Duration Of Postoperative Hospital Research Articles

Association between hydroxyethyl starch 130/0.4 administration during noncardiac surgery and postoperative acute kidney injury: A propensity score-matched analysis of a large cohort in China

Study objectiveThe use of hydroxyethyl starch 130/0.4 has been linked to renal injury in critically ill patients, but its impact on surgical patients remains uncertain. DesignA retrospective cohort study. SettingThis study was conducted at one tertiary care hospital in China. PatientsWe evaluated the records of 51,926 Chinese adults who underwent noncardiac surgery from 2013 to 2022. Patients given a combination of hydroxyethyl starch 130/0.4 and crystalloids were propensity-matched at a 1: 1 ratio of baseline characteristics to patients given only crystalloids (11,725 pairs). InterventionsEligible patients were divided into those given a combination of hydroxyethyl starch 130/0.4 and crystalloid during surgery and a reference crystalloid group consisting of patients who were not given any colloid. MeasurementsThe primary outcome was the incidence of acute kidney injury. Secondarily, acute kidney injury stage, need for renal replacement therapy, intensive care unit transfer rate, and duration of postoperative hospitalization were considered. Main resultsAfter matching, hydroxyethyl starch use [8.5 (IQR: 7.5–10.0) mL/kg] did not increase the incidence of acute kidney injury compared with that in the crystalloid group [2.0 vs. 2.2%, OR: 0.90 (0.74–1.08), P = 0.25]. Nor did hydroxyethyl starch use worsen acute kidney injury stage [OR 0.90 (0.75–1.08), P = 0.26]. No significant differences between the fluid groups were observed in renal replacement therapy [OR 0.60 (0.41–0.90), P = 0.02)] or intensive care unit transfers [OR 1.02 (0.95–1.09), P = 0.53] after Bonferroni correction. Even in a subset of patients at high risk of renal injury, hydroxyethyl starch use was not associated with worse outcomes. ConclusionsHydroxyethyl starch 130/0.4 use was not significantly associated with a greater incidence of postoperative acute kidney injury compared to receiving crystalloid solutions only.

Standardized phase angle: relationship with functionality, muscle mass and postoperative outcomes in surgical cancer patients.

To evaluate the association of standardized phase angle (SPA) with nutritional status, functional parameters, and postoperative outcomes in surgical cancer patients. This prospective study includes 59 cancer patients from Pelotas (Brazil) admitted for elective cancer surgery. We obtained the phase angle through Bioelectrical Impedance Analysis (BIA) and standardized it according to the population's reference values. We estimated the muscle mass using BIA for later calculation of the Skeletal Muscle Index (SMI) and performed handgrip strength (HGS) and gait speed (GS) tests. We used the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutritional status. Postoperative complications and duration of hospital stay were evaluated as the outcomes. The prevalence of malnutrition in the sample was 28.8%, according to ASG-PPP. SPA was statistically lower in patients with malnutrition, with lower HGS and reduced GS. For postoperative outcomes, patients with severe complications and those with prolonged hospitalization also had lower SPA values. The greater the number of functional alterations in patients, the lower the SPA value, mainly when associated with reduced muscle mass assessed by BIA, suggesting that muscle mass reduction plays an important role in the association between functional alterations and phase angle in patients with cancer. According to the parameters used in this study, low SPA value was associated with impaired nutritional and functional status and negative outcomes in the analyzed sample.

Pyridostigmine to Reduce the duration of postoperative Ileus after Colorectal surgery (PyRICo-RCT): randomized clinical trial.

