Emergency Abdominal Surgery Research Articles

Non-Malformative Emergency Abdominal Surgery in Children Aged 0 - 5 Years

Childhood abdominal surgery emergencies are a major challenge and problematic for the surgeon. The objective is to assess the pattern of non-malformative emergency abdominal surgery in children under 5 years old and to evaluate their management. Patients and Methods: A retrospective study of children under five years of age operated between January 2015 and December 2019 who presented with non-malformative abdominal surgical emergency at the Niamey National Hospital. Results: We collected 327 patients aged 0 to 5 years who underwent surgery for abdominal emergency. The average age was 2.8 ± 0.7 years. Boys accounted for 70.64% (n = 231) of the cases. Non-traumatic emergencies accounted for 97% (n = 317) of the cases. They were dominated by peritonitis in 44.6% (n = 146) and strangulated hernia in 43.7% (n = 143). Peritonitis was attributed to ileal typhoid perforation in 85.61% (n = 125) cases. The strangulated hernias were umbilical at 87.41% (n = 125) and inguinal at 12.59% (n = 18). Abdominal trauma accounted for 3% (n = 10); including 6 cases of abdominal contusion and 4 cases of penetrating wound. Intestinal resection with or without stoma was performed in 28.44% (n = 93). Postoperative complications were observed in 8.5% (n = 28) of the cases and mortality was 5.5% (n = 18). Conclusion: Non-malformative emergency abdominal surgery for children under 5 years was dominated by peritonitis. The morbidity and mortality are high. Fight against disease due to dirty hands and fecal peril like such as typhoid fever will reduce their frequency, but also improve the prognosis.

ОЖИРЕНИЕ - КАК РИСК ВОЗНИКНОВЕНИЯ ОСЛОЖНЕНИЙ В ЭКСТРЕННОЙ ХИРУРГИИ

In recent years, both the actual number of overweight and obese people and their share in the population have been steadily increasing worldwide. Obese patients can no longer be considered as a small group, and they deserve special attention in relation to their surgical treatment. The results of this treatment are often difficult to combine due to differences between surgical interventions, surgical approaches, organ-specific complications, surgical techniques, and classifications of complications. This review aims to provide results on the impact of obesity on the frequency and types of complications after emergency abdominal surgery based on recent publications.

Validation of surgical APGAR score in abdominal surgeries at a tertiary care teaching hospital in South India

Background: A ten-point surgical APGAR score (SAS) has been previously developed and validated that provides surgeons with a simple, objective and direct rating of operative performance and risk. This score has been evaluated in different types of surgeries till date. We validated SAS in both elective and emergency abdominal surgeries separately which was not done previously.Methods: In this prospective, observational and longitudinal study, 105 surgical cases undergoing open abdominal surgeries were studied. The SAS was calculated for all patients, patients were followed up for the occurrence of any major complications or mortality during hospital stay after surgery. All the patients were divided into three groups based on their SAS score (high risk: SAS 0–4, moderate risk: SAS 5–7 and low risk: SAS 8–10) using a threshold that has been previously established.Results: The occurrence of major complications was significantly higher in high-risk SAS group (12%) than in the moderate risk group (5%). In the low-risk SAS group, the occurrence of major complications was low (1%). The mortality rate in high-risk SAS was more than that in low-risk SAS group with statistical significance both in elective and emergency cases.Conclusions: In our study, we found that patients who belong to high-risk SAS group were significantly associated with post-operative major complications and mortality in both elective and emergency surgeries. A patient with low intraoperative SAS should be considered at risk and monitored meticulously.Trial Registration: Clinical Trials Registry-India (CTRI) identifier No. CTRI/2019/02/017567.

