmethacrylate (PMMA) implants manufactured after 3D modelling on a specific workstation. The virtual images were transformed into a two-piece physical model using a 3D printer for the biomaterials. PMMA implant was produced intraoperatively with the custom mould. Cosmetic results were analysed by comparing pre- and postoperative 3D computed tomography (CT) images and asking if the patient was satisfied with the result.ResultsThe average total time for planning and production of customised mould was 10 days. The 16 patients were satisfied with the result, and CT images presented harmonious symmetry when comparing pre- and postoperative scans. Cases of postoperative infection, bleeding, or reoperation in this series were not observed.ConclusionCranioplasty with high-technology customised 3D moulds for PMMA implants can allow for an aesthetic reconstruction with a fast and cost-effective manufacturing process and possibly with low complication rates.

A case of post-operative infection of an iliac bone graft which was successfully treated with novel negative pressure wound therapy with instillation and dwelling

A case of post-operative infection of an iliac bone graft which was successfully treated with novel negative pressure wound therapy with instillation and dwelling

A Dynamic Costal Cartilage Platform Promotes Ocular Prosthetic Excursion: Preliminary Report.

Background:The quality of life of the face involves mainly its configuration, and it plays an important functional role in communication skills. Thus, having artificial eyes is extremely essential in maintaining the quality of life of patients who have lost their eyeballs. We will present the details of the technique, including tips and innovations for eye socket reconstruction using spherical costal cartilage implant, which leads to dynamic and aesthetic results.Methods:There were 19 cases of eye socket reconstruction using costal cartilages from 2008 to 2020. The patient age range was 18–77 years old. There were 10 cases of anophthalmia and 9 cases of ocular phthisis. In our operative method, we created the costal cartilage implant by harvesting the sixth costal cartilage of the affected side. If extraocular muscle remained, we sutured each muscle to the cartilage.Results:Our method made application of thin artificial eyes possible in all cases. Regarding postoperative complications, there were 1 case of postoperative infection and 1 case of vascular failure of temporoparietal fascial flap. Seventeen cases were wet socket, and 2 cases were dry socket. We had attained movement of the artificial eye in 15 cases.Conclusions:Eye socket reconstruction is considered one of the most challenging operations, and various postoperative complications appear in the long term. Costal cartilages are considered as the most suitable materials to create the base of artificial eyes.

Efficacy of external fixation of a straight silicone stent in the treatment of subglottic stenosis.

The incidence of subglottic stenosis is rising year by year. For this difficult clinical problem, the efficacies of surgical and bronchoscopic intervention treatments vary. A simple and effective method to affix silicone stents is needed for the treatment of subglottic stenosis. Eight patients suffering from subglottic stenosis underwent straight silicone stent placement with external fixation in the First Affiliated Hospital of Chengdu Medical College between January 2015 and August 2019. All patients received regular postoperative bronchoscopy. A retrospective analysis was conducted to analyze the efficacy and complications of the operation. Straight silicone stent placement was successful in seven patients and the external fixation of stents was completed. Symptoms of dyspnea were resolved in seven cases (87.5%), and the mean diameter of the upper trachea was significantly increased from 3.54±0.59 to 12.71±2.42 mm after the operation (t=15.78, P=0.002). The modified Medical Research Council dyspnea scale score significantly decreased from 3.4 (2.7, 3.8) to 0.8 (0.4, 1.4) after the operation (Z=-6.63, P=0.001). Postoperative complications were observed, including one case of mediastinal emphysema and pneumothorax, two cases of granulation tissue hyperplasia, four cases of intractable cough, six cases of postoperative infection at the external fixation site, one case of postoperative bleeding, and one case of sputum retention. All were promptly treated and quickly controlled. No stent displacement was observed during follow-up. External fixation of straight silicon stents for the treatment of subglottic stenosis had good short-term outcomes and stable stent fixation. The proportion of postoperative infections was high. Therefore, the advantages and disadvantages of this operation need to be considered.

First Identification of a Patient with Prosthesis-Related Infection Caused by an MCR-1.1-Producing ST131 Escherichia coli After Rhinoplasty.

BackgroundThe most common procedure of rhinoplasty is the implantation of a synthetic prosthesis. However, the complications, especially postoperative infection, could lead the suboptimal aesthetic outcome, economic losses and health threats. There is currently little literature providing an incidence of rhinoplasty infection and microbiological and antimicrobial resistance situations.MethodsTherefore, we performed a retrospective observational study which included 173 patients who received a rhinoplasty from 1 January 2015, to 31 December 2019, in the department of plastic surgery of a tertiary hospital in Guangzhou, China. The samples from the infection site were collected and performed the bacterial culture. The antimicrobial susceptibility testing was performed by VITEK and minimum inhibition concentration testing. The whole-genome sequencing was performed by Illumina Hiseq4000 platform.ResultsWe found that eight (4.6%) patients were infected by S. aureus (6), E. raffinosus (1) and E. coli (1), of which are susceptible to most antimicrobials. Remarkably, E. coli RS1231 was resistant to colistin and polymyxin B which conferred by mcr-1.1 locating on an IncI2 plasmid with 59,170-bp sequence length. Through sequence comparison, we speculate that the pRS1231S-MCR-1 was derived from animal sources. Besides, E. coli RS1231 belongs to ST131 O25:H4-fimH22 pandemic subclone and phylogroup B2, which can induce a broad variety of infections.ConclusionOur study provided a rhinoplasty infection incidence, microbiological and antimicrobial resistance prevalence data, and revealed, to our knowledge, the first case of postoperative infection of rhinoplasty by mcr-1.1-positive, highly susceptible, and remarkably virulent E. coli isolate.