Postoperative ileus, driven by the cholinergic anti-inflammatory pathway, is the most common complication in patients undergoing colorectal surgery. By inhibiting acetylcholinesterase, pyridostigmine can potentially modulate the cholinergic anti-inflammatory pathway and accelerate gastrointestinal recovery. This study aimed to assess the efficacy of pyridostigmine in improving gastrointestinal recovery after colorectal surgery. This double-blinded RCT enrolled adult patients undergoing elective colorectal surgery at two hospitals in South Australia. Patients were randomized to 60 mg oral pyridostigmine or placebo twice daily starting 6 h after surgery until the first passage of stool. The primary outcome was GI-2, a validated composite measure of time to first stool and tolerance of oral diet. Secondary outcomes included incidence of postoperative ileus (defined as GI-2 greater than 4 days), duration of hospital stay, and 30-day complications, evaluated by intention-to-treat univariate analysis. Of 130 patients recruited (mean(s.d.) age 58.4(16.4) years; 73 men, 56%), 65 were allocated to each arm. The median GI-2 was 1 day shorter with pyridostigmine compared with placebo (2 (i.q.r. 1-3) versus 3 (2-4) days; P = 0.015). However, there were no significant differences in postoperative ileus (17.2 versus 21.5%; P = 0.532) or duration of hospital stay (median 5 (i.q.r. 4-8.75) versus 5 (4-7.5) days; P = 0.921). Similarly, there were no significant differences in overall complications, anastomotic leak, cardiac complications, or patient-reported side effects. Pyridostigmine resulted in a quicker return of GI-2 and was well tolerated. Larger multicentre studies are required to determine the optimal dosing and evaluate the impact of pyridostigmine in different surgical settings. Registration number: ACTRN12621000530820 (https://anzctr.org.au).

Prevention of systemic inflammatory response syndrome after emergency on-pump coronary artery bypass grafting with high-dose ascorbic acid: a prospective randomized controlled trial

INTRODUCTION: Emergency coronary artery bypass grafting (CABG) surgery carries a risk of postperfusion systemic inflammatory response syndrome (SIRS). The prophylactic use of high doses of ascorbic acid, which possesses an antioxidant and immunomodulatory effect, may be justified, but has not been sufficiently studied in this clinical scenario. OBJECTIVE: To determine the possibilities of preventing the systemic inflammatory response with ascorbic acid (AA) during emergency coronary artery bypass grafting under cardiopulmonary bypass (CPB). MATERIALS AND METHODS: We prospectively examined 60 patients (32 men and 28 women, aged 63 (59; 70) years who underwent CABG (3 ± 1 bypass), performed for emergency indications under CPB 95 (77; 122) min. Patients were randomly divided into two groups: patients in the main group (n = 30) were given 4 grams of AA intravenously 1 hour before the skin incision, patients in the control group (n = 30) received standard pre-operative prevention of SIRS. RESULTS: The use of AA (n = 30) was accompanied by a decrease in the incidence of SIRS (20 and 47 %; p = 0.048) and a reduction in postoperative hospitalization (9 [8; 10] and 11 [10; 16] days; p = 0.013). CONCLUSIONS: Prophylactic use of AA is safe and can reduce the frequency of individual manifestations of SIRS and the duration of postoperative hospitalization.

Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm–3 cm: a randomized controlled study from a university teaching hospital

PurposeTo assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24–30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm.MethodsFrom February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups.ResultsMean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98% vs 94%, p = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant.ConclusionSuper-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.

Body lift with lateral thigh lift: surgical technique and comparison with the inferior body lift.

Despite its rarity, cutaneous adipose tissue excess in the trochanteric region following massive weight loss is a surgical challenge. The aim of this work is to propose a surgical technique for lifting the outer thighs by describing its indications and its limitations. 74 patients were recruited into the study between 2018 2021. Two groups were identified: patients with bodylift combined with lateral thigh lift (n=20) and patients with lower bodylift (n=54). Satisfaction was obtained through the BODY Q questionnaire. The average operating time is 45 minutes longer when an outer thigh lift is performed. The median length of hospitalization is similar. The complication rate is 26% for the bodylift group and 60% for the thigh lift group (p<0.01); the most common complication is dehiscence. Data analysis shows that the lateral thigh lift technique does not affect immediate postoperative evolution or hospitalization duration, proving its safety. There was an increase in total complications among patients who underwent lateral thigh lifts. Dehiscence is the most common complication, which is an outpatient treatment. The satisfaction rate is high. Satisfaction is linked to improved quality of life. In our experience, the technique described is an effective means of trochanteric deformities.

