Complications In Surgical Patients Research Articles

Repair of large incisional hernias with onlay mesh

Background Any surgical incision can lead to the occurrence of incisional hernia (IH) even laparoscopic trocar incision. IHs typically develop within the first 5 years of surgery; however, their development may be delayed. In large hernias, the amount of viscera which progressively stretches and holds the hernia sac can form a 'second abdomen' making the repair of hernia difficult. Aim IH after abdominal surgery is an important problem. We aimed to evaluate the short-term recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for large and giant IHs. Patient and methods In our study, we had 40 patients who were complaining of large IH with a defect size of 10 cm or more. All of these patients were operated using the onlay mesh technique in which polypropylene mesh was used. Results A total of 40 cases of IH were repaired with placement of onlay mesh; two (5%) cases developed recurrence. The incidence of seroma in our study was 22.5%, making it the most common complication following the repair of IH. Seroma formation was followed by surgical site infection (15%) as the second most common complication. Conclusion Repair of large and giant IH using prosthetic nonabsorbable mesh has a reasonably good outcome with acceptable rates of recurrence. The technique of mesh placement is still at the surgeon's discretion. However, onlay mesh repair has shown promising results in our study. Seroma is the most common complication following the repair of large and giant IHs.

Association of tourniquet utilization with blood loss, rehabilitation, and complications in Chinese obese patients undergoing total knee arthroplasty: A retrospective study.

Obesity not only gives rise to more blood loss volume but also correlates with postoperative rehabilitation and complications in surgical patients. It is not clear at present whether tourniquet utilization is associated with blood loss, rehabilitation, and complications, and it is imperative to ascertain the tactics of utilizing tourniquet in obese patients undergoing total knee arthroplasty (TKA). The present study was designed to explore the association of tourniquet utilization with blood loss, rehabilitation, and complications, and ascertain the tactics of utilizing tourniquet in obese patients undergoing TKA.A total of 130 patients from January 2014 to December 2014 were categorized into tourniquet group (n = 94) and non-tourniquet group (n = 36) based on whether the tourniquet was utilized or not during operation. Recorded data were as follows: total blood loss volume, intraoperative blood loss volume, hidden blood loss volume, blood transfusion volume, drainage volume, difference between hemoglobin value before operation and that on the fifth day after operation (5d Hb D-value), thigh swelling rate and visual analogue scale (VAS) score of motion pain, and Knee Society Score (KSS) score.Mean age was 65.27 ± 7.43 (49–82) years, and 15 patients (11.5%) were men. No significant difference in total blood loss volume, drainage volume, blood transfusion volume, and 5d Hb D-value was noted between the 2 groups (P > .05 for all). Tourniquet group had significantly less intraoperative blood loss volume and significantly more hidden blood loss volume than the non-tourniquet group (P < .05 for all). Tourniquet group had significantly higher thigh swelling rate and VAS score of motion pain on the third day after operation, and significantly lower KSS function score in the third week after operation than non-tourniquet group (P < .05). No significant difference in KSS function score in the first year after operation was found between the 2 groups (P > .05). No difference in postoperative complications was observed between the groups (P > .05).The current study demonstrated that the tourniquet is not associated with reduced blood loss and increased postoperative complications in obese patients undergoing TKA. Step-down postoperative rehabilitation related to tourniquet is short-term rather than long-term in obese patients undergoing TKA.

Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy.

The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy. From 2009 to 2013, 859 patients who underwent curative resection for gastric cancer were enrolled from a prospectively maintained database. Visceral fat area (VFA) was assessed by preoperative CT scans. Patients were divided into two groups by VFA. Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group. Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival. Some 859 patients were included in the study, 308 of whom were classified as high VFA. High VFA was correlated with advance age (P = 0.020), higher albumin levels (P = 0.001), hemoglobin levels (P < 0.05), ASA grade (P = 0.043) and Charlson Comorbidity Index (P = 0.004). Relative to patients with low VFA, those with high VFA had longer surgical durations (P = 0.004), higher rate of postoperative complications (P = 0.004), and longer hospital stays (P = 0.004). High VFA was identified as the only determinant for surgical complications by logistic regression analysis (OR, 2.236, 95% CI, 1.537-3.254; P < 0.001). Cox proportional hazards regression revealed no correlation between VFA and overall survival (OS) or disease-free survival (DFS). Increased VFA independently predicts surgical complications in patients after gastrectomy. However, VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer.