Preventive abdominal wall reconstruction in patients with risk factors of eventration undergoing emergency abdominal surgery

To prevent eventration via preventive abdominal wall reconstruction in patients with risk factors of eventration undergoing emergency abdominal surgery. Treatment results in 120 patients with risk factors of eventration undergoing emergency abdominal surgery were retrospectively analyzed. Patients were divided into 2 groups by 60 people. In the first group, traditional layer-by-layer suturing of the abdominal wall was performed. Preventive abdominal wall reconstruction with a standard polypropylene prosthesis was applied in the second group. We assessed postoperative complications and mortality. The following risk factors of eventration were detected: elderly and senile age (82.5%), long laparotomy (72.5%), decompensated comorbidities (62.5%), widespread peritonitis (52.5%), intestinal obstruction (42.5%), severe internal bleeding (12.5%), disseminated cancer (12.5%), obesity grade 3-4 (10%). In the first group, postoperative morbidity and mortality were 61.7% (n=37) and 13.3%, in the second group - 25% (n=15) and 8.3%, respectively. Preventive abdominal wall reconstruction is advisable in patients with risk factors of eventration.

Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services.

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

Clinical characteristics, morbidity and mortality following an emergency abdominal surgery in patients with COVID-19

Objective: To present the clinical characteristics, laboratory analyses, diagnosis, treatment and evolution of patients with SARS-CoV-2 infection who underwent an emergency surgery. Materials and methods: A multicenter, descriptive and retrospective study conducted in 45 patients who underwent an emergency surgery for acute (surgical) abdomen with a diagnosis of COVID-19 between April and August 2020. Results: Forty-five (45) patients with acute abdomen underwent surgery, out of which 55.55 % were men and 44.44 % were women, with a mean age of 48.33 years. The most frequently used diagnostic test for COVID-19 was the serology test (88.88 %). All the patients underwent a chest computed tomography scan which showed no alterations (31.11 %) and bilateral consolidation of the lungs (48.88 %). The most frequent diagnoses were acute appendicitis (64.44 %) and intestinal obstruction (15.55 %). Postoperative complications occurred in 16 patients (35.55 %). The most frequent complications were respiratory failure (15.55 %) and acute renal failure (13.33 %). Two patients (4.4 %) died due to severe respiratory failure. Conclusions: COVID-19 was diagnosed based on serology tests and chest computed tomography scan findings. The most frequent surgery was appendectomy. Low morbidity and mortality rates were observed in relation to those reported in the medical literature.

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis.

About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2days of hospital admission. Of 3246721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) (P-value <.01, respectively). Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

The significance of theme expertise of the quality of medical care in achieving successful results in treating patients with acute gastrointestinal bleeding

Abstract. This piece of work has evaluated the quality of medical care provided in 2015 to 1,158 patients with acute gastrointestinal bleeding in 11 medical institutions of Saint Petersburg that are licensed to provide in-patient examination and treatment for people with acute surgical diseases abdominal organs. The data on the possible correlative relationship of negative consequences for the implementation of the medical treatment and diagnostic process in cases of insufficient activity in terms of conducting clinical expert work on the profile of emergency abdominal surgery have been analysed in particular. It has been shown that providing medical care to patients with gastrointestinal bleeding is associated with defects in the medical diagnostic process in almost every second case. In the structure of inaccuracies, there prevailed cases of improper examination and treatment of patients (48 and 36%, respectively). Defects in making diagnosis and providing continuity comprise 13 and 3% respectively. The most significant drawback in providing medical care to patients with gastrointestinal bleeding was the use of low-effective anti-ulcer drug therapy schemes (16% of observation cases) and attempts to perform hemostasis by using outdated technologies of intraluminal endoscopy (16% of cases). It is noted that in cases of providing medical care to patients with acute gastrointestinal bleeding, a differentiated principle should be observed. It is proved that the proper quality of medical care for patients with acute gastrointestinal bleeding can be achieved by consistent, programmed provision of it with coordinated activities not only of surgeons directly involved in the treatment and diagnostic process, but also with their purposeful interaction with specialists of other medical fields.

Emergency Abdominal Laparoscopic Surgery During the Coronavirus Disease 2019 Pandemic: Experience in a Private Center in Peru.