Surgical options and survival prognosis in geriatric patients beyond average lifespan with locally advanced gastric cancer: a propensity score-matched analysis.

The appropriateness of laparoscopic gastrectomy (LG) for super-geriatric patients with locally advanced gastric cancer (LAGC) is inconclusive, and the prognostic factors are also yet to be elucidated. Herein, we aimed to investigate the surgical and oncological outcomes of LG versus open gastrectomy (OG) for geriatric patients with LAGC who have outlived the average lifespan of the Chinese population (≥ 78years). This is a monocentric, retrospective, comparative study. A 1:1 propensity score matching (PSM) was performed to minimize selection bias and ensure well-balanced characteristics. The primary endpoint of interest was 3-year overall survival, while secondary endpoints included procedure-related variables, postoperative recovery indices, and complications. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify unfavorable prognostic factors. Of 196 eligible individuals, 107 underwent LG and 89 underwent OG, with a median age (interquartile range [IQR]) of 82 [79, 84] years. PSM yielded 61 matched pairs, with comparable demographic and tumor characteristics. The LG group had a significantly lower overall complication rate than the OG group (31.1% vs. 49.2%, P = 0.042), as well as shorter duration of postoperative hospital stay [12 (11, 13) vs. 13 (12, 15.5) d, P < 0. 001], less intraoperative blood loss [95 (75, 150) vs. 230 (195, 290) mL, P < 0.001], but a longer operative time [228 (210, 255.5) vs. 196 (180, 219.5) min, P < 0.001]. The times to first aerofluxus, defecation, liquid diet, and half-liquid diet were comparable. Kaplan-Meier analyses revealed no significant difference in 3-year overall survival between the groups, either in the entire cohort or in subgroups with different TNM staging. Moreover, Age-adjusted Charlson Comorbidity Index scores of > 6 [hazard ratio (HR) 4.003; P = 0.021] and pathologic TNM stage III (HR 3.816, P = 0.023) were independent unfavorable prognostic factors for long-term survival. LG performed by experienced surgeons offers the benefits of comparable or better surgical and oncological safety profiles than OG for super-geriatric patients with LAGC.

Analysis of risk factor for surgical site infection and other postoperative complications in patients following loop ileostomy reversal.

Introduction:Loop ileostomy reversal (LIR) procedure is associated still with relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. As a result of SSI, it leads to prolonged hospital stay, delay the adjuvant therapy and increase the hospital costs. Aim of the study:The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.Material and methodsA single-centre retrospective analysis was conducted in a tertiary reference center. Finally, sixty five patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled into the study. Data were collected retrospectively based on the available medical charts. The study group comprised of 23 women (35%) and 42 men (65%) with the mean age 48.914.5 years and the mean body mass index 24.34.9 kg/m2. The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n=42; 64.6%).Results:The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which was important, among others, in during hospitalization after surgery, the need for antibiotic therapy or CRP values. 9 patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI it was over 13 days compared to almost 6 days in the group without SSI (p=0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (p=0.01). The type of intestinal anastomosis had a significant impact on the operative time (p=0.0011) and the time of hospital stay after surgery (p=0.04).Conclusions:Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor of increasing the risk of other postoperative complications and significantly increases the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities, which made patients more likely to develop SSI, CRP increase or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.