Long-term quality of life associated with early surgical complications in patients with ulcerative colitis after ileal pouch–anal anastomosis: A single-center retrospective study

BackgroundIleal pouch-anal anastomosis (IPAA) is recommended for patients with ulcerative colitis (UC) in terms of surgical treatment. Measuring surgical complications of IPAA and long-term quality of life (QOL) are important to achieve an acceptable risk/benefit ratio for patients with UC. Materials and methodsPatients with UC who underwent total proctocolectomy (TPC) with IPAA from February 2008 to July 2016 at our institute were included. Early surgical complications were defined as mechanical/infectious events within one month after IPAA. Assessment of QOL was performed using the Cleveland Global Quality of Life instrument (CGQL), with 50% improvement as a cut-off value. Demographic and clinical variables were compared with univariable analysis and step-wise logistic regression models were also performed. ResultsA total of 58 eligible patients had a median follow-up time of 78.5 months [interquartile range (IQR), 34.4–92.8] from February2008 to March 2017, including 25 cases (43.1%) developed early surgical complications. Age at pouch surgery and excessive blood loss were risk factors associated with early surgical complications (p < 0.05). In multivariate analysis, older age at surgery [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01–1.1] and significant blood loss (≧400 ml) (OR, 4.31; 95% CI, 1.21–16.87) were contributing factors for developing early surgical complications. The CGQL score was significantly increased after IPAA (0.728 ± 0.151 vs. 0.429 ± 0.173, p < 0.001). Early surgical complications (OR, 5.55; 95%CI, 1.44–21.37), older age at surgery (OR, 1.06; 95% CI, 1.01–1.12) and use of immunomodulatory (OR, 17.50; 95% CI, 1.52–201.39) were associated with poor long-term QOL. ConclusionThe study demonstrated that early surgical complications might contribute to develop a poor CGQL score, suggesting intentional control of risk factors associated with early surgical complications should be taken into consideration for patients with UC for pouch surgery.

Longer operative time is associated with increased post-operative complications in patients undergoing minimally-invasive surgery for endometrial cancer.

To examine the impact of operative time on the development of post-operative medical and surgical complications in patients undergoing minimally-invasive surgery for endometrial cancer. Patients who underwent laparoscopic surgery for endometrial cancer from 2005 to 2014 were identified from the ACS-NSQIP database. Operative times were initially divided into hour-long intervals and complication rates were determined. Outcomes included development of any complication, medical complication, or surgical complication. Subsequent analysis were based on dividing patients into 2 groups based on operative times <240min and operative times ≥240min. Associations between categorical variables were determined using Chi-Squared and Fisher's exact tests. Differences between means of continuous variables were determined using Student's t-tests. Univariate and multivariate analysis using logistic regression were used to identify predictors of post-operative complications. 9145 patients were included, of which 639 (7%) experienced a complication. As operative time increased, rates of complications also increased. Operative time ≥240min was associated with increased overall complication rate (11.7% vs. 6%, p<0.001), medical complication rate (9.3% vs. 4.2%, p<0.001), and surgical complication rate (3.9% vs. 2.4%, p=0.001). When performing multi-variate logistic regression of factors associated with increased complication rates, increased operative time, COPD, hypertension, diabetes, ASA class ≥3, dependent functional status, and chronic steroid use were found to be independently associated with increased complications. Lymphadenectomy was not associated with increased operative time or increase in complications. Increased operative time is independently associated with increased risk of developing complications after laparoscopic surgery for endometrial cancer.

Risk for surgical complications after previous stereotactic body radiotherapy of the spine

ObjectStereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level.MethodsBased upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT.ResultsThirty patients, median age 59 years (range 27–84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15–65 Gy) delivered in median 1 fraction (range 1–17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1–39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation.ConclusionIn this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.

