Increase In Surgical Complications Research Articles

The Effect of Obesity on Surgical Outcomes in General Surgery Patients: A Systematic Review of 1,680,694 patients

The study examined the impact of obesity on general surgery patients, analyzing eleven studies with 1,680,694 patients. Results showed that obesity increases postoperative wound infection risk, blood loss, and recovery times. However, prospective studies found no increase in surgical complications or hospitalization expenses. Obesity may protect against venous thromboembolism and death, but post-operative complications in obese patients undergoing general surgical procedures remain controversial due to metabolic, pharmacologic, and systemic illnesses. Obesity increases surgical duration and SSIs, potentially increasing immediate complications.

Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases

ObjectiveTo evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. MethodsDuring a period of two years, all General Surgery resident doctors at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. ResultsThere was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. ConclusionThe impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.

Transplanting a left or right donor kidney into the left or right iliac fossa: importance of laterality and site of venous anastomosis.

Data on the impact of donor-to-recipient laterality on kidney transplantation are lacking. This study evaluated the impact of donor-to-iliac fossa laterality and the site of venous anastomosis on operating time and surgical outcome. This retrospective single-center study analyzed 1262 deceased donor adult kidney transplants into pristine iliac fossa. Multivariable linear and logistic regression analyses were used to identify variables with an impact on operating time and surgical complications. Operating time was shorter by 11min in median for transplantations into the right iliac fossa compared to the left iliac fossa (p < 0.001). Operating time in left-to-right donor-to-recipient combination was shorter by 17min in median if venous anastomoses were performed on the caval vein or common iliac vein as compared to anastomoses to the external iliac vein (p < 0.001). Overall, the shortest operating times (median 112.5min) were achieved in left-to-right donor-to-recipient combinations with venous anastomosis to the caval or common iliac vein, without an increase in surgical complications. Kidney transplantation into the right iliac fossa with anastomosis to the caval vein or the common iliac vein saves operating time and reduces thrombotic complications. Acceptance of a left donor kidney is likely to further reduce operating time.

Comparative evaluation of enema alone and in combination with oral polyethylene glycol for bowel preparation before transvaginal pelvic floor reconstruction in elderly patients: a retrospective cohort study

The aim of this retrospective study was to assess the value of using an enema alone for mechanical bowel preparation (MBP) before transvaginal pelvic floor reconstruction (TPFR) in patients ≥65 years old. In total, 190 patients were included [81 in the enema group vs. 109 in the enema + polyethylene glycol (PEG) group]. The levels of serum potassium (p = .004) and calcium (p = .005) were higher in the enema group after surgery. The decrease in serum calcium was more significant in the enema + PEG group (p = .027). More patients in the enema + PEG group developed hypokalaemia (p = .035) or hypocalcaemia (p = .008) after surgery. The incidence of thrombus and surgical site infection was similar and earlier bowel movement was evident in the enema group (p = .000). Overall, the enema group used more laxatives (p = .026). Using enema alone before TPFR reduces the incidence of electrolyte disturbances with no increase in surgical complications in elderly patients. IMPACT STATEMENT What is already known on this subject? TPFR is an effective treatment for pelvic organ prolapse (POP) in elderly women. Bowel preparation performed before gynecological surgery can reduce surgical site infection, but increase discomfort and electrolyte disturbance. What do the results of this study add? The levels of serum potassium and calcium were lower in the enema + PEG group than in the enema group after surgery and more patients developed hypokalaemia or hypocalcaemia in the enema + PEG group. The incidence of thrombus and surgical site infection was similar between the two groups. Bowel movement was earlier in the enema group. What are the implications of these findings for clinical practice and/or future research? Using enema alone before TPFR reduces the incidence of electrolyte disturbance and does not increase surgical complications. This conclusion needs to be confirmed by random controlled trial studies in the future.

Safety of Breast Reconstruction Using Inferiorly Based Dermal Flap for the Ptotic Breast.