Comparative study of elective cholecystectomy with and without antimicrobial prophylaxis: A prospective randomized study

Background: Cholecystectomy is one of the most common, clean, and contaminated surgery operations performed by surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Aims and Objectives: The aims and objectives are to study antimicrobial prophylaxis on elective laparoscopic cholecystectomy and to compare surgical site infections (SSI) between the two groups after laparoscopic cholecystectomy with respect to (a) duration of surgery, (b) post-operative pain, (c) complications encountered, and (d) post-operative hospital stay. Materials and Methods: Patients were randomly divided into the study group (Group A) and the control group (Group B). Antibiotic dose of ceftriaxone + sulbactam 1.5 g will be administered intravenously 2 h before induction of anesthesia for the patients in the study Group A (n=30), and no antibiotic will be administered prophylactically to the control Group B (n=30). Results: In the study group, one patient developed fever, and in the control Group, 4 patients developed fever. In this study, SSIs were considered. In the study group, two patients (6.67%) developed pus discharge from the port site which was considered superficial infection, and in the control group, five patients (16.67%) developed pus discharge. Conclusion: Based on our study, in elective cholecystectomy, a single dose of intravenous ceftriaxone + salbactam 1.5 g given before the operative procedure does not lead to a higher SSI rate as compared to the conventionally given antibiotics which are continued postoperatively for a variable length of time.

The Association of Body Composition Parameters Measured by Computed Tomography with Cancer Stage, Prognosis, and Survival in Patients with Renal Cell Carcinoma.

This study aims to investigate the association of preoperative body composition parameters, measured by computed tomography in patients undergoing surgery for renal cell carcinoma, with its stage and to survey the relationship with postoperative hospitalization duration and survival. Demographic data, pathology results, cancer stages, and hospitalization duration of 104 patients undergoing surgery at the urology clinic due to renal cell carcinoma between 2019 and 2023 were analyzed retrospectively. On computed tomography scans acquired during diagnosis, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue, and skeletal muscle area were measured. The ratios of body composition parameters were computed. When the correlation between survival time and body composition in deceased patients was analysed, a moderate but significant correlation was observed between skeletal muscle area value and total adipose tissue / skeletal muscle area ratio (r=0.630, p=0.001; r=0.598, p=0.002). A significant and strong correlation was observed between total adipose tissue value and survival (r=0.704, p<0.001). Subcutaneous adipose tissue / skeletal muscle area was found to be an independent risk factor associated with mortality, and a ratio of 0.98 or less increased the mortality risk approximately 16-fold. The relationship between body composition parameters measured by computed tomography, which can be easily evaluated pre-treatment, and mortality, postoperative recovery and length of hospital stay can be evaluated, giving clinicians an idea about the potential difficulties that patients may encounter during the treatment process. For this purpose, the subcutaneous adipose tissue / skeletal muscle area ratio is the most helpful parameter that can be used.</P>.

Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain

Objectives: Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds.Design: This was a prospective comparative hospital-based study.Setting: Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied.Participants: Fifty patients aged 16 years and above who presented with secondary peritonitis.Intervention: Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not.Main outcome measures: Development of incisional surgical site infection, wound dehiscence, and duration of postoperative hospital stay.Results: The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005).Conclusion: Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantlyreduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. Thereduction in surgical wound dehiscence observed in this study was, however, not statistically significant.

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function.

