Postoperative Inflammatory Complications Research Articles

Can Patients With Isolated Mandibular Fractures Be Treated as Outpatients?

Treating mandibular fractures urgently is controversial. The purpose of this study was to estimate and compare the rates of postoperative inflammatory complications (POICs) in patients with isolated mandibular fractures treated in a nonurgent manner by an outpatient protocol versus a traditional, urgent inpatient protocol. We implemented a retrospective cohort study and enrolled a sample of patients with isolated mandibular fractures treated with open reduction-internal fixation (ORIF). The primary predictor variable was the treatment protocol: outpatient (elective) or inpatient (urgent). The outpatient group was treated with closed reduction and intermaxillary fixation, discharged, and scheduled for definitive treatment as outpatients.The inpatient group was admitted to the hospital, and the fracture was treated with ORIF as soon as possible. The primary outcome variable was POIC (present or absent). Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between the treatment protocol and POICs, with statistical significance set at P<.05. The study sample was composed of 193 patients, with 82 in the outpatient group and 111 in the inpatient group. The frequency of POICs was 17.1% and 18.9% in the outpatient and inpatient groups, respectively (P=.13; relative risk, 0.80; 95% confidence interval [CI], 0.62 to 1.0). The time to ORIF was not significantly associated with POICs (P=.71). After adjustment for treatment group, fracture location, and time to fracture stabilization, smoking (P=.04, odds ratio, 2.3; 95% CI, 1.0 to 5.1) and intraoral incision with a transbuccal trocar (P=.02, odds ratio, 3.4; 95% CI, 1.2 to 9.8) were associated with an increased risk of POICs. Length of stay was 0.6±0.8days in the outpatient group compared with 2.7±2.0days in the inpatient group (P<.0001). An outpatient model to treat isolated mandibular fractures was not associated with an increased risk of POICs. This outpatient care model reduced the hospital length of stay without increasing the risk of POICs.

ЗАСТОСУВАННЯ ЛЮКСАТОРА «DIRECTA» ДЛЯ ОПЕРАЦІЇ ВИДАЛЕННЯ ЗУБА

В статті представлені дані особливостей та порівняння застосування люк- сатора «Directa» із традиційними інструментами – елеватором та щипцями для виконання операції типового видалення зуба. Результати дослідження показали значні переваги викори- стання люксаторів і, в тому числі, зменшення та відсутність ускладнень під час операції та в післяопераційному періоді, які є причиною запальних процесів альвеоли зуба. У дослідженні запропоновано використання люксатора для підвищення якості та пришвидшення часу про- ведення операції. Висновки в статті представили важливі характеристики застосування люксаторів, як альтернативи традиційним інструментам, що використовується у практиці хірургів-стоматологів.

Effectiveness of morphogenetic protein rhBMP-2 use in atypical third mandibular molars extraction.

Objective – improving the effectiveness of treatment of patients with retention and dystopia of the third molars of the lower jaw in their horizontal or inverse position by developing an integrated approach using photodynamic therapy and drugs that enhance osteogenesis (platelet autoplasma enriched with i-PRF fibrin and recombinant morphogenetic protein (rhBMP-2). 82 patients with difficult eruption of third molars of the lower jaw aged 19 to 37 were included in research: 40 (48.8%) men and 42 (51.2%) women. The standard approach to performing operations of atypical removal of retined third molars causes a significant number of complications (large bone defects, inflammatory contracture, post-traumatic neuritis, etc.). Treatment process was provided in two stages. During the first (preoperative) stage sanitation was done to eliminate or stabilize an acute infection which is inflammatory process in the area of impacted third molar. The second stage provides abscessed tooth extraction, wound sanitation, formed defect filling with osseo-inductive medications under the collagen membrane and complete closure. The developed surgical method for treating retention and dystopia of the lower third molars using biomaterial based on demineralized bone matrix (BCP) saturated with recombinant morphogenetic protein of bone rhBMP-2 can reduce the occurrence of postoperative inflammatory complications by 35.4%, and also reduce the time for their elimination as well.

SURGICAL TREATMENT OF NECROTIZING INFECTION OF THE SOFT TISSUES OF THE NECK

Summary. Early diagnosis and timely surgical treatment of necrotizing soft tissue infection of the neck is an urgent problem of modern medicine, far from a definitive solution.&#x0D; The purpose of the work is to optimize the surgical treatment of patients with necrotizing infection of the soft tissues of the neck.&#x0D; Materials and methods. The results of surgical interventions of 76 patients with odontogenic phlegmon of the neck that were treated at the surgical ward were analyzed.&#x0D; Results and discussion. The essential condition for successful treatment of phlegmon neck is immediate surgery. Indications for surgery in the mediastinum should be considered in the total involvement in the necrotic process of the deep and superficial cell spaces of the neck. Preventive antibiotic therapy in patients after surgery on the neck helps to reduce the incidence of postoperative inflammatory complications and improve the quality of life of patients.&#x0D; Conclusions. Mortality in acute purulent odontogenic mediastinitis depends on timely hospitalization, diagnosis and early surgical treatment using extracorporeal detoxification methods.

