Cause Of Postoperative Complications Research Articles

Cohort profile of BIGPROMISE: a perioperative biobank of a high-risk surgical population

PurposePostoperative complications increase mortality, disability and costs. Advanced understanding of the risk factors for postoperative complications is needed to improve surgical outcomes. This paper discusses the rationale and profile of...

The protective effect of Dogwood preparation on hepatic ischemia–reperfusion injury in mice by down-regulating PTGS2

Hepatic ischemia - reperfusion injury (HIRI) is a major cause of postoperative complications and mortality after hepatobiliary surgery, but there is currently no effective treatment strategy. Dogwood is a valuable Chinese Medicine which helps to protect the liver. Our animal experiments showed that ethanol extract (DD) of Dogwood could significantly lower the levels of Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) in HIRI mice serum. The findings revealed that DD had protective effect against HIRI in mice. Furthermore, we used network pharmacology to screen 613 target genes corresponding to Loganin, Ursolic acid and Oleanolic acid of the main active components contained in DD and 1117 target genes corresponding to HIRI, with 87 common target genes among them. The STRING database was then used to generate a protein–protein interaction (PPI) dataset of 87 target genes, which was then imported into Cytoscape3.7.2 to generate the top 10 target genes using the MCC function of cytoHubba. Next, using the DAVID online database, 87 target genes were assigned to 35 KEGG pathways. Pathways in cancer had 17 target genes with the highest score. The top 10 target genes identified by MCC function were cross-referenced with 17 target genes identified by Pathways in cancer. HSP90AA1, MAPK3, PTGS2, MMP2, IL2, PPARG, MTOR and IL6 were identified as target genes. In the meantime, transcriptomic sequencing was performed, and a total of 165 differential genes between drug administration group and HIRI group were identified. At last PTGS2 is locked as the hub target gene of DD intervention in HIRI. Following that, immunohistochemistry and real-time fluorescence quantitative PCR were used to verify the results. The results showed that DD protected mice against HIRI by lowering the expression level of PTGS2. In conclusion, DD may protect the mice against HIRI by regulation of PTGS2 expression.

Surgical management of acute intestinal obstruction study of 50 cases operated in emergency

Background: Intestinal obstruction is one the major cause that patients underwent emergency operations and which might lead to complications that could be turn fatal. Prompt evaluation and treatment prevents mortality and morbidity of post-operative patients. Methods: Prospective study conducted between 01 April 2020 to 31 March 2022 in 50 patients of intestinal obstruction operated in emergency according to inclusion criteria. Pre-operative, intraoperative, and post-operative assessment and recording of data done. Results: In 50 cases of intestinal obstruction, commonest age group is 41 to 60 years, pain and obstipation remains major presenting symptoms and tenderness, guarding and rigidity were most common signs. The commonest cause of intestinal obstruction in the adults in this study was postoperative adhesions (44%) followed by Koch’s abdomen (30%). Malignancy of the large bowel was seen in 6 cases constituting 12% of cases, obstructed hernia in 5 cases (10%), intussusception in 3 cases (6%) and gut malrotation in 1 case (2%). Comorbidity like hypertension and diabetes were main causes of post-operative complications. Conclusions: Maximum incidence of intestinal obstructions were reported in Age group 41-60 years with male predominance. Abdominal pain was the consistent symptoms followed by obstipation. Post-operative adhesion were the most common cause of the intestinal obstruction. Malignancy and multiple comorbidity remains the major risk factor for the post-operative complications and mortality.

Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery: a cohort study.

Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery. This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO2) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO2 in the forearm and that in the thigh. We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center. Muscular tissue desaturation, defined as a baseline SmtO2 < 80% in the forearm, may be associated with an increased risk of POP. No. ChiCTR-ROC-17012627.

Does living at high altitude increase the risk of bleeding events after total knee arthroplasty? A retrospective cohort study.

