Hematoma Infection Research Articles

Should we inform women about the recognised risks of childbirth?

At present in Australia women are not routinely, systematically informed of the risks of childbirth. It is hoped this presentation of the perspective of some women who suffer unexpected obstetric complications will encourage change. The experience of women involved in obstetric medicolegal reports prepared by a colorectal surgeon over tenyears is analysed. Twenty women were identified. Sixteen had vaginal deliveries. All 16 suffered third or fourth-degree tears, six developed rectovaginal fistulae, six required stomas and 11 developed faecal incontinence. Of the four women who delivered by caesarean section, there were two post-operative caecal perforations, one unrecognised small bowel enterotomy, and one patient developed sepsis due to an infected haematoma. Seventeen of the 20 women were noted to suffer psychological sequalae. None of the women recollected being warned of the complication they suffered, and there was no record of such warnings in their medical records. Informed written 'consent' for natural vaginal delivery is, understandably, a contentious topic. Although learning from medicolegal cases may go against the grain, as medical professionals it is very difficult to ethically justify the status quo, where women are not routinely simply informed of the risks of childbirth. This is not fair. Even if informing women does not decrease the incidence of complications, the women who subsequently suffer these complications may well handle them much better, recognising they could occur.

Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound

Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.

Which Criterion for Wound Drain Removal is Better Following Posterior 1-Level or 2-Level Lumbar Fusion With Instrumentation: Time Driven or Output Driven?

Case-control study. To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II (P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance (P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups (P > 0.05). This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.

Perioperative Complications in 255 Patients Who Underwent Lateral Anterior Lumbar Interbody Fusion (LaLIF) Surgery.

To investigate the perioperative complications of lateral anterior lumbar interbody fusion (LaLIF) surgery. The participants were patients who underwent LaLIF surgery for degenerative lumbar diseases between April 2016 and November 2020. The collected data were classified into intraoperative and early-stage postoperative (1month) complications. Intraoperative complications were subcategorized into nerve root injury, sympathetic chain injury, segmental artery injury, iliolumbar vein injury, peritoneum laceration, temporary psoas injury, endplate damage, and vertebral body fractures. Postoperative complications were subcategorized into surgical site infection, cage migration, cage subsidence and psoas major hematoma. In the 255 included patients, 39 complications (15.3%) were reported. One patient (0.4%) had residual neurological symptoms (numbness) at the last follow-up after conservative management. The most common complications were temporary psoas injury (3.9%), followed by sympathetic chain injury (2.7%) and endplate damage (2.0%). The most frequent postoperative complication was cage migration (1.6%), followed by cage subsidence (1.2%), and surgical site infection (0.8%). The complication rates for LaLIF are generally low and comparable to those for conventional OLIF and XLIF that have been reported in other studies. Almost all complications were transient after LaLIF. Severe complications can be avoided by using sufficient muscle relaxant, instruments with the required characteristics and vertical trajectories in multiple steps.

Retraction: Failure of an Ancient Breast Implant Can Lead to Significant Morbidity.

[This retracts the article DOI: 10.7759/cureus.13700.].

ИСПОЛЬЗОВАНИЕ МЕТОДА NPWT В ЛЕЧЕНИИ ОБШИРНОЙ НАГНОИВШЕЙСЯ ПОДШЛЕМНОЙ ГЕМАТОМЫ У ВЗРОСЛОГО

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative purulent process was contributed both by the patient’s late request for medical help (18&lt;sup&gt;th&lt;/sup&gt; day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

Robotic hepaticojejunostomy for biliary stricture after liver transplantation: technical description and case series