Amniotic membrane transplantation in ocular surface diseases

Abstract Objective: To evaluate the clinical effectiveness of amniotic membrane transplantation for ocular surface reconstruction. Methods: Prospective study including 23 eyes of 21 patients who underwent amniotic membrane transplantation at Hospital de Clinicas da Universidade Federal do Parana (HC-UFPR) and at Cirurgia e Diagnose em Oftalmologia do Parana (CDOP) clinic, located in Curitiba, PR, Brazil, from may 2015 to july 2019. The amniotic membrane was collected from elective and term cesarean delivery, and conserved in preservation medium and glycerol 1:1, stored at -80° Celsius. The membrane was fixed on the ocular surface with 10-0 nylon, 8-0 vicryl, biological glue or a combination of these materials. Results: The ocular surface reconstruction was successful in 22 eyes (95.6%). Failure was observed only in 1 case (bullous keratopathy) in which the condition was maintained postoperatively. Patients' age ranged from 11-82 years, with a mean age of 37.4 years. There was a higher incidence in males (66.6%). A difference was perceived in the distribution of the affected eye (which was greater in the right eye - 65.2%). As for the previous ophthalmic surgery history, 12 of the 23 eyes had a positive history (52.2%). It was observed that all patients who had preoperative visual acuity assessed showed improvement or maintenance of corrected visual acuity. In the postoperative period, complications associated with the underlying disease were observed, although not particularly related to the amniotic membrane transplantation. There were not any cases of postoperative infection. Conclusions: There was an improvement in the general state of the ocular surface in almost all of the cases in which the transplant was performed. Therefore, the amniotic membrane can be considered a good alternative for reconstructing the ocular surface, as a single or supporting treatment.

Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects

To investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects. The clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side. Eighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° ( t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° ( t=0.444, P=0.660). The application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.

Clinical Evaluation a New Treatment for Infection After Ventriculoperitoneal Shunt.

To explore a new surgical treatment for infection and obstruction of ventriculoperitoneal shunt in hydrocephalus. Two cases of post-operative infection of ventriculoperitoneal shunt were analyzed retrospectively. One case was cryptococcal infection, the other case was Acinetobacter lwoffii. The number of cerebrospinal fluid cells was high, the infection of ventriculoperitoneal shunt was generally complicated with abdominal obstruction, and the hydrocephalus was aggravated again, The authors try to pull out the drainage tube at the end of abdominal cavity for external drainage, combined with intravenous antibiotics, completely control of infection, and then use the original shunt device for intraventricular jugular shunt. The authors explore that this method is simple, safe and effective, and it is an effective and feasible method for the treatment of infection after ventriculoperitoneal shunt.

S1015 Bariatric Surgery Can Be Performed Safely at Yale-New Haven Hospital in Patients With Cirrhosis

INTRODUCTION: Cirrhosis due to nonalcoholic fatty liver disease (NAFLD) is a growing problem, contributing to increasing health care burden. The most effective weight loss intervention is bariatric surgery, but there is little data on ability of medical centers to safely conduct bariatric surgery in this population. We investigated the safety, efficacy, and outcomes of patients with cirrhosis receiving surgery, compared to those without cirrhosis at our medical center. METHODS: We performed a historical cohort study of patients with a diagnosis of cirrhosis undergoing bariatric surgery at Yale-New Haven Hospital. We identified cases through electronic query of patients receiving surgery between 2014 and 2017, with diagnosis codes of cirrhosis. Controls were matched in a 2:1 ratio, by surgery time period. Patient demographic, baseline liver-related and metabolic data, and perioperative outcomes were obtained at time of surgery. Metabolic and liver-related outcomes were assessed at 3 years after surgery. RESULTS: A total of 52 patients were included (18 with cirrhosis, 34 without cirrhosis) (Table 1). Perioperatively, 3 patients with cirrhosis developed bleeding compared to none of the non-cirrhotic patients (P = 0.03). Bleeding was self-limited and did not require surgical intervention or blood transfusion. There were no cases of post-operative infection, leak, revision surgery, nor deaths. Median length of stay was 2 days in both groups. Over 3 years, serum ALT significantly improved in patients with cirrhosis (−13.3 ± 5.1 U/L, P = 0.01). Average MELD and Child-Pugh scores did not worsen over 3 years, and MELD score trended towards improvement (−0.75 ± 0.4 points, P = 0.08). Significant decreases in body weight (−16.4 ± 2.8 kg, P < 0.0001), body mass index (BMI) (−6.1 ± 1.0 kg/m2, P < 0.0001) were observed in those with cirrhosis. There was a trend towards decreased mean glycosylated hemoglobin (−0.9 ± 0.7%, P = 0.20) and total cholesterol (−29.6 ± 19.2 mg/dL, P = 0.18) (Figure 1). CONCLUSION: Bariatric surgery is safe in patients with cirrhosis at our medical center. For patients with metabolic liver disease such as NAFLD, surgery holds promise even after the development of cirrhosis. Further study is needed to develop criteria which will identify patients with cirrhosis who can safely undergo surgery. This will likely be coupled with the development of destination centers which can safely carry out surgery in such high-risk patients and link to further clinical resources.Table 1.: Baseline Characteristics of Patients with and Without Cirrhosis Undergoing Bariatric Surgery.Figure 1.: 3-Year Change in Liver-Related and Metabolic Parameters in Patients with Cirrhosis Receiving Bariatric Surgery.