Compare the anesthesia effects of combined intravenous and inhalation anesthesia (CIVIA) and total intravenous anesthesia (TIVA) in laparoscopic surgery. Furthermore, our objective is to examine the elements that contribute to the delay in postoperative recovery of neurocognitive function and anticipate the manifestation of delayed recovery by analyzing serum cytokines. The CIVIA group and the TIVA group both consisted of 130 patients who were scheduled to have elective major abdominal surgery through laparoscopy. The criteria taken into account by the observational and record-keeping study were the patients' ages, sexes, body masses, heights, and the presence or absence of any preexisting problems. Both groups also had their anesthetic depth, duration, and per-unit-of-time muscle relaxant and analgesic dosages recorded. Finally, the length of each patient's stay in the hospital as well as their overall length of stay were tracked. By using the Mini-Mental State Examination (MMSE) to measure cognitive function, we assessed the mental states of the subjects. Additionally, we wanted to identify any biomarkers that could be linked to postoperative cognitive decline or delays in neurocognitive recovery. A total of 51 participants from the CIVIA group and 53 participants from the TIVA group satisfactorily completed the necessary neuropsychological exam for identifying delayed neurocognitive recovery at the study's completion. In the initial data of the two groups, no significant discrepancies were found (p > 0.05). The CIVIA group exhibited noteworthy reductions in the quantity of administered analgesics and muscle relaxants per unit of time in comparison to the TIVA group (p < 0.05). In addition to this, the duration from the sevoflurane tank being closed to the extubation period demonstrated a significant reduction in the CIVIA group compared to the TIVA group (p < 0.05). Moreover, no statistically notable distinction was observed in terms of postoperative hospitalization duration and overall hospitalization duration among both groups (p > 0.05). According to the study, both the CIVIA group and the TIVA group had a total of 7 (13.72%) and 17 (32.07%) individuals, respectively, who met the criteria for neurocognitive delayed recovery (Odds Ratio: 0.336; 95% CI: 0.134-0.864; p = 0.026). According to the research findings, it is indicated that there is a possibility for an increased presence of IL-6 in the bloodstream within 60 min following the incision made on the skin. This occurrence subsequently leads to the prolonged restoration of neurocognitive capabilities. The CIVIA technique outperforms the TIVA method in terms of overall assessment in the setting of laparoscopic surgery. It's also important to remember that an increased blood IL-6 level during laparoscopy may operate as a separate risk factor for a delay in the restoration of neurocognitive function.

Effect of Perioperative Allogeneic Blood Transfusion in Causing Surgical Site Infection in Elective Gastrointestinal Surgeries: A Comparative Study among the Pediatric Population in A Tertiary Care Hospital of Bangladesh

Background: Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing elective gastrointestinal surgery. Objective: To find out whether perioperative allogeneic blood transfusion is a significant risk factor for surgical site infection in children undergoing elective gastrointestinal surgery. Methods: This prospective observational study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka, from January, 2021, to June, 2022, for a period of 18 months. According to CDC standards, patients who underwent elective gastrointestinal surgical procedure or clean-contaminated surgical wound (class II) were chosen as the study population. Total 256 patients were divided into two groups according to the blood transfusion as transfused and non-transfused group. Preoperative and postoperative day 1 CBC were done to observe the lymphocyte count. Blood transfusions were recorded during the perioperative period. After surgery, patients were followed up to check for surgical site infection and anastomotic leakage. Pus or wound swab for C/S was done in all the patients who developed SSI. The duration of the hospital stay after surgery was also noted. Results: Most of the study subjects in both the groups were ≤5 years(p=0.095). Males were predominant than females in both groups (p=0.014). Infection was found significantly higher among the transfused group (34.6%) than non-transfused group (14.6%) (p=0.001). In both the groups common infection was superficial SSI (12.0% in transfused group and 6.5% in non-transfused group). Among the infections, bacterial growth was 39.1% in Group A and 38.9% in Group B (p&gt;0.786). Postoperative duration of hospital stay was 10.56 ± 4.05 days and 8.47 ± 2.67 days in Group A and Group B respectively (p&lt;0.001). Mean lymphocyte count in Group A and group B was (2353.9±1647.7 vs 3792.5±1455.9; p&lt;0.001). Conclusion: Allogeneic blood ........

Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study.

The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m2. This paper aims to summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm. Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05. In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05). MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases. We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.

Incidence, risk factors and impact of anemia after elective neurosurgery: A retrospective cohort study