Presenter: Jason Hawksworth MD | MedStar Georgetown University Hospital Background: Biliary strictures after liver transplantation are common and when refractive to endoscopic and percutaneous intervention require surgical biliary revision. Traditional open biliary revision may result in substantial wound morbidity and prolonged hospitalization in this high-risk population. Robotic technology facilitates minimally invasive biliary reconstruction and has not previously been described following liver transplantation. Methods: A brief description of the robotic approach is as follows: Peritoneal access is obtained at the umbilicus and a 12mm assist port is placed. Robotic ports are placed across the mid abdomen parallel to the umbilical port including 3x 8mm ports and 1x 12mm port. Lysis of adhesions is performed until the liver hilum is isolated. The bile duct is encircled and the stricture resected until healthy appearing donor bile duct is visualized. The hilar inflow structures are carefully preserved during this dissection. The inframesocolic compartment is exposed and the first jejunal loop divided with the robotic stapler. The roux limb is routed retrocolic and an isoperistaltic end-to-side jejunojejunostomy created with the robotic stapler. The common enterotomy is closed with running suture. Attention is returned to the liver hilum where an end-to-side hepaticojejunostomy is created with interrupted monofilament suture. Ultrasound is used during the case to aid in identification of the hilar structures and at the end of the case to confirm patency of the hepatic artery. The robotic cases were retrospectively compared to historical open cases over a time period from May 2013 to October 2020, including demographics, perioperative complications and outcomes. All patients had at least 3 months follow up. Results: During the study period there were 3 robotic and 4 open surgical biliary revisions. All cases were hepaticojejunostomies for choledochocholedochostomy related anastomotic strictures. In one robotic case involving a donation after cardiac death (DCD) graft, the bile duct was also noted to be sclerotic up to the liver hilum and the anastomosis was fashioned to the right and left hepatic ducts. In all cases the biliary strictures presented >90 days after transplant and were refractive to multiple endoscopic and percutaneous interventions. Median (range) case time was longer the in the robotic (373 minutes (286-373)) compared to open (280 minutes (163-321)) group. Blood loss was minimal ( < 50mL) in all robotic and open cases. The median length of stay was lower in the robotic (4 days (1-4)) compared to open (7 days (4-10)) group. Morbidity included 2 wound infections in the open group (grade 2), 1 gastrointestinal bleed requiring a blood transfusion in the robotic group (grade II), 1 infected hematoma in the robotic group (grade IIIa) and 1 bile leak on the open group (grade IIIa). Nadir bilirubin was similar between the robotic (0.2 (0.2-0.3)) and the open (0.3 (0.2-0.4)) group. Nadir alkaline phosphatase was also similar between the robotic (154 (92-245)) and the open (132 (72-166)) groups. There was no mortality in either group. Conclusion: Robotic biliary revision is a safe alternative to traditional open surgery for refractive biliary strictures after liver transplantation.

Spontaneous Broad Ligament Hematoma after Vaginal Delivery Requiring Hysterectomy

Background Broad ligament hematomas are rare in the setting of vaginal delivery. When they do occur, patients typically present with acute hemodynamic instability. No cases of infected broad ligament hematomas have been reported. Case A 22-year-old G2 P1011 status post vaginal delivery complicated by chorioamnionitis and pre-eclampsia presented 5 days postpartum with subjective complaints of fever, vomiting, and increased vaginal bleeding. She was treated with antibiotics and uterine evacuation was planned for presumed retained products. After dilation and curettage, the patient was transferred to our facility, as her clinical status did not improve, and was later found to have an infected broad ligament hematoma requiring hysterectomy. Conclusion Though uncommon, broad ligament hematomas should be considered in postpartum women presenting with anemia and vaginal bleeding, even without hemodynamic instability. Recent intrauterine infections may predispose to hematoma infection.

Death, a Rare Complication of Cranioplasty in Emergency: A Case Report

Cranioplasty is a reconstructive procedure which is performed to restore the calvarial integrity with either a stored autologous bone flap or a custom synthetic prosthesis. It is performed to protect the brain and as a cosmetic procedure. It has been shown to improve patient’s functional outcome. This procedure has been performed as early as &lt;14 days postdecompressive craniectomy. Cranioplasty in emergency which is a variant of secondary cranioplasty is rarely indicated after decompressive craniectomy. Complication rate associated with cranioplasty is relatively high. Infection, convulsions, and epidural haematoma are frequent complications of cranioplasty which are not life threatening. Fatal complications associated with this procedure are not well documented and that could be among one of the reason that death, as a complication following cranioplasty is substantially low. Here, a case of unexpected death of a 37-year-old female postcranioplasty which was performed as an emergency procedure is reported. She was a previous case of right mid one-third parasagittal meningioma who developed severe sinking skin flap syndrome after three months of parasagittal craniectomy. The patient was operated under general anaesthesia for reconstruction of the residual calvarial defect. However, the patient developed bacterial meningitis and on the 16th day postcranioplasty procedure, she died of cardiac arrest. The procedure had otherwise been uneventful and it was speculated that infection and cerebral oedema postcranioplasty might have been the cause of death.