Post-operative bleeding after total knee arthroplasty (TKA) is a frequent cause of post-operative complications. This study compared blood loss and indicators of coagulation and fibrinolysis between TKA patients living at low or high altitudes. We retrospectively analyzed 120 patients at our institution who underwent primary TKA from May 2019 to March 2020, and we divided them into those living in areas about 500m or > 3000m above sea level. We compared the primary outcome of total blood loss between them. We also compared them in terms of several secondary outcomes: coagulation and fibrinolysis parameters, platelet count, reduction in hemoglobin, hidden blood loss, intra-operative blood loss, transfusion rate, and incidence of thromboembolic events and other complications. Total blood loss was significantly higher in the high-altitude group than in the low-altitude group (mean, 748.2mL [95% CI, 658.5-837.9] vs 556.6mL [95% CI, 496.0-617.1]; p = 0.001). The high-altitude group also showed significantly longer activated partial thromboplastin time, prothrombin time, and thrombin time before surgery and on post-operative day one, as well as increased levels of fibrinogen/fibrin degradation product on post-operative days one and three. Ecchymosis was significantly more frequent in the high-altitude group (41.7 vs 21.7%; relative risk (RR) = 1.923 [95% CI, 1.091-3.389]; p = 0.019). The two groups showed similar transfusion rates, and none of the patients experienced venous thromboembolism, pulmonary embolism, or infection. High altitude may alter coagulation and fibrinolysis parameters in a way that increases risk of blood loss after TKA. Such patients may benefit from special management to avoid bleeding events.

Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams

Features| August 2022 Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams Dustin R. Long, MD; Dustin R. Long, MD Search for other works by this author on: This Site PubMed Google Scholar Vanessa Makarewicz, RN, MN, CIC; Vanessa Makarewicz, RN, MN, CIC Search for other works by this author on: This Site PubMed Google Scholar Chloe Bryson-Cahn, MD; Chloe Bryson-Cahn, MD Search for other works by this author on: This Site PubMed Google Scholar Arman Dagal, MD, FRCA, MHA Arman Dagal, MD, FRCA, MHA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 19–20. https://doi.org/10.1097/01.ASM.0000855656.97932.62 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Dustin R. Long, Vanessa Makarewicz, Chloe Bryson-Cahn, Arman Dagal; Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams. ASA Monitor 2022; 86:19–20 doi: https://doi.org/10.1097/01.ASM.0000855656.97932.62 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: nosocomial infection, partnerships, prevention Infection prevention and control (IPC) are critical elements of perioperative quality and safety. Healthcare-associated infection is the leading cause of postoperative complications and hospital readmissions (asamonitor.pub/3tk4yG9). Perioperative teams and pre-anesthesia clinics are uniquely positioned to implement interventions that reduce postoperative infection (Anesthesiology June 2022). However, anesthesiologists have not historically partnered with IPC (or “hospital epidemiology”) teams, and conflicting perspectives have occasionally produced discord between these groups (asamonitor.pub/3p3IgVo). Despite the role of anesthesiologists as perioperative physicians, representation from our specialty is lacking in national guidelines for surgical antimicrobial prophylaxis and the prevention of surgical site infection (Am J Health Syst Pharm 2013;70:195-283; JAMA Surg 2017;152:784-91). This is now changing, as reflected in the work of Randy Loftus, David Birnbach, and Andrew Bowdle (AMA Netw Open 2020;3:e201934; Anesth Analg 2020;131:37-42; Br J Anaesth 2019;123:531-4; Anesth Analg 2015;120:853-60; Anesth... You do not currently have access to this content.

Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes

Background Stapled hemorrhoidopexy is widely practiced worldwide since its introduction to the world of proctology and replaced conventional hemorrhoidectomy in treating hemorrhoids. The technique of executing the procedure dictates the outcomes and complications. Here, we attempted to establish the cause of postoperative complications and attributed them to the presence of muscle of fibers in the excised doughnut specimens. Materials and Methods A prospective observational analysis of histopathological specimens obtained from patients who underwent stapled hemorrhoidopexy using procedure for prolapse and hemorrhoids-03 circular staplers in the department of surgery of a tertiary care hospital in southern India was performed, and the correlation between the presence or absence of muscle fibers in the specimens and postoperative complications was evaluated. The patients were followed up for 12 months after the procedure. Results In this study, 155 patients, including 54, 91, and 10 patients with Grade 2, Grade 3, and Grade 4 hemorrhoids, respectively, were included. Group A consisted of 19 patients with muscle fibers on the specimens, whereas Group B consisted of 139 patients without muscle fibers on the specimens. Early complications within 7 days after the procedure were as follows: 21 and 0.7% of the patients in Groups A and B, respectively, presented with postoperative pain with a visual analog scale score of more than 4; 47 and 6% of the patients in Groups A and B, respectively, presented with urinary retention; 26 and 2% of the patients in Groups A and B, respectively, presented with bleeding; and 21 and 2.9% of the patients in Groups A and B, respectively, presented with fecal urgency. A significant association was found between the presence of muscle fibers and early complications ( p < 0.001). Late complications, such as proctalgia and bleeding, accounting for 36.8 and 6.6% in Groups A and B, respectively, were significantly associated with the presence of muscle fibers in histopathology ( p < 0.001). Meanwhile, other late complications, such as incontinence, stenosis, and recurrence, exhibited no association ( p > 0.05). Conclusion The technique in taking purse-string sutures and the depth of the suture bite above the dentate line carry the utmost importance in preventing postoperative complications. Therefore, surgeons should refine their technique of appropriate depth to avoid incorporation of muscle fibers while executing the procedure.

Complications After Implantation of Subcutaneous Central Venous Ports: Focus on Infection and Catheter Pinch-off

Objective The objective of this study was to determine the causes of postoperative complications associated with subcutaneous central venous ports. Summary of Background Data Central venous ports were subcutaneously implanted in 523 patients between January 2005 and December 2013. Methods The purpose of port implantation was administration of chemotherapy in 439 patients and home central venous nutrition in 84 patients. The underlying disease was malignant in 481 patients and benign in 42. Results The median follow-up was 12 months (range, 1–99 months), and postoperative complications developed in 69 patients (13%). Infection occurred in 40 patients (7.6%) and catheter pinch-off in 11 patients (3%). Significant risk factors for infection were nutritional port placement (P &amp;lt; 0.001) and use of a femoral vein approach (P = 0.001). A left subclavian approach was a significant risk factor for catheter pinch-off (P = 0.003). Conclusions Postoperative complications, mainly infections and catheter pinch-off, developed in 13% of the patients. As for measures against complications, a femoral vein approach should be avoided to prevent infection. Moreover, because ports for parenteral nutrition require multiple punctures, methods to reduce the number of punctures and techniques for disinfection and management should be reevaluated. To prevent catheter pinch-off, an internal jugular vein approach should be used instead of a left subclavian approach.

Вміст факторів росту та фактора 1α, індукованого гіпоксією, в рановому ложі шкіри щурів різного віку

The aim of the study was to determine the content of vascular endothelial growth factor (VEGF), nerve growth factor (NGF) and hypoxia-inducible factor-1alpha (HIF- 1α) in the skin of 40 female rats of different ages (3 and 12 mo) after closure of the wound bed. In each age group composed of 20 rats, 10 rats served as a control group, and in remaining rats a facelift operation was performed and cut wounds on the anterior abdominal wall (5 cm × 0.5 cm) were simulated. The duration of wound surface healing in rats of different age groups was recorded. On the day of complete healing, the animals were killed, and the skin was cut in the areas of the former wound bed. In control rats, the skin was excised in the same places. The content of VEGF, NGF and HIF-1α was determined in the skin by enzyme- linked immunosorbent assay. It was found that in the group of young (3-month-old) rats, complete healing of the wound surface after facelift surgery occurred after 14.0 ± 1.0 days, and on the anterior abdominal wall - after 13.0 ± 1.0 days. In 12-month-old rats, the duration of wound surface healing after facelift surgery and incised wound on the anterior abdominal wall increased to 17.0 ± 1.5 days. In the former wound bed, the content of HIF-1α in young rats increased by 60.7%, and in 12-month-old rats - by 231.6%. In the former wound bed, the content of VEGF and NGF in young rats increased by 14.8 and 11.7%, respectively, and in 12-month-old rats - by 182.4 and 152.6%, respectively. It was concluded that more pronounced hypoxia in the skin after surgery in 12-month-old rats may be the cause of postoperative complications.