Comparing Modified with Conventional Parotidectomy for Benign Parotid Tumors

Purpose: We conducted a study to compare the functional outcomes and surgical complications of patients with benign parotid tumors treated with conventional parotidectomy and modified parotidectomy. Methods: This study retrospectively analyzed 99 patients who had benign parotid lesions and underwent parotidectomy using either conventional or modified parotidectomy. The operation time, cosmetic outcome, great auricular nerve anesthesia, incidence of Frey syndrome, and secretory function with the two techniques were compared. Results: The mean operation time was shorter and the total complication rate was obviously lower in the modified surgery group (p < 0.001). In the modified surgery group, the incision was more cosmetic (p < 0.001), the sensory deficit rate was low (p < 0.001), and the sensory recovery rate was high, and transient facial paralysis and Frey syndrome were rare. Furthermore, glandular function was preserved in patients with a conserved Stensen duct. There was no tumor recurrence in the two groups during a mean follow-up of 29.8 months. Conclusion: Modified surgical techniques for benign parotid neoplasms significantly reduced the surgery time and improved the surgery outcomes compared with the conventional approach. This adds to the evidence to support the effectiveness of modified parotidectomy in selected patients with benign parotid tumors.

Clinical outcomes after craniotomy for unruptured intracranial aneurysm in patients with coronary artery disease

BackgroundCoronary artery disease (CAD) patients receiving antiplatelet agents occasionally undergo craniotomy. We aimed to clarify clinical outcomes after craniotomy for unruptured intracranial aneurysm (UIA) in patients with CAD. We also aimed to identify the possible predictive factors for morbidity and surgical complications in patients on antiplatelet treatment. MethodsWe retrospectively analyzed 401 consecutive patients who had undergone craniotomy for UIA at our institution between January 2006 and December 2016. Forty-three patients (10.7%) received antiplatelet agents during the perioperative period. The underlying reasons for antiplatelet treatment were CAD in 12 patients and other diseases in 31 patients. ResultsSevere morbidity and intracranial hemorrhage occurred more commonly and symptomatic brain infarction occurred less frequently in patients with CAD compared to patients with other underlying diseases (16.7% versus 3.2%, 16.7% versus 9.7%, and 8.3% versus 16.1%, respectively), though differences between the two groups were not significant. Univariate analysis revealed that a low preoperative baseline platelet count was significantly correlated with the occurrence of intracranial hemorrhage (cutoff value, 16.5×104/µL; odds ratio (OR), 46.67; 95% confidence interval (CI), 3.88–561.95; p=0.0005), and a high baseline platelet count tended to correlate with severe morbidity (cutoff value, 29.8×104/µL; OR, 11.33; 95% CI, 0.88–145.52; p=0.0550). ConclusionsOur results suggest that surgical complications and clinical outcomes after craniotomy may depend on the underlying reason for antiplatelet treatment. Moreover, a preoperative platelet count can be useful in predicting the occurrence of intracranial hemorrhage and severe morbidity after craniotomy in patients receiving antiplatelet agents.

Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study.

Observational cohort pilot study. To determine the impact of a multidisciplinary conference on treatment decisions for lumbar degenerative spine disease. Multidisciplinary decision making improves outcomes in many disciplines. The lack of integrated systems for comprehensive care for spinal disorders has contributed to the inappropriate overutilization of spine surgery in the United States. We implemented a multidisciplinary conference involving physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopaedic spine surgeons, physical therapists, and nursing staff. Over 10 months, we presented patients being considered for spinal fusion or who had a complex history of prior spinal surgery. We compared the decision to proceed with surgery and the proposed surgical approach proposed by outside surgeons with the consensus of our multidisciplinary conference. We also assessed comprehensive demographics and comorbidities for the patients and examined outcomes for surgical patients. A total of 137 consecutive patients were reviewed at our multidisciplinary conference during the 10-month period. Of these, 100 patients had been recommended for lumbar spine fusion by an outside surgeon. Consensus opinion of the multidisciplinary conference advocated for nonoperative management in 58 patients (58%) who had been previously recommended for spinal fusion at another institution (χ = 26.6; P < 0.01). Furthermore, the surgical treatment plan was revised as a product of the conference in 28% (16 patients) of the patients who ultimately underwent surgery (χ = 43.6; P < 0.01). We had zero 30-day complications in surgical patients. Isolated surgical decision making may result in suboptimal treatment recommendations. Multidisciplinary conferences can reduce the utilization of lumbar spinal fusion, possibly resulting in more appropriate use of surgical interventions with better candidate selection while providing patients with more diverse nonoperative treatment options. Although long-term patient outcomes remain to be determined, such multidisciplinary care will likely be essential to improving the quality and value of spine care. 3.