Risk factor analysis of surgery-related complications in primary cervical spine surgery for degenerative diseases using a surgeon-maintained database.

This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed. The significant risk factors (p < 0.050) for ULP were OPLL (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.29 to 2.75), foraminotomy (OR 5.38, 95% CI 3.28 to 8.82), old age (per ten years, OR 1.18, 95% CI 1.03 to 1.36), anterior spinal fusion (OR 2.85, 95% CI 1.53 to 5.34), and the number of operated levels (OR 1.25, 95% CI 1.11 to 1.40). OPLL was also a risk factor for neurological deficit except ULP (OR 5.84, 95% CI 2.80 to 12.8), dural tear (OR 1.94, 95% CI 1.11 to 3.39), and dural leakage (OR 3.15, 95% CI 1.48 to 6.68). Among OPLL patients, dural tear and dural leakage were frequently observed in those with a canal-occupying ratio ≥ 50%. Cervical rheumatoid arthritis (RA) was a risk factor for SSI (OR 10.1, 95% CI 2.66 to 38.4). The high risk of ULP, neurological deficit except ULP, dural tear, and dural leak should be acknowledged by clinicians and OPLL patients, especially in those patients with a canal-occupying ratio ≥ 50%. Foraminotomy and RA were dominant risk factors for ULP and SSI, respectively. An awareness of these risks may help surgeons to avoid surgery-related complications in these conditions. Cite this article: Bone Joint J 2021;103-B(1):157-163.

Problem of the Care of Digestive Surgical Emergencies at the Visceral Surgery Department of Donka National Hospital in Conakry

Introduction: The goal was to highlight the issue of management of digestive surgical emergencies in our department. Methods: This was a prospective study that brought together patients treated for digestive surgical emergencies over a 10-month period (January - October 2014). Results: We collected 135 patients or 21% of all abdominal surgical conditions during the period (N=649). The average age of our patients was 34 years (range: 11 and 80); The sex ratio was 2.19. Public transport was the means used by patients. The reasons for consultation were: abdominal pain (89.63%), vomiting (77.78%), cessation of materials and gas (60%). The average consultation time was 6 days (range: 2 hours and 21 days). Acute generalized peritonitis was the most common (44.44%). The average time to treatment was 11 hours (range: 1 and 29 hours). The management was medico-surgical. The postoperative consequences were simple in (50.37%), the postoperative complications were dominated by parietal infection (30.53%), evisceration (3.70%) and scrotal hematoma (2.96%). One death was noted in (17.04%). The average length of stay was 12 days (range: 1 and 54 days). Conclusion: The management of digestive surgical emergencies remains a challenge. Morbidity and mortality would be revised downwards by reducing the diagnostic delay due to dysfunction of the care system and problems of access to care.

Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study.

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

Management of cold Abscess: A novel approach

Percutaneous abscess drainage is a widely accepted method of treatment of an accessible abscess. Consistently, poor results have been reported by various authors due to presence of infected hematomas or presence of thick, viscous and purulent material. Several studies have proven the potential benefit of fibrinolytic therapy for treating abscess especially those with thick purulent material, old blood or loculations. The present report highlights the efficacy of fibrinolytic therapy in loculated abscess. Keywords: Cold abscess; Fibrinolytic agent; TB.