К ВОПРОСУ ПРЕВЕНЦИИ И РАННЕЙ ИДЕНТИФИКАЦИИ ХАРАКТЕРА И ПРИЧИН ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ ПРИ ВМЕШАТЕЛЬСТВАХ ПО ПОВОДУ РАЗЛИЧНЫХ КЛИНИКО-АНАТОМИЧЕСКИХ ФОРМ ТЯЖЕЛОЙ ЧЕРЕПНО-МОЗГОВОЙ ТРАВМЫ

The analysis of the causes of postoperative complications was carried out, as well as of the failures and errors or the same omissions in postoperative management. The total number of cases was 177 (5%) among more than 3500 patients, being operated on various clinical and anatomical forms of craniocerebral trauma.In 63.8% (in 113 patients), worsening of condition was associated with the postoperative hemorrhage, which in 54% of cases was shell- recurrent. In 36.6% of observations (in 64 patients), deteriorated states of the brain swelling or edema were associated with an increase of cerebral edema.The main causes of the postoperative volume hemorrhages were the inadequacy of homeostasis and fluctuations in blood pressure during the first hours and days after surgery, with a tendency of significant increase of that latter. Diagnostic errors were the result of underestimation or incorrect evaluation of neurological symptoms and clinical signs of repeated volumetric hemorrhages.Late diagnosis of postoperative complications resulted in a lethal outcome in 79 (44.6%) cases among 177 patients with the complications in the postoperative process. Neurological and clinical signs and their combinations characteristic for postoperative volumetric hemorrhages are given in the article, as well as are offered the ways of their prevention.

Methods for Minimizing Bleeding in Facelift Surgery: An Evidence-based Review.

Introduction:Bleeding and hematoma remain leading causes of postoperative complications and unsatisfactory patient outcomes in facelift surgery. Several methods have been implemented, and continue to be developed, to minimize bleeding in facelift surgery. These methods include perioperative blood pressure management, compression dressings, drains, tissue sealants, wetting solution infiltrate, and tranexamic acid.Methods:An evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database according to PRISMA guidelines. Included studies were evaluated for the effects of implemented methods on bleeding outcomes in facelift surgery. Recommendations for each method evaluated were determined based on the amount, level, and heterogeneity of included studies.Results:Thirty-six studies were included in the evidence-based review. Effective strategies to reduce the time to hemostasis, postoperative drainage volume, and hematoma rate included perioperative blood pressure management, tissue sealants, and tranexamic acid. While the use of drains or wetting solution infiltrate did not demonstrate to significantly influence bleeding outcome measures, these methods may provide other advantages to facelift surgery. Compression dressings have not demonstrated a significant effect on facelift outcome measures.Conclusions:Perioperative medical management of blood pressure, tissue sealants, and tranexamic acid are most effective in facilitating hemostasis and preventing postoperative hematoma in facelift surgery.

Results of surgical treatment of the oral and oropharyngeal cancer

Materials and methods: The results of surgical treatment in 30 patients with oral and oropharyngeal cancer were studied. Postoperative surgical complications were analyzed according to the Clavien-Dindo classification, the causes of postoperative complications after reconstructive operations. Results: Postoperative complications developed in 20.0% of cases and were represented by dehiscence of the wound edges, bleeding, and in the long-term period by the formation of a pharyngostomy, osteradionecrosis with a pathological fracture of the jaw. The resulting post-resection defects are inevitably accompanied by severe functional impairments: impaired opening of the mouth was noted in 36.7% of patients, impaired swallowing - in 3.3%, speech impairments - in all patients. The acoustic characteristics of speech were lower than those of a healthy person.