ObjectivesAnemia after surgery is common and is associated with adverse clinical outcomes. Understanding the incidence and risk factors for postoperative anemia is important to reduce anemia-related complications and blood transfusion. There is lack of data regarding postoperative anemia and its contributing factors in neurosurgery. This study evaluates the incidence and risk factors of postoperative anemia, and its impact on clinical outcomes. MethodsThis was a single centre, retrospective study of patients who underwent elective neurosurgery over seven months. Data regarding age, gender, body mass index, American Society of Anesthesiologists (ASA) physical status, diagnosis, surgery, preoperative hemoglobin, surgery duration, intraoperative blood loss and red blood cell (RBC) transfusion, dose of tranexamic acid, intraoperative fluid balance, years of surgeon’s experience, postoperative hemoglobin, postoperative RBC transfusion, Glasgow Coma Scale (GCS) score at hospital discharge, and duration of postoperative intensive care unit and hospital stay were collected. Logistic regression was used to identify predictors of postoperative anemia. ResultsThe incidence of postoperative anemia was 11.3% (116/1025). On univariate analysis; age, preoperative hemoglobin, surgery duration, gender, ASA grade, surgery type, and surgeon’s experience were associated with postoperative anemia. Lower preoperative hemoglobin (p<0.001) and non-tumor surgery (p<0.001) were predictive of postoperative anemia on multivariate analysis. Postoperative anemia resulted in increased RBC transfusion (p<0.001) and lower GCS score at discharge (p=0.012). ConclusionsAtleast one in ten patients undergoing elective neurosurgery develop postoperative anemia. Lower preoperative hemoglobin and non-tumor surgery predict anemia. Anemia results in increased RBC transfusion and lower discharge GCS score.

Prevention of Postoperative Malnutrition with Oral Nutritional Supplements in Patients Undergoing Gastrointestinal Surgery.

Oral nutritional supplements (ONSs) offer support for the nutritional needs of surgical patients. However, their efficacy is contingent upon the nutrient composition, absorption efficiency, and postingestion tolerance. Our study included a cohort of 84 patients who underwent elective open surgery involving at least one intestine anastomosis. To mitigate the risk of malnutrition, 2 groups of 28 patients each received either a high-protein low-osmotic ONS (Group I) or a high-calorie high-osmotic ONS (Group II). A standard diet was used in the control group (Group III). The metabolic effects were evaluated by measuring body weight and relative change in body weight (Δkg) from 24 h (-1 day) presurgery to 28 days postprocedure. Subjective tolerance following ONS consumption on the second postoperative day was also assessed. Our findings showed that, across all groups, the average body weight decreased during the initial 2 weeks postsurgery, subsequently stabilizing or returning to baseline levels by the third and fourth week of observation. Patients receiving ONS demonstrated greater weight gain between days 14 and 28, with Group I exhibiting the highest rate of gain. Low-osmotic ONS displayed superior tolerance and elicited fewer patient complaints postconsumption. Postoperative hospitalization duration did not differ significantly among the nutritional strategies. In conclusion, early administration of ONS supplies essential nutrients and facilitates refeeding, thereby reducing the risk of malnutrition. Low-osmotic preparations are better tolerated and contribute more effectively to the restoration of preoperative body weight, despite their lower caloric content.

The Role of Tranexamic Acid in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Tranexamic acid (TXA) is an essential procoagulant drug used in various intra- and postoperative situations. Its efficacy and safety profile in obese cases undergoing laparoscopic sleeve gastrectomy (LSG) is still unresolved. Therefore, this meta-analysis evaluated and investigated the current intra- and postoperative effects and hazards of TXA on patients undergoing LSG. As for methodology, Web of Science, Cochrane Library, Scopus, and PubMed were thoroughly searched for relevant studies. Retrieved results were prepared for screening through Endnote, helping to identify eligible studies. Relevant patient characteristics and outcomes were extracted. The methodological quality of the relevant studies was appraised using the respected appraisal tool. Six studies of different designs were enrolled, comprising 753 cases that underwent LSG and administered TXA. Their mean BMI and age went from 37.3 to 56.25 kg/m2 and 33.5 to 43.25 years, respectively. Tranexamic acid significantly linked to reduction in intraoperative bleeding instances, operative blood loss, and operative duration, compared to placebo ((RR = 0.66, 95% CI [0.44, 0.98], P=0.04, I2 = 81%); (MD = -39.64, 95%CI [-75.49, -3.78], P=0.03, I2=94%); (MD=-5.84, 95%CI [-9.62, -2.05], P=0.003, I2=73%)). Tranexamic acid also significantly showed superiority regarding postoperative bleeding events and duration of hospitalization compared to the control group ((RR= 0.45, 95%CI [0.29, 0.69], P=0.0002, I2 =0%); (MD=-0.24, 95%CI [-0.32, -0.17], P< 0.0000, I2 =0%)). Moreover, follow-up of the enrolled patients for a minimum of three to six months resulted in no reported thromboembolic instances, suggesting a negligible risk for thromboembolism among patients undergoing LSG and receiving TXA. In conclusion, tranexamic acid demonstrates a robust safety and efficacy profile for its use in patients undergoing LSG, with no reported instances of thromboembolism. Variations in TXA administration regimens, bleeding definitions, procedural techniques, and potential confounding medications could not be accounted for, necessitating additional large-scale RCTs to address and bridge knowledge gaps.

