Deep Site Research Articles

Can magnetically controlled growing rods be successfully salvaged after deep surgical site infection?

The purpose is to compare the rate of recurrent deep wound infection in patients who retained MCGRs versus those who underwent implant removal and exchange following index deep wound infection. Using a multicenter registry, we identified patients with EOS who underwent surgical correction with MCGR. We defined deep SSI as any infection that required subsequent I&D and antibiotic therapy. Recurrent infection was defined as any additional deep SSI following treatment of index deep infection. We considered MCGR to be salvaged if implant exchange or removal was not performed for at least 1year following date of infection. Bivariate statistical analyses were performed. 992 EOS patients were identified, of whom 33 (3.3%) developed deep SSI. The mean time between initial surgery and first deep SSI was 13.1months (Interquartile range [IQR]: 1 to 25months. Infection rates by EOS diagnosis were as follows: 13/354 patients (3.6%) had neuromuscular scoliosis (NMS), 9/225 (4.0%) syndromic, 6/248 (2.4%) idiopathic, 3/135 congenital (2.2%), and 2/30 (6.6%) unknown etiology. MCGR was salvaged in 69% of NMS patients, 77% of syndromic patients, 100% of congenital patients, and 83% of idiopathic patients (83%). There were only four recurrent infections (2/13 NMS, 2/9 syndromic) and no differences in rates of recurrent infection between salvaged or replaced/exchanged MCGR. (p = 0.97). Deep wound infection occurred in 3% of MCGR patients at a mean of 13.1months. There were no significant differences in rates of recurrent infection between salvaged implants and those removed or exchanged.

Identification of a 3-miRNA Signature Associated With the Prediction of Prognosis in Nasopharyngeal Carcinoma.

Nasopharyngeal carcinoma (NPC) is a malignant tumor caused by an infection of the epithelial cells of the nasopharynx, which is highly metastatic and aggressive. Due to the deep anatomical site and atypical early symptoms, the majority of NPC patients are diagnosed at terminal stages. There is growing evidence that microRNAs offer options for early detection, accurate diagnosis, and prediction of malignancy treatment response. Therefore, the purpose of this article was to identify microRNAs that predict the prognosis of patients with NPC by integrating biological information analysis. In this study, we utilized the GSE36682 dataset rooted in the Gene Expression Omnibus (GEO) data bank, including 62 cases of NPC tissues and six cases of non-cancerous tissues. The miRNAs were subjected to weighted gene co-expression network analysis, and hub miRNAs were screened for differentially upregulated miRNAs from modules highly correlated with tumor progression. We took a lot of time to calculate the risk scores of miRNA markers for 62 NPC patients, and incidentally combined the clinical survival information of patients to finally identify the three key miRNAs, and then divided the patients into low- and high-risk groups. Kaplan-Meier curve analysis revealed that the overall survival of patients in the high-risk group was obviously shorter than that of the low-risk group. Subsequently, the target genes of the three miRNAs were predicted and analyzed for functional enrichment. In summary, a prognostic predictive risk model based on three miRNA profiles may increase prognostic predictive value and provide reference information for the precise treatment of nasopharyngeal carcinoma.

A contemporary series of surgical outcomes following subtotal colectomy and/or completion proctectomy for management of inflammatory bowel disease.

The main indications for emergency subtotal colectomy (SC) include management of toxic colitis, refractory haemorrhage and/or perforation. Alternatively, elective surgery is performed for those refractory to medical therapy or with evidence of multifocal dysplasia. Overall, the annual incidence of SC has fallen since the introduction of biologic therapies and we aimed to review our current practices. A retrospective review of inflammatory bowel disease (IBD) patients undergoing subtotal colectomy between 2013 and 2020 was performed. Medical records, operative notes, discharge summaries, histopathology reports and other supporting documents were reviewed. Indication for surgery, management of the rectum (i.e. maintenance of rectal stump, progression to completion proctectomy or IPAA formation) associated morbidity (Clavien-Dindo classification) and length of hospital stay were examined. Fifty-six IBD patients underwent a subtotal colectomy. Twenty-five patients (UC 14, Crohn's 11) had an elective procedure, and 31 patients (UC 19 Crohn's 12) had an emergency/semi-urgent procedure. Interestingly, 80% (n = 25) of the emergency cohort and 68% (n = 17) of the elective cohort had a laparoscopic resection. Major morbidity (Clavien-Dindo > 2) was higher among the emergency group (39% vs. 24%). Deep surgical site infection was the commonest morbidity (13%) in the emergency group, while superficial surgical site infection was commonest in the elective cohort (20%). Overall, there was no difference in surgical re-intervention rate (13% vs 12%), and there were no perioperative mortalities. Median post-operative length of stay was shorter in the elective cohort (9 versus 13days). A significant proportion of IBD patients still require semi-urgent/emergency colectomy, which is associated with considerable length of stay and morbidity. The results of our study provide real-world outcomes to help counsel patients on expected outcomes.

Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

Background: Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes. Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9). Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

This study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine lipomas and 56 ALT/WDLS were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (> 11 cm), thick septa (> 2 mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0–16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.

A Clinicopathological Appraisal of Port-site Infections after Laparoscopic Cholecystectomy: Our Experience at Shaheed Suhrawardy Medical College Hospital

Background: Undoubtedly the port site infections have remarkably enhanced to be a stigma as post laparoscopic morbidity and is still a field of debate and further exploration to surgeons. These port site infections (PSI) are infrequent surgical site infection, complicating the recovery of patients undergoing laparoscopic cholecystectomy. Hence, the necessity of further evaluation of the regarded facts was intended to be explored. Aim: This study was aimed to evaluate the factors that created or provoked PSI after laparoscopic removals of gall-bladder and at analysing which of these factors can be traced and modified to combat PSI in a trail to conquer these complications and to achieve maximum advantages from laparoscopic surgeries. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies in our hospital as well as at other facilities remote from our work stations. Factors as gender, site of infected port, types of microorganism, acuteness versus chronicity of the disease, types of infection (superficial or deep infection) and intraoperative spillage of stones, bile or pus were analysed in our study. Swabs were taken for culture and sensitivity tests in all patients who developed infections. Explorations were done under GA for some patients who had deep surgical site infections and wound debridement was done, excisional biopsies were taken for histopathological studies, and tissue samples for Gene-Xpert analysis for detection of Mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively at our surgery unit rooms. Results: Port site infection rate was recorded in 40 cases amongst 340 procedures from the July 2018 to June 2020 (11.76%). A higher rate was observed in female patients 32 cases (9.41%) and 13 cases (3.82%) of acute cholecystitis. Larger number of cases of the PSI were superficial infections (77.5%) with non-specific microorganism in 34 cases (80.0%). Conclusion: We reconciled a significant association of PSI with spillage of bile or stones during the procedure and with acute cholecystitis. Most of the infections are superficial and more common in males. Precautions and protocols should be taken in measure to avoid unnecessary hurry and faulty procedure of sterilization during and prior to the whole surgery to combat PSI effectively. J Shaheed Suhrawardy Med Coll 2020; 12(2): 76-81

Associations of Statin Use with Deep Surgical Site Infections and Late Non-Infectious Revision Surgeries in Patients Undergoing Orthopedic Surgery: A Clinical Cohort Study

Statins have multiple preventive properties. We investigate if a chronic perioperative statin medication for cardiovascular indications reduces deep orthopedic surgical site infections (SSI), and other late non-infectious complications, in adult patients. We performed a single-center cohort of primary orthopedic interventions 2014-2019; with the exclusion of infection surgery and diabetic foot surgery. Group comparisons with Cox regression analyses; with and without propensity-score matching (nearest neighbor approach). We included 20,088 interventions in 20,088 different patients (median age 53 years, 49% females, 5% diabetes mellitus). Among them, 2,486 episodes (12%) revealed a pre-operative statin therapy (222 different brands and doses). After a median follow-up of 11 months, 1,414 episodes needed a surgical revision: 158 (0.8%) due to deep SSI and 1256 (6.3%) for non-infectious reasons. In multivariate Cox regression analyses, statin use was unrelated to both SSI (hazard ratio (HR) 0.9; 95% confidence interval (CI) 0.6-1.4) and non-infectious complications (HR 1.1, 95%CI 0.9-1.3). We equally lacked associations when we associated deep SSIS with statin use for the subgroups of implant-related surgery (HR 0.8, 95%CI 0.4-1.6) or orthroplasties (HR 0.8, 95%CI 0.3-2.6), separately. Likewise, propensity-score matched analyses on the variable “statin” equally failed to alter these outcomes. In our large cohort study with 20,088 orthopedic interventions, we found no protective association of a statin medication on deep SSI risks; or on other late non-infectious complications requiring revision surgery.