Postoperative complications in cranial and spine neurosurgery: a prospective observational study.

Postoperative complications do occur in all neurosurgical departments, but the way they are defined, and their true incidence vary a lot. The aim of the present study was to objectively assess the morbidity and mortality related to all neurosurgical procedures performed in our department and provide insight on their main causes and identify key factors to reduce their incidence. Data were retrieved from a prospectively maintained database regarding all patients undergoing a cranial or spinal neurosurgical procedure between November 2016 and April 2016 in the neurosurgical department in Timone University Hospital (APHM- Marseille). Patients undergoing a functional, pediatric, or interventional neuroradiological procedures were not included. The medical records of a total number of 963 patients were analyzed. A postoperative complication occurred in 208 patients (21.6%) including 115 (26.6%) in the cranial surgery group and 93 (17.5%) in the spinal surgery group. A complication occurred 1.5 more frequently in the cranial than in the spinal surgery group. Cranial surgery is 1.5 times more at risk of complications than spinal surgery (P=0.007). Preoperative comorbidities (ASA Score >3 to 4) were significantly associated with the occurrence of complications (P<0.001). In the cranial group, procedures performed in an emergency setting were 1.8 times more at risk of complications than scheduled surgeries (P<0.001). Conversely, in the spine group, scheduled surgeries were 1.4 times less at risk than emergency procedures (P=0.04). The main complication in both groups was found to be postoperative infection, with an incidence of 9.3% and 11.1% for cranial and spinal surgery respectively. Postoperative mortality reached 4.9% and 1.7% and the average length of stay was 12 and 11 days respectively. The incidence of complication in our series was found to be relatively high with predominantly infection as the main cause of postoperative complications. Reinforcing good practice measures at every step should help to significantly decrease our complication rate.

Antimicrobial Susceptibility Pattern in the Bacteria Isolated from Surgical Site Infection: Emphasis on Staphylococcus Aureus; Yasuj City, Southwest Iran.

Surgical site infections (SSIs) in surgical wards remains the most common cause of postoperative complications and realistically is the third most common origin of healthcare-related conditions. Staphylococcus aureus is undoubtedly the most common bacteria causing SSIs. The current study aimed at investigating the antimicrobial susceptibility pattern in bacteria isolated from SSIs, evaluation of tetracycline resistance genes, and SCCmec typing in S. aureus isolates isolated from patients with SSIs from 2018 to 2019 in Yasuj, Kohgiluyeh, and Boyer-Ahmad Province, Iran. This study diligently investigated 240 potential patients. Antimicrobial susceptibility testing was performed properly by the disk diffusion method. For the final confirmation of isolated bacteria, PCR was used. The presence of tet genes and SCCmec typing was carried out by multiplex PCR. The results showed that the most common isolated pathogens included S. aureus, E. coli, P. aeruginosa, Coagulase-negative Staphylococci, and K. pneumonia in 58.8%, 19.8%, 9.2%, 6.8% and 5.4% of cases, respectively. The majority of the Gram positive isolates were resistant against penicillin (86%) and Gram negative were resistant against ciprofloxacin (75.6%). In isolates of Staphylococcus aureus, the mecA gene was detected in 63.6% of isolates. The predominant SCCmec types were type III (59.1%) and type I (18.4%). The tetK and tetM genes were detected in 80.7% and 71.9% of the S. aureus isolates, respectively. There was a statistically significant difference between tet genes (tetK and tetM) from the viewpoint of resistance to tetracycline (p = 0.024). According to the results of the current study, it is recommended to administer vancomycin, amikacin, and imipenem in Yasuj to treat SSIs.