Background: During the Health Emergency due to coronavirus disease 2019 (COVID-19) in Peru, elective surgeries were suspended and only emergency surgeries were allowed. Conservative management was considered as an alternative and laparoscopic surgery was indicated following safety recommendations. Surgically operated patients were at higher risk of becoming infected with COVID-19 due to hospital exposure, being more susceptible to complications. Methods: Retrospective cohort-type analytical study that includes patients who were admitted to a private center due to an emergency and who underwent laparoscopic gastrointestinal surgery during the National Health Emergency (group exposed to the COVID-19 pandemic) from March 11, 2020 to June 8, 2020 and were compared with those patients operated between March 11, 2019 and June 8, 2019 (group not exposed to the COVID-19 pandemic). Results: A total of 104 patients were identified, 59 patients operated during the COVID-19 pandemic. All were operated by laparoscopy, both groups with a similar degree of disease severity. There was no mortality or surgical reintervention. No surgeon at the institution was infected with the virus during the study period. Conclusions: The degree of severity of abdominal surgical pathologies in this time of pandemic has not increased compared with the previous year. Likewise, the laparoscopic approach to emergency surgery was safe and effective during the pandemic.

Effect of head and tail rope‐assisted recovery of horses after elective and emergency surgery under general anaesthesia

SummaryThe recovery phase is a critical period during equine anaesthesia. In an attempt to reduce the risk of recovery, several recovery systems, including head and tail ropes, have been developed over time. However, the clinical safety and efficacy of these systems have not been compared to a nonassisted group in a larger study. The objective of this comparative, retrospective, nonrandomised single‐centre study was to determine whether the risk of developing fatal and nonfatal complications after general anaesthesia is reduced in horses assisted with head and tail ropes during recovery compared with horses recovering unassisted. Included were all horses undergoing general anaesthesia at the Large Animal Hospital, University of Copenhagen, Denmark, from 2010 to 2019. Analysed data included age, body mass, American Society of Anesthesiologists grade of physical status (ASA score), type of surgery and anaesthetic duration. Complications were divided into none, fatal and nonfatal. Logistic regression was performed to analyse the risk and predictors of fatal and nonfatal complications using the built‐in R function ‘step’. Tukey’s honest significance difference test was applied to determine significance, set at P&lt;0.05, within the categorical variables of the reduced models. The study included 1252 horses: 662 recovered with assistance (group A) and 590 without (group NA). Overall recovery‐associated mortality was 1.4%: 0.6% in group A and 2.2% in group NA. Both emergency abdominal surgery (P = 0.004) and duration of surgery (P = 0.0001) affected the risk of fatal complications negatively. Assisted recovery (P = 0.02) significantly reduced the risk of fatal complications after emergency abdominal surgery. The limitation of the study was a lack of randomisation and potentially a larger proportion of sedation among assisted horses. It was concluded that emergency abdominal surgery and duration of anaesthesia are significant risk factors for fatal complications during recovery. Head and tail rope‐assisted recovery is a significant factor of reducing fatal complications during recovery after emergency abdominal surgery.

Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China

Objective: Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence. Methods: Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS. Results: A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ(2)=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ(2)=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ(2)=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ(2)=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ(2)=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ(2)=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ(2)=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions: For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk

If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk

Validity and Utility Testing of a Criteria-led Discharge Checklist to Determine Post-operative Recovery after Abdominal Surgery: an International Multicentre Prospective Cohort Trial.