The use of an inferiorly based dermal flap (IBDF) with implant insertion allows for 1-step reconstruction of a ptotic breast after mastectomy. An IBDF allows for secondary protection of the inferior pole and provides a vascularized pocket for implant insertion. Previous literature has demonstrated the use of this surgical approach for optimal patient satisfaction and higher patient-reported outcomes.For this approach, the dermal flap epidermis is removed before insetting; however, invaginations containing epithelial components may serve as a nidus for infection. There is no study that has compared the safety of an IBDF technique to standard reconstruction. We hypothesize that there is no increase in surgical complications in the IBDF approach versus standard reconstruction. This is a single-institution retrospective chart review of all patients who underwent implant-based reconstruction from June 2016 through December 2020. Patients who did not have a permanent implant placed by December 2020 or had delayed reconstruction were excluded. Two cohorts were established: those who underwent immediate reconstruction after mastectomy via IBDF and reconstruction without an IBDF. Patient demographics, use of the IBDF technique, and surgical complications were recorded and compared. A total of 208 breasts were included: 52 breasts in the IBDF cohort and 156 breasts in the control cohort. There were no statistically significant differences between cohorts, except that the IBDF cohort has a significantly higher body mass index (mean = 30.9 vs 26.5, P ≤ .001).There was no statistically significant difference in the rate of complications between the IBDF and control groups, including seroma (5.8% vs 3.8%), hematoma (3.8% vs 0.6%), wound dehiscence (0.0% vs. 1.9%), mastectomy flap necrosis (11.5% vs 6.4%), breast infection (5.8% vs 7.1%), implant salvage (0.0% vs 5.8%), and implant loss (5.8% vs. 5.8%), respectively. Using an IBDF to reconstruct a ptotic breast immediately after mastectomy has a similar risk profile to an immediate standard breast reconstruction. This technique has resulted in optimal patient satisfaction scores and allows for a "one-stop reconstruction" of ptotic breasts that normally would undergo sequential revisions. In conclusion, immediate implant-based reconstruction of a ptotic breast after mastectomy using a IBDF can be performed safely.

Nighttime Kidney Transplant From Donor With Controlled Cardiac Death: Greater Functionality at the Cost of More Complications?

Kidney transplantation surgery from controlled cardiac death donor (Maastricht III) is frequently performed at night, without taking into account the accumulated fatigue that the surgical team may experience. The objective of the study is to assess whether surgical complications and the functionality of the graft in the short and long term are affected by the time of day in which kidney transplantation from controlled cardiac death donors is performed. A retrospective observational study was carried out. Patient were classified according to the start of surgery, daytime hours (8:00 AM to 7:59 PM), and nighttime hours (8:00 PM to 7:59 AM). Baseline and intraoperative parameters, postoperative complications, and parameters related to graft functionality were analyzed. A total of 77 patients were included: 37 patients had kidney transplantations performed during the daytime (48.05%), and 40 patients had kidney transplantations performed at nighttime (51.95%). No statistically significant differences were found between the baseline characteristics of both groups except for sex (55.0% men in daytime vs 78.4% men in nighttime, P=.03) and time on pretransplant dialysis (33.1 months in daytime vs 13.8 months in nighttime, P=.008). The incidence of surgical complications and the functionality of the graft was similar in both groups; however, the surgical time was shorter in night transplants (163.2 minutes in daytime vs 136.5 minutes at nighttime, P=.0006) CONCLUSION: The performance of kidney transplants at night is not associated, either in the short or long term, with an increase in surgical complications or conditions leading to the deterioration in the functionality of the graft.

Controversy and prospect of transanal total mesorectal excision

As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.

Clinical Outcomes Following Regionalization of Gastric Cancer Care in a US Integrated Health Care System.

In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for patients eligible for curative-intent surgery. This study evaluated the effect of regionalization on outcomes. The retrospective cohort study included gastric cancer cases diagnosed from January 2010 to May 2018. Information was obtained from the electronic medical record, cancer registry, state vital statistics, and chart review. Overall survival was compared in patients with all stages of disease, stage I-III disease, and curative-intent gastrectomy patients using annual inception cohorts. For the latter, the surgical approach and surgical outcomes were also compared. Among 1,429 eligible patients with gastric cancer with all stages of disease, one third were treated after regionalization, 650 had stage I-III disease, and 394 underwent curative-intent surgery. Among surgical patients, neoadjuvant chemotherapy utilization increased from 35% to 66% (P < .0001), laparoscopic gastrectomy increased from 18% to 92% (P < .0001), and D2 lymphadenectomy increased from 2% to 80% (P < .0001). Dissection of ≥ 15 lymph nodes increased from 61% to 95% (P < .0001). Surgical complication rates did not appear to increase after regionalization. Length of hospitalization decreased from 7 to 3 days (P < .001). Overall survival at 2 years was as follows: all stages, 32.8% pre and 37.3% post (P = .20); stage I-III cases with or without surgery, 55.6% and 61.1%, respectively (P = .25); and among surgery patients, 72.7% and 85.5%, respectively (P < .03). Regionalization of gastric cancer care within an integrated system allowed comprehensive multidisciplinary care, conversion to laparoscopic gastrectomy and D2 lymphadenectomy, increased overall survival among surgery patients, and no increase in surgical complications.