Complicaciones postquirúrgicas de colecistectomía laparoscópica, Hospital Traumatológico Dr. Ney Arias Lora, junio 2018-junio 2019

Objetivo: determinar la frecuencia y causas de complicaciones postquirúrgicas de colecistectomía laparoscópica, en el Hospital Traumatológico Doctor Ney Arias Lora, junio 2018 - junio 2019.&#x0D; Método: se realizó un estudio de tipo observacional descriptivo, de corte transversal&#x0D; y de fuente retrospectiva, cuya población fue de 617 pacientes, de los cuales solo 19 presentaron complicaciones, representando la muestra de este estudio. Los datos fueron procesados utilizando el sistema Epi-Info 7.0.&#x0D; Resultados: de 617 pacientes en cuales se realizó una colecistectomía laparoscópica, 19 presentaron complicaciones, para una tasa de 3.1 %; el estudio demostró que el sexo más afectado es el femenino entre los y 26-30 años.&#x0D; El tipo de complicación postquirúrgica más frecuente fueron las hemorragias causando un 33 % de las complicaciones, seguidas por náuseas y/o vómitos con un 21 % de las mismas.&#x0D; Conclusión: el estudio demuestra que, dentro de las complicaciones principales de colecistectomías laparoscópicas, las hemorragias ocupan el primer lugar, representando un 33 % de las complicaciones, seguidas por un 21 % de náuseas y/o vómitos y, en tercer lugar, la ictericia y la omoalgia con 17 % cada una.

Extracellular Vesicles Derived from Human Umbilical Cord Mesenchymal Stem Cells Protect Liver Ischemia/Reperfusion Injury by Reducing CD154 Expression on CD4+ T Cells via CCT2.

As a cause of postoperative complications and early hepatic failure after liver transplantation, liver ischemia/reperfusion injury (IRI) still has no effective treatment during clinical administration. Although the therapeutic potential of mesenchymal stem cells (MSCs) for liver IRI has been previously shown, the underlying mechanisms are not completely clear. It is accepted that MSC‐derived extracellular vesicles (MSC‐EVs) are newly uncovered messengers for intercellular communication. Herein, it is reported that umbilical cord‐derived MSCs (UC‐MSCs) improve liver IRI in mice through their secreted EVs. It is also visualized that UC‐MSC‐EVs mainly concentrate in liver after 6 h of reperfusion. Furthermore, UC‐MSC‐EVs are found to significantly modulate the membranous expression of CD154 of intrahepatic CD4+ T cells, which is an initiation of inflammatory response in liver and can aggravate liver IRI. Mechanistically, protein mass spectrum analysis is performed and it is revealed that Chaperonin containing TCP1 subunit 2 (CCT2) enriches in UC‐MSC‐EVs, which regulates the calcium channels to affect Ca2+ influx and suppress CD154 synthesis in CD4+ T cells. In conclusion, these results highlight the therapeutic potential of UC‐MSC‐EVs in attenuating liver IRI. This finding suggests that CCT2 from UC‐MSC‐EVs can modulate CD154 expression of intrahepatic CD4+ T cells during liver IRI through the Ca2+‐calcineurin‐NFAT1 signaling pathway.

Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery

BackgroundGastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the accuracy of specific perioperative risk assessment tools to predict postoperative complications, identifying the most informative variables and combining them to test their prediction ability as a new score.MethodsA prospective cohort study of digestive cancer surgical patients admitted to the surgical intermediate care unit of the Portuguese Oncology Institute of Porto, Portugal was conducted during the period January 2016 to April 2018. Demographic and medical information including sex, age, date from hospital admission, diagnosis, emergency or elective admission, and type of surgery, were collected. We analyzed and compared a set of measurements of surgical risk using the risk assessment instruments P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score according to the outcomes classified by the Clavien-Dindo score. According to each risk score system, we studied the expected and observed post-operative complications. We performed a multivariable regression model retaining only the significant variables of these tools (age, gender, physiological P-Possum, and ACS NSQIP serious complication rate) and created a new score (MyIPOrisk-score). The predictive ability of each continuous score and the final panel obtained was evaluated using ROC curves and estimating the area under the curve (AUC).ResultsWe studied 341 patients. Our results showed that the predictive accuracy and agreement of P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score were limited. The MyIPOrisk-score, shows to have greater discrimination ability than the one obtained with the other risk tools when evaluated individually (AUC = 0.808; 95% CI: 0.755–0.862). The expected and observed complication rates were similar to the new risk tool as opposed to the other risk calculators.ConclusionsThe feasibility and usefulness of the MyIPOrisk-score have been demonstrated for the evaluation of patients undergoing digestive oncologic surgery. However, it requires further testing through a multicenter prospective study to validate the predictive accuracy of the proposed risk score.