Does Negative Pressure Wound Therapy Reduce Superficial/Deep Surgical Site Infections after Pancreatic Surgery?

Introduction: The role of negative pressure wound therapy (NPWT) in the prevention of superficial and deep surgical site infections (SSIs) after pancreatic surgery remains controversial. Randomized and retrospective trials of NPWT have demonstrated mixed results. Small numbers of patients and inadequate control for wound protectors and antibiotic prophylaxis have been confounding issues. This analysis aims to determine the role of NPWT in a large cohort of patients undergoing pancreatic surgery controlling for numerous patient, perioperative, and operative factors.

The Importance of HbA1c and Left Ventricular Ejection Fraction in Predicting the Development of Postoperative Mortality and Complications in Coronary Artery Bypass Graft Surgery.

IntroductionIn this study, we aimed to investigate the relationship between postoperative mortality, morbidity, hospital stay and development of postoperative complications with the glycosylated hemoglobin (HbA1c) level and low left ventricular ejection fraction (LVEF) in diabetic and non-diabetic patients who underwent elective coronary artery bypass (CABG) surgery.MethodsThe medical records of patients who underwent CABG at our clinic between January 2015 and December 2019 were retrospectively analyzed. All patients were divided into two groups according to their diabetes mellitus (DM) diagnosis. Diabetic patients were also divided into two groups according to their HbA1c levels. The HbA1c threshold value was 7%. All patients were divided into two groups in terms of LVEF. The LVEF threshold value was 40%.ResultsWe analyzed 393 patients, of which 304 (77.4%) were male and 177 (45.04%) patients were diabetic. For lower LVEF and HbA1c values, we found no relationship between postoperative mortality, prolonged intensive care unit (ICU) stay and development of postoperative complications. Deep surgical site infection (DSSI) was found to be more common in diabetic patients who had a higher HbA1c value. Length of hospital stay was longer in diabetic patients with HbA1c levels <7%.ConclusionNo statistically significant relationship was found between LVEF and HbA1c levels and postoperative mortality, prolonged ICU stay and postoperative complications.

Diabetic Kidney Disease is Associated with Increased Complications Following Operative Management of Ankle Fractures

Category:Trauma; Ankle; DiabetesIntroduction/Purpose:Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as dependent variables in studies of diabetic ankle fracture cohorts, but these factors are typically treated as binary risk factors. Thus, we sought to quantify additional risk factors for complication specific to diabetic patients undergoing fracture fixation.Methods:We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010-2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including Hemoglobin A1c and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the OR and failure of fixation. Logistic regression was performed, and odds ratios (OR) calculated.Results:The overall the complication rate was 24.2% (22/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative Hemoglobin A1c in patients who experienced postoperative complications was 7.6% (Range: 5.1%- 14.2%) compared to 7.8% (Range:5.6%-13.5%) who did not (p=0.69). Diabetic patients with chronic kidney disease (eGFR<60 ml/min/BSA) (OR=5.29, p=0.006) and peripheral neuropathy (OR=4.61, p=0.003) were at significantly higher risk of all complications compared to diabetic patients without these comorbidities. Of note, we did not find an association between perioperative Hemoglobin A1c or Body Mass Index and complication rate.Conclusion:Patients with diabetes complicated by chronic kidney disease are at significantly higher risk of complications following operative management of ankle fractures. Our study also corroborated previous reports that within this high-risk cohort, the presence of peripheral neuropathy is a significant risk factor for complications. These sequalae of diabetic disease extends beyond simple glycemic and are manifestations of microvascular disease, glycosylation of soft tissues and impaired metabolic pathways. Identifying these risk factors in diabetic patients allows for patient specific risk stratification, education, and management decisions of ankle fractures.