Impact of surgeon rhBMP-2 cost awareness on complication rates and health system costs for spinal arthrodesis.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used in spinal arthrodesis procedures to enhance bony fusion. Research has suggested that it is the most cost-effective fusion enhancer, but there are significant upfront costs for the healthcare system. The primary objective of this study was to determine whether intraoperative dosing and corresponding costs changed with surgeon cost awareness. The secondary objective was to describe surgical complications before and after surgeon awareness of rhBMP-2 cost. A retrospective medical record review was conducted to identify patients who underwent spinal arthrodesis procedures performed by a single surgeon, supplemented with rhBMP-2, from June 2016 to June 2018. Collected data included rhBMP-2 dosage, rhBMP-2 list price, and surgical complications. Expected Medicare reimbursement was calculated. Data were analyzed before and after surgeon awareness of rhBMP-2 cost. Forty-eight procedures were performed using rhBMP-2, 16 before and 32 after surgeon cost awareness. Prior to cost awareness, the most frequent rhBMP-2 dosage level was x-small (38.9%, n = 7), followed by large (27.8%, n = 5) and small (22.2%, n = 4). After cost awareness, the most frequent rhBMP-2 dosage was xx-small (56.8%, n = 21), followed by x-small (21.6%, n = 8) and large (13.5%, n = 5). The rhBMP-2 average cost per surgery was $4116.56 prior to surgeon cost awareness versus $2268.38 after. Two complications were observed in the pre-cost awareness surgical group; 2 complications were observed in the post-cost awareness surgical group. Surgeon awareness of rhBMP-2 cost resulted in use of smaller rhBMP-2 doses, decreased rhBMP-2 cost per surgery, and decreased overall hospital admission charges, without a detectable increase in surgical complications.

326 Placenta accreta spectrum treatment with intraoperative multivessel embolization to improve surgical outcomes: the PASTIME protocol

To assess the implementation of a novel protocol for treating placenta accreta (PAS) spectrum, combining cesarean delivery with immediate vascular embolization and subsequent hysterectomy in a single procedure using a hybrid operative suite. A matched pre-post implementation study of PAS cases managed before (2010-2017) and after implementation of the PASTIME protocol (2018-2020) at a tertiary medical center. PASTIME cases were matched to pre-PASTIME controls in a 1:2 ratio on PAS severity and surgical urgency. The primary outcome was intraoperative blood loss (EBL). Secondary outcomes included transfusion rate, surgical time, intra and post-operative complications, Intensive care unit (ICU) and total length of stay, maternal mortality, and neonatal outcomes. Thirteen PASTIME cases and 26 matched controls were included. No significant demographic differences were noted between groups. EBL was significantly lower in the PASTIME group (750 vs 1750 mL, p = 0.01). Transfusion (38.5% vs 61.5%, p = 0.20) and massive transfusion (0% vs. 19.2%, p = 0.15) trends were improved in the PASTIME group. Surgical times were similar between groups, whereas an average of 58.2 minutes was required for embolization in the PASTIME group. ICU and postpartum LOS, non-transfusion related intra and post-operative complications were similar between groups. Three maternal deaths were observed in the control group while none occurred in the PASTIME group. Gestational age and birth weights were similar, while low 5-min APGAR was more common in the PASTIME group (76.9% vs 38.5%, p = 0.04). A multidisciplinary pathway including a single-surgery protocol with multivessel uterine embolization significantly decreases maternal blood loss with no increase in surgical complications. This PASTIME protocol provides a definitive surgical method that warrants consideration by centers specializing in PAS treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of the Extent of Microsurgical Resection in Sphenopetro-clival Meningiomas Trough a Multistaged Approach: A Volumetric Analysis.