Features of the diagnosis and treatment of patients with postoperative peritonitis

Annotation. The aim of the work is to improve the diagnosis and treatment of patients with postoperative peritonitis. The work is based on an analysis of the treatment results of 98 patients who were in the clinic from 2010 to 2019, of which 47 (48%) were admitted to the hospital with a peritonitis clinic, and 51 (52%) had a prolonged bowel paresis in the postoperative period. The diagnosis was established on the basis of data from an objective examination, laboratory parameters and radiation research methods — radiography of the abdominal organs and ultrasound. Based on the analysis of clinical material, it was found that for patients with primary peritonitis, more pronounced clinical symptoms are more characteristic. Postoperative peritonitis in its clinical manifestations proceeds under the mask of a protracted intestinal paresis. Due to the ultrasound criteria of 51 patients with postoperative paresis, 32 (63%) prolonged paresis were allowed conservatively, which avoided unnecessary repeated surgical interventions. In 19 (37%), the causes of postoperative complications were diagnosed and relaparotomy was performed in a timely manner to these patients. Postoperative mortality was 5.1%.

Can preventive hyperbaric oxygen therapy optimise surgical outcome?: A systematic review of randomised controlled trials.

A primary underlying cause of postoperative complications is related to the surgical stress response, which may be mitigated by hyperbaric oxygen therapy (HBOT), the intermittent administration of oxygen at a pressure higher than the atmospheric pressure at sea level. Promising clinical studies have emerged suggesting HBOT's efficacy for reducing some postoperative complications. Notwithstanding, the effectiveness (if any) of HBOT across a range of procedures and postoperative outcomes has yet to be clearly quantified. This systematic review aimed to summarise the existing literature on peri-operative HBOT to investigate its potential to optimise surgical patient outcome. A systematic review of randomised controlled trials (RCTs) with narrative summary of results. MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched without language restrictions through to 19 June 2018. Studies were included if they involved patients of any age undergoing any surgical procedure and provided with at least one HBOT session in the peri-operative period. Two independent reviewers screened the initial identified trials and determined those to be included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. The search retrieved 775 references, of which 13 RCTs were included (627 patients). Ten RCTs (546 patients) reported treatment was effective for improving at least one of the patient outcomes assessed, while two studies (55 patients) did not find any benefit and one study (26 patients) found a negative effect. A wide range of patient outcomes were reported, and several other methodological limitations were observed among the included studies, such as limited use of sham comparator and lack of blinding. Peri-operative preventive HBOT may be a promising intervention to improve surgical patient outcome. However, future work should consider addressing the methodological weaknesses identified in this review. The protocol (CRD42018102737) was registered with the International ProspectiveRegister of Systematic Reviews (PROSPERO).

Complications of Laparoscopic Cholecystectomy in a Sample of Patients Admitted to Al-Ramadi Teaching Hospital, Anbar-Iraq

Laparoscopic cholecystectomy is currently thought as a surgical procedure that can be done with less risk of complications. However, intraoperative and postoperative complications were existing in 56 (15.01%) patients. Open surgery is the case when laparoscopic cholecystectomy fails to be proceeded with due to many causes such as difficult Calot triangle dissection and empyema of gallbladder. The high occurrence of cholecystitis in the group of patients aged 40-60 (56%) with 151 female and 59 males initiating the floor to many arguments that may help give a good understanding for such a problem. Iatrogenic perforation of gallbladder was the most common cause of intraoperative complications. Wound infection was the most cause of postoperative complications. Difficult Calot triangle dissection was the most common cause to convert to open surgery.