A retrospective analysis of emergency referrals and admissions to a regional neurosurgical centre 2016–2018

Background and objectives Emergencies account for 60% of UK neurosurgical workload. We analysed the emergency referrals made to the on-call neurosurgical registrar in a regional centre over three years, aiming to identify temporal trends in volume of referrals, admission practices and major diagnostic categories contributing to referrals and admissions. Methods Individual referrals recorded in on-call databases were processed to extract basic demographics, call timing, diagnosis category and whether the patient was admitted under neurosurgery. Linear regression analysis was used to identify temporal trends across the three years. Results A total of 18128 calls were made to the on-call registrar between 2016 and 2018, with a significant increase in monthly calls. On average, one call was received every 88 minutes. An increasing proportion of these calls were taken out of office hours. Diagnostic categories accounting for the largest percentage of calls were traumatic brain injury (17.7%) and cauda equina syndrome (13%). Significant increases in referral volume were seen in cauda equina syndrome, traumatic brain injury, spinal trauma and spinal tumours, while no category had a significant decrease. The admission rate was 17.1% – no change was seen in this across the study period, resulting in increasing numbers of admissions, reflecting increasing referrals. Categories most likely to result in admission were hydrocephalus (41.1%), spontaneous subarachnoid haemorrhage (39.4%), intracranial infection (32.6%) and chronic subdural haematoma (CSDH, 32.2%). A change in admission rate was seen only for CSDH, with a significant increase in the percentage of referrals across the study period. Conclusion Emergency neurosurgical referrals continue to rise in the UK at a rate exceeding population growth. This implies a decreasing referral threshold. However, the constant admission rate suggests either an increasing amount of neurosurgical pathology, the threshold for admission/intervention has decreased, or a combination. Neurosurgical services need to adapt in order to meet increasing demands.

Symptomatic pelvic hematoma following hysterectomy: risk factors, bacterial pathogens and clinical outcome

BackgroundPelvic hematoma is a common finding following hysterectomy which at times may become infected causing substantial morbidity. The aim of this study was to describe the incidence, clinical manifestation and identify risk factors for infected pelvic hematoma. We also attempted to identify specific bacterial pathogens which may cause this phenomenon.MethodsWe conducted a retrospective cohort study at a tertiary university teaching hospital. Included were all women who underwent hysterectomy and were diagnosed with a pelvic hematoma following surgery from 2013 to 2018. In an attempt to assess possible risk factors for infected pelvic hematoma women with asymptomatic pelvic hematoma were compared to women with an infected pelvic hematoma.ResultsDuring the study period 648 women underwent hysterectomy at our medical center. Pelvic hematoma was diagnosed by imaging in 50 women (7.7%) including 41 women who underwent vaginal hysterectomy and 9 women who underwent abdominal hysterectomy. In 14 (2.2%) cases the hematoma became infected resulting in need for readmission and further treatment. Women who underwent vaginal surgery were more likely to return with infected pelvic hematoma compared to women who underwent open abdominal or laparoscopic surgery (4.5% vs. 1.1%, p < 0.05). In 8 women bacterial growth from hematoma culture was noted. Enterococcus faecalis, was the most abundant pathogen to be isolated in this sub-group.ConclusionVaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.

First surgical experience with a COVID-19 positive patient in Costa Rica: case report, staff safety protocol and brief review of literature

BackgroundThe safe management of patients with COVID-19 has been a challenge during the current pandemic, leading to healthcare workers being disproportionately affected by the virus. In Costa Rica, 20% of all infections and 27% of all ICU cases during the initial weeks of the outbreak were healthcare workers. The existing recommendations and protocols on how to care for an infected patient that requires acute surgical management have been applied successfully in various scenarios. We look to describe the first case of a COVID-19 patient that required surgical management in Costa Rica and present a summary of the protection measures utilized in a tertiary care hospital.Materials and methodsA review of literature utilizing Embase, Medline Complete and Google Scholar was performed. A surgical case report using the SCARE statement guidelines was drafted and a brief summary of the 54 items contained in the hospital’s COVID-19 surgical protocol is described.Case presentationWe present the case of a 29 year old obese male who had acute appendicitis with perforation that contracted SARS-CoV-2 and became symptomatic at home on pod#3, who later required multiple surgeries to address an infected abdominal hematoma both while having an active COVID-19 infection and afterwards.ConclusionsSafety measures for both staff and patients are of the utmost importance during the current coronavirus pandemic. Limitations in the availability of personal protection equipment as well a lack of knowledge and experience with handling surgical patients with this condition have led to various safety and attention protocols being drafted. The successful management of this patient is the first experience in Costa Rica on how to properly address staff safety during a surgical procedure. None of the workers involved in care of this patient were diagnosed with SARS-CoV-2.