Microsurgical Treatment of Sporadic and von Hippel-Lindau Disease Associated Spinal Hemangioblastomas: A Single-Institution Experience.

Study DesignRetrospective cohort study.PurposeTo examine the clinical profile and surgical complications in patients with spinal hemangioblastomas and to evaluate the long-term outcome in them.Overview of LiteratureAlthough considered to be histologically benign, hemangioblastomas may cause significant neurological deficits. The proportion of spinal hemangioblastomas associated with von Hippel–Lindau (VHL) disease has been estimated be 13%–59%. Preoperative neurological function correlates with postoperative neurological status. Studies have shown no difference in outcomes between sporadic and VHL-associated spinal hemangioblastomas.MethodsThis retrospective study included 14 consecutive patients treated for spinal hemangioblastomas at our institute between January 2000 and June 2013. The mean follow-up period was 5 years. Magnetic resonance imaging of the complete neuraxis was performed in all cases, and preoperative embolization was performed in two cases.ResultsIn total, 14 patients underwent 18 surgeries, of which 15 were for spinal hemangioblastomas. Of all the patients, 86% had motor weakness and 79% presented with sensory disturbances. Preoperative McCormick functional grades were grade I in 7 (50%), grade II in 3 (21%), and grade III in 4 (29%) patients; 50% patients were diagnosed with VHL disease. All patients underwent complete resection of the tumor. Eight patients experienced deterioration in their neurological status in the immediate postoperative period; among them, five had gradual improvement. At 5-year follow-up, 11 (78.57%) patients showed good functional outcomes.ConclusionsMicrosurgical excision of spinal hemangioblastomas can cause postoperative morbidity, mainly in the form of neurological deterioration. Almost half of our patients had deterioration in the McCormick grade in the immediate postoperative period. However, a complete microsurgical excision can result in good long-term functional outcomes, as most of the immediate postoperative neurological deterioration in our patients was reversible. There was no difference in the long-term functional outcomes between sporadic and VHL-associated spinal hemangioblastomas.

Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy.

IntroductionAge is considered as a risk factor in bariatric surgery. The observation was made on the basis of results from studies where patients underwent different type of surgery, but laparoscopic sleeve gastrectomy (LSG) was not among them. It is necessary to reevaluate the association of age with adverse events in the group of patients after LSG.AimTo investigate the association of age with surgery-related adverse events in patients after LSG.Material and methodsRetrospective analysis of medical data was performed. The study involved 345 patients who underwent LSG in our institution between January 2013 and December 2014. The patients were subdivided by age into four groups according to quartiles. In 30-day follow-up adverse events were evaluated. We considered the presence of the following events as the endpoint of our study: death, medical events and surgical events.ResultsIn general, we observed adverse events in 36 (10.4%) patients. The mortality rate in our study was 0.59%. Nineteen events were surgical and 18 medical. In 1 patient a surgical event was associated with a medical event. Bleeding was the most common surgical event and was observed in 17 (4.9%) cases. Age was not associated with surgical events (OR = 1.032, 95% CI: 0.991–1.075, p = 0.33) or medical events (OR = 0.997, 95% CI: 0.956–1.039, p = 0.89).ConclusionsThe LSG is a safe bariatric procedure with low mortality. Bleeding is the most frequent surgical complication. Our findings suggest that age is not associated with increased risk of surgical or medical adverse events after LSG.

Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications.

PurposeSurgical-site complications (SSCs) affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT) implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures.Patients and methodsA total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment.ResultsPatients developing an SSC absorbed i) 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05) and ii) 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05). If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483,787.92) and an organizational saving in terms of length of stay equal to −1.10% (−898 days), thus allowing 95 additional procedures.ConclusionThe implementation of a portable device for NPWT would represent an effective and sustainable strategy for reducing the management costs of patients. Economic and organizational savings could be reinvested, thus i) treating a wider population and ii) reducing waiting lists, with a higher effectiveness in terms of a decrease in complications.

Diabetes and hyperglycemia as risk factors for postoperative outcome in maxillofacial surgery

BackgroundAim of this study was to investigate the frequency of complications in maxillofacial surgery in-patients in correlation to diabetes mellitus or a pathologically altered glucose metabolism. Materials and methodsAll patients' electronic health records were analyzed retrospectively. Diabetes mellitus anamnesis, the treatment regime, blood glucose levels, and the duration of inpatient treatment were recorded. Glucose readings ≥200 mg/dL measured at any time and fasting glucose levels of ≥110 mg/dL were defined as hyperglycemic. Noted complications were infection, dehiscence, swelling, and necrosis. Results8.7% out of 1374 patients had a known diabetes diagnosis. 13.0% had high fasting glucose and 11.4% aberrant maximum glucose readings. Complications did not occur more often in patients with a previously known diabetes but more often in patients with high maximum blood glucose levels. Of these patients, only 56.3% were known diabetics. ConclusionsDiabetes mellitus does not necessarily lead to higher frequency of complications in surgical patients. Moreover, patients with well-controlled diabetes seem to have a similar outcome compared to nondiabetics. Hyperglycemia however has an important impact on treatment outcome.

POSTOPERATIVE COMPLICATIONS OF COMBINED SURGERIES IN PATIENTS WITH DISSEMINATED FORMS OF COLON CANCER

OBJECTIVE. The authors investigated the peculiarities and character of complications in gerontological patients with disseminated forms of colon cancer after combined and extended operative interventions. MATERIALS AND METHODS. A retrospective analysis of treatment results of 154 patients was made. The single-stage combined operations were performed on 32 patients of the first group with IV stage of colon cancer. The operation included removing of primary tumor and liver metastases. Combined and extended operative interventions were carried out on 122 patients of the second group with locally-advanced colorectal cancer (T3-4N1-3M0). The patients of both groups were divided into 2 subgroups according to the age: subgroup A - over 60 years of age, subgroup B - younger than 60. Comparison of parameters of postoperative period was made separately in each group between subgroups. RESULTS. There weren’t noted any reliable increase in rate of surgical complication in patients of elderly and senile age with disseminated forms of colon cancer after combined operations. These operations accompanied by high risk of development of functionally-somatic complications as a rule connected with decompensation of concurrent pathology. CONCLUSIONS. The authors recommend to make the careful assessment of general somatic status of gerontological patients with disseminated forms of colorectal cancer and apply the multidiscipline approach in order to balance on time the concurrent pathology after combined operations.

Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy

IntroductionThe local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. ObjectivesTo evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). Material and methodsA prospectively maintained database of 2054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. ResultsA total number of 1042 patients in the group 1 (≤12 cores) and 1012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; p=0.03), but high grade complication (Clavien 3–4) were similar (G1 1.4 vs. G2 2.2%; p=0.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; p=0.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. ConclusionHigher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients.

Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

Update on surgical sepsis syndrome.