Experimental Study on Double Row Micropiles and Anchors Composite Retaining Structure in Deep Fill Site

In recent years, with the continuous advancement of urbanization in China and the gradual increase in the utilization scale of underground space, foundation pits may build in a narrow and compact environment. Meanwhile, miscellaneous fill layers in the city may cause construction difficulties when new foundation pits are excavated and supported. While we focus on the above problems, new retaining structure forms which are safe and economical are urgently needed. In this study, based on the excavation in a deep filling site in Jinan, the double row micropiles and anchors composite retaining structure is monitored under excavation, loading, and unloading conditions by installing sensors and testing. The stress and axial force distribution of the front and back row micropiles and anchors in the composite retaining system under different excavation depths and different loads are analyzed. The performance changes of the front and back row micropiles under different conditions and the contribution of anchors at different depths to the structure resistance during excavation and loading tests are discussed. The results show that double row steel piles and anchors composite retaining structure is feasible when excavating deep fill site in the urban area. In the composite retaining system, the stress of the front pile is greater than the back pile, the back pile has a lag when it starts working, and the axial force of the middle and upper anchor is greater than that of the bottom anchor.

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database.

BackgroundAlthough plastic surgeons commonly perform capsulectomies for a variety of peri-prosthetic capsular conditions, the safety of capsulectomy remains unknown, and the literature lacks evidence describing its morbidity and complication rates for patients inquiring about its associated risks.ObjectivesThe present study aims to identify and define the complication rates associated with capsulectomies.MethodsAn analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between the years 2015 and 2018. All information pertaining to demographics, patient-related information, surgical indications, procedure-related information, outcomes, and complications were assessed. ResultsThe study identified 2231 cases of surgeon-reported capsulectomies; indications most commonly reported included capsular contracture (n = 638, 28.6%) and breast implant rupture (n = 403, 18.1%). In total, 141 patients (6.32%) were hospitalized for longer than 1 postoperative day (range, 2-28 days), while the overall complication rate was 3.0% (n = 67/2231 patients). Incidence of minor complications, representing superficial surgical site infections, was 0.8%, while the major complication rate was 2.24%. These included 7 cases of deep surgical site infections (0.3%), 19 organ space infections (0.9%), and 8 cases of wound dehiscence (0.4%). Eight patients developed sepsis (0.4%); 6 patients required transfusions (0.3%); 1 case of postoperative pneumonia and 1 myocardial infarction were also identified (n = 1 each, 0.0%). The overall reoperation and readmission rates were 2.0%, representing a readmission rate of 66% among patients with complications.ConclusionsThe present study provides the first estimate of the incidence of complications associated with capsulectomies. Although the NSQIP database contains significant limitations, the data presented herein describe a complication profile that plastic surgeons can share with their patients during informed consent. Level of Evidence: 4

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

BACKGROUND: We aimed to assess functional and clinical outcomes of patients who underwent open reduction and internal fixation of distal intra-articular fractures of the humerus through a previously undescribed approach through the triceps tendon, called the triceps-off, transfascial sleeve (TOFS) approach METHODS: We conducted an ambispective cohort study of ten patients who underwent open reduction and internal fixation of the distal humerus through the TOFS approach at a tertiary hospital between March 2016 and January 2019. Patients were identified from the prospectively kept surgical database. All had AO type C fractures of the distal humerus. The mean age was 36.7 ± 14.9 years (range 19-68). The assessment consisted of a review of their hospital records, range of motion, triceps strength, ultrasound evaluation of triceps tendon integrity, X-rays for union rates and adequacy of reduction, and DASH scores RESULTS: The mean time of follow-up was 10.8 ± 4.7 months (range 6-19). The mean arc of motion was 114.7 ± 25.1 degrees (range 80-150). There was a decrease in mean triceps muscle strength compared to the uninjured side: 66% at 45° of flexion, 70% at 90° and 86% at 120° of elbow flexion. The mean DASH score was 15.7 ± 8.9, indicating mild residual impairment (range 5-31). The DASH score had a strong correlation (r = 0.71; p &lt; 0.05) with the follow-up period. All tendons were intact on ultrasound evaluation. One patient had deep surgical site infection, treated with surgical debridement, antibiotics and plate removal with resolution of sepsis and healing. All fractures united by six months CONCLUSION: TOFS is a successful surgical approach for reduction and fixation of AO type C intra-articular distal humerus fractures, with excellent tendon healing rates. It is, however, associated with mild residual functional impairment and residual triceps weakness Level of evidence: Level 4