Effect of Sutimlimab Treatment on Healthcare Resource Utilization in Patients with Cold Agglutinin Disease

Introduction Cold agglutinin disease (CAD) is a serious and rare autoimmune disorder associated with severe fatigue, weakness and other symptoms of chronic anemia and hemolysis. Prior studies have demonstrated that CAD is associated with substantial economic burden and healthcare resource use, including blood transfusions, and highlight an unmet need for novel treatments (Mullins M et al. Blood Adv 2017; Su J et al. J Med Econ 2019). In the pivotal CARDINAL study (Part A), sutimlimab (BIVV009), a monoclonal antibody that targets the underlying cause of hemolysis in CAD by selectively inhibiting complement C1s, provided clinically meaningful improvements with an acceptable safety profile in CAD patients (Röth A et al. Blood 2019). A post hoc analysis was conducted to describe the impact of sutimlimab treatment on healthcare resource utilization (HCRU) in CAD patients. Methods CARDINAL is a Phase 3 open-label, international, multicenter, single-arm study (NCT03347396), evaluating the efficacy, safety, and tolerability of sutimlimab in patients with primary CAD and a recent history of blood transfusion (defined as having ≥1 transfusion 6 months prior to enrollment). The study enrolled 24 patients who received an IV infusion of sutimlimab over approximately 60 minutes on Day 0, Day 7, and every 14 days thereafter through Week 25. Post-hoc analysis of the full analysis set assessed hospitalizations and transfusions that occurred in the 6 month period pre- and post-administration of the first treatment dose. Distribution and descriptive statistics (mean, SD, median, min and max) were determined pre- and post-treatment periods and calculated for the differences between the pre- and post-treatment periods. Results The number of hospitalizations experienced by CAD patients in this post hoc analysis decreased 3.3-fold following sutimlimab treatment: from 10 patients (41.7%) in the pre-treatment period to 3 patients (12.5%) in the post-treatment period. Pre-treatment hospitalizations were the result of CAD-related symptoms or blood transfusion. Reasons for post-treatment hospitalizations included sepsis, infection and blood transfusion. The mean number of hospitalizations per patient decreased post-treatment compared with pre-treatment, but the mean duration of hospitalization per patient was similar between treatment periods (Table). During the post-treatment period, one patient was hospitalized for 18 days due to an infected hematoma following surgery, unrelated to sutimlimab treatment. Nine patients (37.5%) experienced fewer hospitalizations, shortened mean and total hospitalization duration following treatment. Similarly, blood transfusion use by CAD patients also decreased following sutimlimab treatment. Pre-treatment, all patients received ≥1 transfusion, decreasing to 41.7% patients post-treatment. This represented a total of 105 transfusions pre-treatment and 25 transfusions post-treatment, respectively (Table). Overall, 95.9% (23/24) patients received, at least, one less transfusion during the post-treatment versus pre-treatment period. The mean number of units transfused per transfusion was similar pre- and post-treatment; notably, the total number of units transfused decreased from 196 pre-treatment to 43 post-treatment (Table). Conclusion This post hoc analysis of HCRU data from the CARDINAL study provides evidence that CAD is a serious condition that can require hospitalization and blood transfusions. Sutimlimab treatment demonstrates substantial reductions in hospitalizations and blood transfusions. This results in a reduced HCRU impact and decreases the associated burden for hospitals, patients and payers. Disclosures Röth: Roche: Consultancy, Honoraria, Research Funding; Biocryst: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Apellis: Consultancy, Honoraria; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria, Research Funding. Guillonneau:Sanofi: Current Employment, Current equity holder in publicly-traded company. Narcisse:Sanofi: Consultancy. Carita:Sanofi: Current Employment, Current equity holder in publicly-traded company. Su:Sanofi: Current Employment, Current equity holder in publicly-traded company. Joly:Sanofi: Current Employment, Current equity holder in publicly-traded company.