Objective Sphenopetroclival meningiomas (SPCMs) represent a challenge for surgical treatment. The authors used an objective volumetric analysis to assess the effect of the grade of resection and different surgical strategies that may affect the outcome of this tumors. Methods Over a period of 4 years, patients with SPCMs were treated using a middle versus posterior fossa approach, or a two-stage surgery combining both approaches, based on the tumor location in relation to the petrous ridge and tumor volume. Retrospectively, all cases were analyzed with regard to tumor volume, extent of resection (EOR), functional outcome, and complications. Results Twenty-seven patients with SPCMs met the inclusion criteria, and the mean follow-up was 24.8 months. Eleven patients underwent a two-stage surgery, while 16 patients had their SPCMs resected via a single craniotomy. Mean EOR was 87.6% and gross total resection was achieved in 48% of patients. Patients with greater EOR had better functional outcomes ( r = 0.81, p < 0.01). Greater EOR was not accompanied by a significant increase in surgical complications. There was a trend toward lower postoperative volumes and better EOR with our two-stage approach (2.2 vs. 3.2 cm 3 , p = 0.09; and 94.1 vs. 91.2%, p = 0.49, respectively), without an increase in the rate of complications (18.7 vs. 18.2%, p = 0.5). Conclusion Staging of the surgical resection of larger tumors may lead to greater EOR, and this strategy should be considered for larger tumors.

Epidemiology and results of surgical treatment of euthyroid and toxic goiter depending on the peculiarities of clinical course, tracheal compression and comorbidity

At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively. To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment. A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations). Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (&chi;2, p&le;0.01). The appearance of &laquo;wheezing&raquo; on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (&chi;2, p&le;0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes. Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.

IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?

ABSTRACTObjective:Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery.Methods:A cohort study was conducted in all patients undergoing free flap limb reconstructions between July 2014 and July 2018. Patients were separated in two groups based on their body mass index (BMI): non-obese and obese (BMI≥30 kg/m2).Results:Twenty-three free vascularized fibular flaps were studied. The indications included trauma in 13, tumors in 7, and congenital pseudarthrosis of the tibia in 3. Obese patients were associated with an increase in surgical complications (p=0.038). During the final follow-up, consolidation was obtained in 17 patients (74%).Conclusion:Obesity is a risk factor for complications in free vascularized fibular flap surgery. Level of evidence IV, original article.

Early Outcomes of Liver Transplantation Using Donors After Circulatory Death in Patients With Hepatocellular Carcinoma: A Comparative Study

IntroductionDonation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not overall recommended because it entails an added risk. However, DCD in selected patients shows acceptable results. ObjectiveThe objective was to analyze the characteristics, early outcomes, and survival at 1 year post-LT from a single institute (January 2015 to May 2017). Materials and methodsWe included 18 DCD-LTs and compared them with a control group of 18 donation after brain death (DBD) LTs. We analyzed pre- and posttransplant variables related to donors, recipients, and intraoperative early outcomes within patients transplanted due to hepatocellular carcinoma (HCC). A descriptive analysis, Mann-Whitney U test, χ2, or Fisher test was performed when appropriate, as well as multivariate analysis in case of statistical significance. A variable is considered as statistically significant when it reaches a value of P < .05. ResultsIn DBD, we found a lower length of stay in the intensive care unit before retrieval and a higher rate of alcoholism and diabetes mellitus, Model for End-Stage Liver Disease score, and Child B and C score (P < .05). Most of the DCD were originally from the same LT recipient center, and a higher donor mean post-LT alanine aminotransferase level was found (P < .05). Survival for the DBD group was 88% and 75% in the DCD group at 1 year post-LT, being not significant (NS). ConclusionHCC recipients who are transplanted with good quality DCD livers do no worse than those transplanted with livers from DBD donors, although a good selection of them is crucial.