Sepsis is a serious complication in surgical patients, and is associated with prolonged hospital stay and high mortality rates. The definitions of sepsis have been revisited recently. This article reviews how definitions have changed over the years, and provides an update on basic pathobiology and essential aspects of treatment. PubMed was searched for reports published in English before October 2016, using the search terms 'surgical sepsis' AND 'surgical ICU'. The reference lists of articles identified in the search were also checked. Other relevant literature was selected based on personal knowledge of developments in the field of sepsis. Sepsis is defined as the presence of infection plus associated organ dysfunction. It occurs as the result of a dysregulated host response to the infection. Prevention of infection is an important means of limiting the development of sepsis. Treatment relies on source control, appropriate antibiotics and organ support. Research continues in an attempt to identify effective immunomodulatory therapies. Sepsis is an important and serious complication of surgery, and precautions must be taken to try to prevent infection in surgical patients. If sepsis develops, rapid diagnosis is crucial so that appropriate source control, antimicrobial therapy and organ support can be started early in the course of disease. New techniques enabling a better classification of a patient's particular sepsis profile will enable more personalized therapy.

The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery

BackgroundSarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS). MethodsOvarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm2/m2). Cox-regression and Kaplan–Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression. ResultsKaplan–Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105–2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968–1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications. ConclusionSarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival.

Does N-terminal Pro-brain Type Natriuretic Peptide Predict Cardiac Complications After Hip Fracture Surgery?

Elderly patients with hip fracture are at risk for cardiac complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been shown to predict cardiac complications in surgical patients; however, to our knowledge, only two studies have evaluated the utility of this test in patients with hip fracture. We believe it is important to assess a more accurate cutoff value of NT-proBNP with exclusion of patients with renal failure. To assess the association between preoperative NT-proBNP and cardiac complications after hip fracture surgery. We performed 450 surgical procedures in patients with hip fractures between January 2011 and December 2014. Exclusion criteria were renal dysfunction and inadequate laboratory tests. The final study population consisted of 328 patients (mean age, 83years; 80% women). Preoperatively, measurement of NT-proBNP level was performed. The primary endpoint was the occurrence of cardiac complications within 14days after surgery based on a chart review. The predictive value of NT-proBNP was assessed using multivariate logistic regression analysis, controlling for relevant confounding variables such as age, gender, body weight, and renal function; we also performed receiver operating characteristic (ROC) curve analysis. Postoperative cardiac complications were encountered in 7% of patients (24 of 328). The median preoperative NT-proBNP level was higher in patients with complications than in those without (1090 [interquartile range, 614-3191pg/mL] vs 283pg/mL [interquartile range, 137-507pg/mL], p<0.001). The cutoff level of NT-proBNP determined by ROC curve analysis was 600pg/mL, with a sensitivity, specificity, positive predictive value, and negative predictive value of 79%, 81%, 25%, and 98%, respectively, and the area under the ROC curve was 0.87 (95% CI, 0.80-0.94; p<0.001). After controlling for potentially relevant confounding variables, we found a preoperative NT-proBNP greater than 600pg/mL was associated with an increased risk of cardiac complications (odds ratio, 13; 95% CI, 4-38; p<0.001) compared with those with NT-proBNP less than 600pg/mL. Preoperative NT-proBNP greater than 600pg/mL is independently associated with postoperative cardiac complications in patients with hip fracture without renal dysfunction. NT-proBNP measurement provides additional information and is clinically useful for predicting cardiac complications during the early phase after hip fracture surgery. Future studies might develop a simple index for prediction of postoperative cardiac complication including cutoff values of NT-proBNP. Level III, diagnostic study.

Анализ электролитных изменений биологических жидкостей у хирургических больных с артериальной гипертензией

The cause of perioperative complications in surgical patients with arterial hypertension (AH) may be largely connected with a preceding electrolyte disbalance of biological liquids. The research of the ionic composition of blood, urine, saliva, and hematosalivary barrier activity in hypertonic patients (HP) revealed new data about systemic electrolyte changes in potassium, natrium, calcium, and magnesium ions. It was discovered that the magnesium level in blood serum in AH is lower, but both in saliva and in urine the increased concentration of natrium and calcium ions along with the reduced concentration of potassium were revealed. So it is possible to declare that electrolyte shifts developing in hypertonic patients’ urine, saliva and blood serum have the similar direction. The increased permeability of hematosalivary barrier for natrium ions and the decreased one for potassium ions also occur. The data enable to correct more precisely the electrolyte disbalance in patients with AH who are planned to be operated on and thus, to reduce the amount of perioperative complications.