Criteria-led discharge (CLD) has promising potential to reduce unnecessary hospital stay after abdominal surgery; however, the validity and utility of CLD is uncertain as studies are limited to small single-centre studies involving predominantly elective colorectal surgery. This prospective international multicentre cohort study explored the relationship between a CLD checklist, post-operative recovery, and hospital length of stay using patient-level data from four clinical trials involving 1071 adults undergoing all types of emergency and elective abdominal surgery at five hospitals across Australia and New Zealand. Patients were assessed daily for 21 post-operative days using a standardised CLD checklist. Surgeons and hospital clinicians were masked to findings. Criterion, construct, and content validity of the checklist to accurately reflect discharge decisions by surgical teams, assess physiological recovery, and encompass parameters signalling physiological readiness to discharge were tested. Potential utility of CLD to minimise unnecessary hospital stay was assessed by comparing day of readiness to discharge to actual day of discharge. The CLD checklist had concordance with existing discharge planning practices and accurately measured a longer post-operative recovery in more complex clinical situations. The CLD checklist in its current format did not detect all legitimate medical and surgical reasons necessitating a continued stay in hospital. Day of readiness to discharge was 0.8days (95% CI 0.7 to 0.9, p < 0.001) less than actual day of discharge. A CLD checklist has excellent criterion and construct validity in measuring physiological recovery following all types of major elective and emergency abdominal surgery. Content validity could be improved. The use of CLD has the potential to reduce unnecessary hospital stay although the safety of discharging patients according to the criteria requires investigation prior to implementation. Trials were prospectively registered at the Australian New Zealand Clinical Trials Registry (LIPPSMAck POP 12613000664741, ICEAGE 12615000318583, PLASTIC 12619001344189, NIPPER PLUS 12617000269336).

Patients' perceptions of barriers to enhanced recovery after emergency abdominal surgery.

The patient-perceived barriers towards an optimized short-term recovery after major emergency abdominal surgery are unknown. The purpose was to investigate which patient-perceived barriers dominated concerning nutrition, mobilization, and early discharge after major emergency abdominal surgery. An explorative study, which focused on patient-perceived barriers for early discharge, mobilization, and nutrition, was performed within an enhanced recovery perioperative setting in major emergency abdominal surgery. Patients were asked daily from postoperative day (POD) 1 to POD 7 of their self-perceived barriers towards getting fully mobilization and resuming normal oral intake. From POD 3 to POD 7, patients were asked regarding self-perceived barriers towards early discharge. A total of 101 patients that underwent major emergency abdominal surgery were included for final analysis from March 2017 to August 2017. The main patient self-perceived barrier towards sufficient nutrition was dominated by food aversion (including loss of appetite). The main patient self-perceived barrier towards sufficient mobilization throughout the study period was fatigue. The patient self-perceived barriers towards early discharge were more diffuse and lacked a dominant variable throughout the study period; however, fatigue was the most pronounced barrier throughout the study period. The leading initial variables were postoperative ileus, insufficient nutrition, and epidural catheter. The leading later variables besides fatigue included awaiting normalization of biochemistry values, pain, and the perception of insufficient oral intake. The major patient-perceived factors that limited postoperative recovery after major emergency abdominal surgery included food aversion regarding normalization of oral intake and fatigue regarding mobilization and early discharge.

The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients.

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor.Trial registration: clinicaltrials.gov identifier: NCT02233153

RETROSPECTIVE CLINICAL STUDY OF ACUTE APPENDICITIS IN COVID-19 PANDEMIC : – A STUDY OF 100 CASES

BACKGROUND - Acute appendicitis is having around 7% probability of occurrence over one’s life time . Acute appendicitis is a common gastro-intenstinal disease affecting 5.7–57 per 1lakh individual each year with a highest incidence in children and adolescents. Acute appendicitis is the most common reason for emergency abdominal surgery and must be distinguished from other causes of abdominal pain. AIM AND OBJECTIVE - To compare the clinical presentation, grade of presentation and post-operative complication of acute appendicitis before (July 2019- February 2020) and during ( March 2020 – October2020) the COVID-19 pandemic. METHOD - Based on clinical and radiological features, cases divided into 2-groups [ pre-pandemic group( group-1) i.e. having 65 cases, and pandemic group (group-2) i.e. having 35 cases] and 5- grades [Grade-1 (Probable appendicitis), Grade-2 (Appendicitis), Grade-3 (Appendicular perforation), Grade-4 (Appendicular abscess), Grade-5 (Complicated appendicitis / appendicular mass). RESULTS- Out of 100 cases enrolled, 65 and 35 cases belongs to pre-pandemic period and pandemic period respectively. Higher grades, post-operative complications were more common in pandemic period. CONCLUSION - This pandemic period affects diagnosis, treatment protocol, and increases post-operative complications, which may be due to delayed presentation in casualty department resulting delayed diagnosis and advanced stage of the disease .