Feasibility and safety of prostatic vaporization using 180W greenlight system in day surgery mode

Objective To evaluate the feasibility and safety of 180W greenlight laser in the treatment of benign prostatic hyperplasia (BPH) in the day surgery mode. Methods A retrospective review included 65 patients with benign prostate hyperplasia who were treated with photoselective vaporization of the prostate (PVP) under 180W greenlight system from Jan 2017 to Jan 2018, was performed. The patients’ age ranged from 54 to 75 years old and the prostatic volume ranged from 42 to 93 ml. All patients were classified into two groups [day sugery group(n=29) and inpatient surgery group(n=36)] based on the wishes of patients. In day sugery group, the admission, operation and discharge were completed in 24 hours. The preoperative clinic parameters such as prostate volume, IPSS, Qmax, QOL and PVR were recorded in the two groups. The prostatic volume in two groups was (67.3±15.9) ml and (70.4±16.1) ml, respectively. The IPSS and QOL scores in two groups were (23.2±4.6 vs. 23.9±4.5) and (4.7±0.9 vs. 4.4±0.8), respectively. The Qmax and PVR in two groups were [(6.7±2.5)ml/s vs. (6.8±2.8)ml/s] and [(133.9±81.3)ml vs.(105.8±76.3)ml], respectively.The time of catheterization and postoperative hospitalization, total cost, postoperative adverse events were recorded, too. All the clinic data of preoperation, intraoperation and postoperation were compared between two groups. Results The operations and follow-up were successfully executed in all patients. There were not statistical significance differences in preoperative parameters between the two groups (P>0.05). There were not statistical significance differences in operating time [(67.8±9.8) min vs.(70.9±12.8) min], laser time [(49.8±8.3) min vs.(51.6±10.4) min], energy used [(295.7±112.6) kJ vs.(285.0±108.2) kJ], between the two groups, too (P>0.05). A significantly less mean catheter duration, hospital stay and hospital charges were observed in the day surgery group [(14.6±2.0)hours, (0.5±0) days and (23 279±511) yuan, respectively] than in the inpatient surgery group [(51.7±11.8) hours, (3.0±0.8) days and (27 452±440)yuan, respectively, P 0.05). However, significant difference of those items could be noticed when compared with those items before surgery(P<0.05). Conclusions In the day surgery mode, 180W greenlight laser vaporization of the prostate is safe and effective, without the increase of surgical complications. The length of stay and hospitalization expenses were much less. Thus, this strategy is worth promoting in clinical practice. Key words: Day surgery; Benign prostatic hyperplasia; Greenlight laser; Photoselective vaporization of the prostate

Outcomes of Liver Transplantation Using Older Donors After Circulatory Death and the Super-Rapid Technique: 14 Cases

IntroductionDonation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not recommended with donors aged 60 years or more because it entails an added risk. However, donation after brain death (DBD)-LT with donors aged 70 years or more shows acceptable results. ObjectiveThe objective was to analyze the characteristics and complications of DCD-LT with donors aged 70 years or more (DCD-70). Materials and MethodsWe included 14 DCD-70-LT and compared them with a control group of 28 DBD-LT aged 70 years or more. Statistical AnalysisA descriptive analysis, Mann-Whitney U test, and Pearson chi-square or Fisher test were performed when appropriate. ResultsSignificant differences were found in aminotransferase peak at 24 hours, with an increase in the DCD-70 group (aspartate aminotransferease [AST] 1038 vs 507, P = .013; alanine aminotransferase [ALT] 750 vs 399, P = .014). The cold ischemia time was lower in DCD-70 although without significant differences (4.8 vs 6.7 hours). Biliary complications (28.6% vs 31.7%) and vascular complications (7.1% vs 7.1%) were similar. A single transplant with DCD-70 required a retransplantation due to arterial thrombosis. Mortality was the same in both cases (14.3%). ConclusionLT results with DCD-70 are similar to those of DBD-70, so the age criteria could also be extended in this type of donation.

Glycemic Outcomes 3 Years After Implementation of a Peri-Operative Glycemic Control Algorithm in an Academic Institution

While hyperglycemia in the postoperative setting has been linked to an increase in surgical complications, limited data are available to inform the management of patients with diabetes in the operating room and the immediate peri-operative period. We describe the results of a peri-operative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120 to 180 mg/dL for patients with diabetes presenting with a BG level >180 mg/dL and included transition to subcutaneous insulin. Patients with known diabetes and a BG >180 mg/dL who underwent surgery were included. The control group included 260 patients from March 2, 2008 through December 31, 2008. The intervention group included 588 patients following protocol implementation from April 1, 2009 through December 31, 2012. Data included demographic information, hospital BG values, length of stay (LOS), mortality, and wound infections. The intervention group had significantly lower BG on arrival in the postoperative care unit (182.2 vs 194.9 mg/dL, P = .012). Mean BG during the first 24 hours after surgery was lower in the intervention group (182.1 vs. 190.5 mg/dL), and there were fewer BG values >200 mg/dL in the intervention group (P = .005). The percentage of BG values <70 mg/dL during the hospital stay was lower in the intervention group (1.94 vs. 2.43%, P<.01). There was no significant difference in mortality, LOS, or wound infections. Following implementation of a hospital-wide peri-operative glycemic control algorithm, we found a reduction in peri-operative BG levels and hypoglycemia rates. Ongoing research is needed to assess the impact on clinical outcomes. BG = blood glucose CCI = Charlson comorbidity index EHR = electronic health record ICD-9 = International Classification of Disease-9 IV = intravenous LOS = length of stay OR = operating room PACU = postoperative care unit POC = point-of-care.