Complications of thyroidectomy: Insights from a single-centre study in northeast India

To study and compare the frequency of post-operative complications associated with thyroid surgeries indicated for various benign and malignant pathologies and assess the outcome of management of such complications in a tertiary care hospital in Northeast India. An analytical study was done at a tertiary care hospital in Assam over a period of 1 year from May 2022 to June 2023. Data was collected from 53 patients who underwent surgery at this hospital. Hemithyroidectomy, subtotal, near-total, and total thyroidectomies were performed in 31(58.4%), 2 (3.7%), 6 (11.3%) and 14 (26.4%) cases respectively. The overall rate of complications was 39.6%. Permanent hypocalcaemia was observed to be the most common complication, followed by transient hypocalcaemia and transient recurrent laryngeal nerve palsy. The complications were found to be more frequent in surgery for malignant thyroid disease. There was no mortality in our study. A better understanding of thyroid gland anatomy, meticulous haemostasis and Identification of Recurrent laryngeal nerve and parathyroid glands lead to favourable post-operative outcomes. Appropriate post-operative care with early identification and management of complications plays an essential role in reducing the duration of postoperative hospital stay and limiting patient morbidity.

Total vNOTES hysterectomy versus conventional total laparoscopic hysterectomy in virgin transgender men

Background and aim: Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH). Material and methods: A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62). Results: TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p = .001). Patients in the TVNH group experienced less pain at two hours (5 ± 1.56), six hours (4 ± 1.57), 12 h (2 ± 0.91), and 24 h (1 ± 0.62) postoperatively (p = .001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 ± 1.01) than in the TLH group (2.9 ± 0.5) (p = .001). Conclusions: For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy.

Epidemiological and Clinical Profiles of Cases of Appendicitis Managed At a Tertiary Hospital in Nepal

&#x0D; &#x0D; ABSTRACT&#x0D; Introduction: Appendicitis is worldwide the most common surgical emergency that affects both genders and all ages.&#x0D; Methods: This study aimed to assess the epidemiology and clinical profiles of cases of appendicitis in Nepal and compare it with the existing literature. A cross-sectional descriptive study was done on 756 patients attending Dhulikhel hospital a tertiary health care center in Dhulikhel Nepal. All the patients clinically diagnosed with appendicitis were included in this study. The required information was coded, and entered in a Microsoft Excel spreadsheet and analysis was done using SPSS version 22. The epidemiological and clinical findings were analyzed. &#x0D; Results: Mean age of patients was 29.13 ± 16 years. Out of 756 patients, 458 (60.9 %) of patients were male and 298 (39.4%) were females. The majority 42.7% of patients were from Brahmin/Chhetri ethnicity. The most common procedure for the management of appendicitis was laparoscopic appendectomy (61.24%) followed by Open appendectomy (30.6%). The mean duration of postoperative hospital stay was highest among conservative (5.2 days) and lowest among laparoscopic appendectomies (2.2 days). Most of the cases were acute inflammation (47.8%). &#x0D; Conclusion: Appendicitis is more common among males than females, and between 20- 30 yrs of age. The most common surgical procedure was laparoscopic appendectomy, and it has been recorded those minimum days of postoperative hospital stay was also found among laparoscopic appendectomy. Most cases are acute inflammation. &#x0D; &#x0D;