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan.

A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the postoperative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chisquare and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and postsurgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). The study found that pre-surgery wound status could be an indicator for risk of SSI in a post-operative scenario.

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia.

ObjectiveOptimizing cardiac stroke volume during high-risk surgical anesthesia is of particular interest with regard to a therapeutic target to reduce the incidence of postoperative complications. However, intensive fluid management in critically ill small animals with pulmonary hypertension (PH) has been empirically performed, and thus it can be challenging. Stroke volume variation (SVV) has been used as a dynamic preload predictor of fluid responsiveness. We hypothesized that if SVV exhibited robust reliability in the setting of hemodynamically unstable condition, it would provide more precise information on fluid resuscitation to translate it into veterinary anesthesia. Thus the aim of this study was to investigate the utility of SVV measured by the electrical velocimetry (EV) method for predicting fluid responsiveness in dogs with PH.MethodsSixteen dogs undergoing emergency abdominal surgery and diagnosed with PH secondary to myxomatous mitral valve disease (MMVD) on preoperative transthoracic echocardiogram were included. Dogs were randomly assigned to 2 groups with and without inotropic cardiac support with dobutamine. Hemodynamic measurements including stroke volume and SVV derived from the EV device were performed under general anesthesia before (baseline) and after surgery (fluid challenge with a colloid solution defined by a SV increase of ≥ 10%).ResultsIn both groups, SVV elevated significantly after abdominal surgery compared with baseline. In dobutamine infused group, the SVV values decreased significantly after fluid challenge (P < 0.05) with a greater number of responders than saline infused control group (P < 0.01). Receiver operating curve analysis of SVV confirmed high positive predictive value for dogs during dobutamine infusion (P < 0.05; cut-off value of 15%; specificity 90%, sensitivity 82%).ConclusionsNoninvasive EV monitoring may be useful for the prediction of fluid responsiveness in critically ill dogs with left-sided heart failure-related PH. This normalization of dynamic preload indices, which could be achieved more precisely under inotropic support, may prevent further detrimental consequence of fluid loading.

The Burden of Emergency Abdominal Surgery Heavily Outweighs Elective Procedures in KwaZulu-Natal Province, South Africa

BackgroundSouth Africa is a middle-income country with major discrepancies in wealth and access to care. There is a significant burden of surgical disease and limited access to quality health care for a large proportion of the population. This article quantifies the burden of abdominal surgery over a 6-month period in KwaZulu-Natal (KZN) province and quantifies the emergency to elective (Ee) ratio for these operations. MethodsThis study describes the abdominal operations conducted at all regional and tertiary hospitals in the public health sector of KZN province for the period of 1 July to December 31, 2015. Operations performed were tabulated in a spreadsheet and categorized as elective, emergency, and trauma. They were further subdivided by anatomical region and by specific predetermined procedures. Uncertain criteria were clarified using a modified Delphi discussion. The Ee ratio was determined using the recently described technique. ResultsBetween June, 1st and December 31, 2015, of 13,282 operations, there were 4580 (34.5%) elective operations, 7777 (58.6%) emergency operations, and 925 (6.9%) trauma-related operations. A total of 5630 abdominal operations were performed of which 2949 were emergency procedures. There were 660 trauma-related abdominal procedures and 2021 elective procedures. There was a heavy weighting toward emergency surgeries with an Ee ratio of 145 for abdominal surgery. The previous sub-Saharan African ratio was estimated to be 62.6. ConclusionsAn overview of abdominal surgery in KZN reveals a high ratio of emergency to elective surgery. This suggests that the current primary health care program is failing to detect and treat acute surgical disease timeously.

Role of Subcutaeous Suction Drain in Reducing Surgical Site Infections in Emergency Abdominal Surgeries

Role of Subcutaeous Suction Drain in Reducing Surgical Site Infections in Emergency Abdominal Surgeries