A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy.

Background. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4–6 mg) (n = 70) or a higher dose (8–14 mg) of dexamethasone (n = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. Results. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P = 0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control (P = 0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. Conclusion. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.

Is Extensive Parenchymal Resection During Robotic Partial Nephrectomy Justified? A Match-Paired Comparison of Two Extirpative Surgical Modalities for Treatment of a Complex Renal Neoplasm.

To analyze the outcomes of robotic partial nephrectomy (RPN) in patients where nephron-sparing surgery would have mandated a large amount of renal volume resection. Patients undergoing RPN with extensive volume resection (≥30%), from 2006 to 2014, were identified. Pre- and postoperative CT/MRI-based volumetric assessment of the operated kidney was performed. To address the possible benefits of RPN, we matched this cohort to patients undergoing laparoscopic radical nephrectomy (LRN). The groups were matched for tumor size, R.E.N.A.L. nephrometry score, age-adjusted Charlson comorbidity index (ACCI), and preoperative estimated glomerular filtration rate (eGFR). Demographics, perioperative, functional, and oncologic outcomes were compared between the groups. Multivariable analysis of factors predicting chronic kidney disease (CKD) upstaging (type of surgery, R.E.N.A.L. score, ACCI, and baseline eGFR) was performed. In total, 52 patients undergoing RPN were matched to 52 LRN patients. The median R.E.N.A.L. score (interquartile range) was 9 (9-10) for both groups. Demographic variables were comparable between the groups. The median renal volume preservation in the RPN group was 57.0% (47.2-67.2). The rates of overall and major complications were comparable between RPN and LRN. The RPN group had higher overall eGFR preservation (75.8% vs 68.5%; p = 0.01) and a lower rate of CKD upstaging (26.9% vs 50.6%; p = 0.001). On multivariable analysis, LRN and baseline eGFR were significant predictors of CKD upstaging (odds ratio [OR] 4.26; 95% CI [1.80-10.12]; p = 0.001 and OR 0.98; 95% CI [0.96-0.99]; p = 0.03, respectively). During the median follow-up time of 21 (9-36) months, local recurrence, metastasis, and cancer-specific and overall survival were comparable between RPN and LRN. RPN requiring extensive volume resection provides renal functional preservation without significant increase in surgical complications or compromising short-term oncologic outcomes.

Topical Tranexamic Acid Reduces Drainage Blood Loss in Primary Total Knee Arthroplasty: A Retrospective Study

Introduction: Total knee arthroplasty (TKA) surgery is associated with significant bleeding and commonly requires allogeneic blood transfusion. Although tranexamic acid (TXA) is reported to reduce post-operative bleeding, concerns on the safety of systemic TXA and of patients with higher risk of deep-vein thrombosis or pulmonary embolism have hindered its wider use. This retrospective study aimed to assess the safety and efficacy of topical TXA in patients undergoing primary TKA. Patients and methods: Between January 2008 and December 2011, a consecutive series of 271 patients who underwent TKAs in hospital single medical center were reviewed. The TXA group received topical tranexamic acid at the end of surgery while the control group did not. Drainage blood loss was measured and the need for blood transfusion was noted. Results: Drainage blood loss was significantly lower in the topical TXA group (304.9 ± 151.2 ml) than in the control group (520.2 ± 251.2 ml) (p ＜ 0.001). Blood transfusion rate was apparently lower in the TXA-treat group (14.3%) when compared to the group without TXA (44.4%) (p=0.013). There was no increase in deep vein thrombosis or wound complication. Conclusions: In this study, topical TXA can effectively reduce blood loss and transfusion rate, and is not associated with any increase in surgical complications.