Complications of Pelvic Organ Prolapse Surgery in the 2015 Finnish Pelvic Organ Prolapse Surgery Survey Study.

To describe the major complications of pelvic organ prolapse (POP) surgery in Finland. The Finnish Pelvic Organ Prolapse Surgery Survey 2015 study is a prospective cohort of POP surgeries performed in Finland in 2015. Perioperative, postoperative, and late complications during 1 year of follow-up were compared among native tissue repair, transvaginal mesh, and abdominal mesh surgery. Major complications were assessed using the Clavien-Dindo grading system. Predictive factors for major complications were studied with logistic regression analysis. Within 1 year after POP surgery, 396 (11.2%) of 3,515 women had at least one complication: 10.9% after native tissue, 11.7% after transvaginal mesh, and 13.5% after abdominal mesh repair. The majority of complications occurred within 2 months after surgery and postoperative infection (4.3%) and bleeding or hematoma (2.6%) were the most frequent. The incidence of organ injuries was low. Mesh-augmented surgery was associated with significantly higher rates of bladder and bowel injuries than native tissue surgery. Complication-related reoperations occurred significantly more often after abdominal mesh repair than native tissue surgery (5.2% vs 1.8%, P=.001). Mesh-related complications were diagnosed more often after transvaginal mesh repair. The overall rate of major complications (Clavien-Dindo grades III-V) was 3.3%. Abdominal mesh surgery was associated with the highest rate of major adverse events (8.8% vs native tissue repair 2.6% and transvaginal mesh 4.9%). The incidence of Clavien-Dindo grade IV or V complications was rare (less than 0.6%). Mesh surgery (transvaginal mesh adjusted odds ratio [aOR] 2.23, 95% CI 1.31-3.80, and abdominal mesh aOR 3.02, 95% CI 1.67-5.46), longer operating time (aOR 2.84, 95% CI 1.78-4.53), prior POP surgery (aOR 1.68, 95% CI 1.00-2.81) and difficult surgery (aOR 2.75, 95% CI 1.63-4.62) were associated with an increased risk for occurrence of major complications. Serious adverse events were rare regardless of the operative approach. However, mesh-augmented surgery was associated with higher risk for major complications.

Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: A single-center retrospective experience.

Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce. A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n=4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P=.007) and fungal contamination of PF (3/7 vs 0/8, P=.008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year. IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.

External validation study of hip peri-prosthetic joint infection with cemented custom-made articulating spacer (CUMARS).

Peri-prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The use of custom-made articulating spacers (CUMARS) has been described for use in the first of 2-stage treatment. We report our outcomes of managing PJI using CUMARS. Patients undergoing 1st-stage revision using the Exeter standard stem, all-polyethylene acetabulum and antibiotic-loaded cement were identified. Medical records were assessed for demographics, microbiological and operative treatment, complications, eradication of infection and reoperations. No postoperative restrictions were enforced. 2nd-stage revision was undertaken in the presence of pain or subsidence. 53 patients underwent 1st-stage revision using this technique. The average follow-up was 3.9 (range 0.5-7.2) years. Infection was eradicated in 47 (88.7%) patients. 2 patients had chronic infection managed with suppressive antibiotics, 2 patients died before eradication confirmed, 1 patient had raised inflammatory markers but no positive aspiration cultures, 1 patient was lost to follow-up. Complications occurred in 5 (9.4%) patients - 4 dislocations and 1 infected haematoma. 4 patients required a repeated 1st stage. 2nd-stage revision was performed in 19 patients (35%). The CUMARS technique is an effective way of eradicating PJI after THA. It maintains function by providing a stable construct that permits weight-bearing. It delays or negates the need for 2nd-stage revision. Furthermore, it allows surgeons to choose between managing patients prospectively as a single-stage revision with the option of reverting to a 2nd stage.