Mean and Turbulent Characteristics of a Bottom Mixing‐Layer Forced by a Strong Surface Tide and Large Amplitude Internal Waves

AbstractWe present 15 days of both mean and turbulent field observations bottom mixing‐layer at a gently sloping 250 m deep continental shelf site, energized by tides and nonlinear internal waves (NLIWs). The tidal frequency forcing was due to the combined effects of the barotropic tide and a mode‐1 internal tide (IT), while the NLIWs were predominantly mode‐1 waves of depression. The bottom mixing‐layer thickness varied at both semidiurnal and sub‐tidal ∼O(10)d frequencies, with an average thickness of around 10 m. Compression and expansion of the mixing‐layer by both the IT and NLIWs affected the mean velocity profiles in the mixing‐layer, while the phasing between the barotropic and baroclinic flows led to an asymmetry in mean velocity profiles between periods of rising and falling isotherms. With the exception of periods of flow reversal, the turbulent kinetic energy balance and turbulent stress observations were consistent with the existence of an inertial‐sublayer with thickness of approximately 10%–15% of the mixing‐layer thickness ( ∼1 m), even beneath NLIWs. In the outer portion of the mixing‐layer—that is, above the inertial‐sublayer—NLIWs modulated the local turbulence spectra. We discuss the observations in the context of a predictive model for mixing‐layer thickness. The analysis suggests that the high‐frequency variability in mixing‐layer thickness was dominated by internal wave pumping, though strength of the ambient stratification and the frequency of the forcing were important controls on the time‐averaged (sub‐tidal) variation.

The application of “deep learning” in construction site management: scientometric, thematic and critical analysis

PurposeThe digital construction transformation requires using emerging digital technology such as deep learning to automate implementing tasks. Therefore, this paper aims to evaluate the current state of using deep learning in the construction management tasks to enable researchers to determine the capabilities of current solutions, as well as finding research gaps to carry out more research to bridge revealed knowledge and practice gaps.Design/methodology/approachThe scientometric analysis is conducted for 181 articles to assess the density of publications in different topics of deep learning-based construction management applications. After that, a thematic and gap analysis are conducted to analyze contributions and limitations of key published articles in each area of application.FindingsThe scientometric analysis indicates that there are four main applications of deep learning in construction management, namely, automating progress monitoring, automating safety warning for workers, managing construction equipment, integrating Internet of things with deep learning to automatically collect data from the site. The thematic and gap analysis refers to many successful cases of using deep learning in automating site management tasks; however, more validations are recommended to test developed solutions, as well as additional research is required to consider practitioners and workers perspectives to implement existing applications in their daily tasks.Practical implicationsThis paper enables researchers to directly find the research gaps in the existing solutions and develop more workable applications to bridge revealed gaps. Accordingly, this will be reflected on speeding the digital construction transformation, which is a strategy over the world.Originality/valueTo the best of the authors’ knowledge, this paper is the first of its kind to adopt a structured technique to assess deep learning-based construction site management applications to enable researcher/practitioners to either adopting these applications in their projects or conducting further research to extend existing solutions and bridging revealed knowledge gaps.

Late Miocene‐Pliocene Vigorous Deep‐Sea Circulation in the Southeast Indian Ocean: Paleoceanographic and Tectonic Implications

AbstractDeep ocean circulation in the Southern Hemisphere plays a central role in global ocean overturning circulation and determines ocean carbon sink variability on multimillion‐year timescales. For this reason, it is important to understand how deep currents that originate in the Southern Ocean responded to past climate fluctuations and changing temperature patterns in the Southern Hemisphere oceans. To investigate this feedback mechanism, we analyze deep‐sea sediment cores formed under the influence of bottom currents from the Mentelle Basin (International Ocean Discovery Program Sites U1513, U1514, and U1516), in the Southeastern Indian Ocean. We show that bottom current activity intensified in the Australian‐Antarctic Basin during the cooling intervals of the late Miocene (ca. 7.8–4.8 Ma) and late Pliocene (ca. 3.59–3.2 Ma). At those intervals, bulk grain‐sizes and terrigenous input increased, via current winnowing. Ferromanganese nodules and stratigraphic hiatuses are also observed within these periods, indicative of intense sediment erosion at the seafloor. Sediment accumulation and preservation in the basin was particularly low at the deep Site U1514 (3,838 m water depth), suggesting that enhanced current transport and sediment erosion occurred preferentially within the deepest parts of the basin. We suggest that bottom water fluxes in the Australian‐Antarctic Basin intensified during late Miocene and Pliocene cooling intervals, likely boosted by renewed Australian‐Antarctic Discordance spreading since the Miocene.

Validation of the artificial intelligence–based trauma outcomes predictor (TOP) in patients 65 years and older

BackgroundThe Trauma Outcomes Predictor tool was recently derived using a machine learning methodology called optimal classification trees and validated for prediction of outcomes in trauma patients. The Trauma Outcomes Predictor is available as an interactive smartphone application. In this study, we sought to assess the performance of the Trauma Outcomes Predictor in the elderly trauma patient. MethodsAll patients aged 65 years and older in the American College of Surgeons–Trauma Quality Improvement Program 2017 database were included. The performance of the Trauma Outcomes Predictor in predicting in-hospital mortality and combined and specific morbidity based on incidence of 9 specific in-hospital complications was assessed using the c-statistic methodology, with planned subanalyses for patients 65 to 74, 75 to 84, and 85+ years. ResultsA total of 260,505 patients were included. Median age was 77 (71–84) years, 57% were women, and 98.8% had a blunt mechanism of injury. The Trauma Outcomes Predictor accurately predicted mortality in all patients, with excellent performance for penetrating trauma (c-statistic: 0.92) and good performance for blunt trauma (c-statistic: 0.83). Its best performance was in patients 65 to 74 years (c-statistic: blunt 0.86, penetrating 0.93). Among blunt trauma patients, the Trauma Outcomes Predictor had the best discrimination for predicting acute respiratory distress syndrome (c-statistic 0.75) and cardiac arrest requiring cardiopulmonary resuscitation (c-statistic 0.75). Among penetrating trauma patients, the Trauma Outcomes Predictor had the best discrimination for deep and organ space surgical site infections (c-statistics 0.95 and 0.84, respectively). ConclusionThe Trauma Outcomes Predictor is a novel, interpretable, and highly accurate predictor of in-hospital mortality in the elderly trauma patient up to age 85 years. The Trauma Outcomes Predictor could prove useful for bedside counseling of elderly patients and their families and for benchmarking the quality of geriatric trauma care.

The usage of antibiotic therapy for septic complications in colorectal surgery

Over the past few decades, surgeons have made many attempts to reduce the incidence of surgical site infections (SSI) after elective colorectal surgery. Routine faecal diversion is no longer practiced in elective colonic surgery and mechanical bowel preparation is on the verge of being eliminated altogether. Intravenous antibiotics have become the standard of care as prophylaxis against SSI for elective colorectal operations. However, the role of antibiotics is still being debated. The aim of the study was to reduce the proportion of antibiotic-resistant strains of pathogens of infectious complications in colorectal surgery by optimizing the use of antimicrobial drugs. Method: We analyzed data of 135 patients who were operated for colorectal cancer in our general surgery department in between 2019 and 2021. Age, gender, body mass index, presence of chronic pulmonary disease, surgery duration, disease location (colon or rectum), and surgeon volume were evaluated for associations with the development of superficial or deep surgical site infection. Results: All parameters were found to be significant for the development surgical site infection except sex. Cut-off values were 63.5 years for age, 167.5 minutes for surgery duration. Conclusion. The introduction of strict monitoring of compliance with the protocols of antibiotic prophylaxis and antibiotic therapy at the level of a separate surgical unit in a multidisciplinary hospital improves conditions for the rational use of antimicrobial drugs.

ASA Physical Status Classification and Complications Following Facial Fracture Repair.

To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P < .001) and risk of overall complications (P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P = .049), postoperative bleeding (P = .036), and failure to wean off ventilator (P = .027). Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.

P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy

Abstract Background Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy. Methods A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates. Results Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI. ALP was higher in patients with superficial SSI (p &amp;lt; 0.001). Lower ALT was associated with wound dehiscence (p &amp;lt; 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p &amp;lt; 0.001). ALP correlated with increased LOS (p &amp;lt; 0.001). On multivariable regression, ALP was associated with superficial SSI (p &amp;lt; 0.001), and LOS (p &amp;lt; 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI. Conclusions Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.