Эффективность препарата «Тантум Верде®» для профилактики воспалительных осложнений в полости рта у больных после оперативного вмешательства на околоушной и поднижнечелюстной железах

Purpose: to define efficiency of preparation of «Tantum Verde®» for the prophylaxis of inflammatory complications in the cavity of mouth for patients after realization of operative interventions on parotid and submandibular glands. Methods. An inspection is conducted 64 patients after operative interventions on large salivary glands. Results. It is set On the basis of the inspections got by us, that hygienical care of cavity of mouth by preparation of «Tantum Verde®» for patients after realization of operative interventions on large salivary glands (parotid and submandibular) is a high-efficiency preventive, as compared to traditionally applied. It is objectively wellproven the methods of inspection, that antiseptic preparation of «Tantum Verde®» is used for the rinse of cavity of mouth has the expressed antiinflammatory effect. The side actions of preparation of «Tantum Verde®» we did not educe. Conclusions. It is well-proven the conducted inspections, that preparation of «Tantum Verde®» can be recommended maxillufacial surgeons and tostomatologies for the prophylaxis of inflammatory postoperative complications in the cavity of mouth for patients after the conducted operative interventions on large salivary glands (parotic and submandibular).

Technologies for producing platelet masses for regenerative medicine

The development of regenerative medicine is to improve existing and to search for new tools for morphological and functional tissue repair, among which plasma or fi brin enriched with platelets (PRP and PRF) can be signifi cant. Autogenic platelet masses stimulate collagen synthesis, induce vascular growth, reduce pain, provide hemostasis, accelerate regeneration, reduce the risk of postoperative infectious and infl ammatory complications, and also have powerful osteoinductive properties. Due to the ability to produce the majority of growth factors, platelets can aff ect all stages of the infl ammatory-regenerative process, and therefore their biological products are of great importance in solving the problems of regenerative medicine. The technologies for obtaining PRP and PRF are based on centrifugation of blood, as a result of which its active components are concentrated in certain areas of the centrifuge. Blood sampling with or without an anticoagulant, as well as modifi cation of centrifugation protocols, allows to obtain various forms of platelet masses, such as a liquid, gel or clots. They are classifi ed, depending on the cellular content and architecture of fi brin, into several categories, namely: pure plasma enriched in platelets (P-PRP), plasma enriched in leukocytes and platelets (L-PRP); injectable fi brin enriched with platelets (i-PRF) and pure fi brin enriched with platelets (P-PRF), as well as fi brin enriched with white blood cells and platelets (L-PRF). The main diff erence in the manufacture of PRP compared to PRF is the use of anticoagulants and activators, as well as the possibility of using two-stage centrifugation. Platelet mass is used as an independent component mainly to stimulate the restoration of muscle tissue, to heal chronic wounds, to treat articular pathologies, and in combination with other materials, in particular to replace bone defects. The mechanisms of infl uence of each of the categories of platelet mass on tissue regeneration remains poorly understood. It is necessary to standardize the protocols for their preparation, taking into account the infl uence of additional substances, such as platelet activators or blood clotting and anticoagulants, as well as optimization of the methods for using each of the platelet mass forms. Key words: platelets, PRP, PRF, centrifuges, centrifugal force.

EFFECT OF PROBIOTICS ON ALTERED GUT MICROFLORA IN PATIENTS WITH SEVERE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

The aim: To estimate intestinal microbial changes and study the efficacy of probiotic preparations in systemic inflammation. Materials and methods: The study involved 202 patients with chronic infections various sites, including 58 (28.7 %) patients with respiratory tract infections, 56 (27.7 %) patients with infections of the genitourinary system, 48 (23.7%) - with purulent inflammatory postoperative complications, and 40 HIV-infected patients. We studied the quantitative and qualitative composition of intestinal microflora on the background correction of probiotic preparations. Results: We have found quantitative and qualitative changes of intestinal microflora in all patients with chronic infections. Dysbiotic changes manifested in reducing the number of major orders symbionts (Lactobacillus spp., Bifidobacterium spp, Escherichia coli with normal enzymatic properties) and increase the number of pathogenic microorganisms (Staphylococcus aureus, Clostridium spp., Candida spp.). In all study groups after using probiotics, the number of pathogenic microorganisms (S. aureus, S. saprophyticus, S. epidermidis, C. albicans, and Cl. perfringens) were decreased and tended to restore normal range of microbial landscape. Conclusion: So, dysbiotic disorders of the intestine in patients with chronic inflammation characterized by decrease in the number of basic gut symbionts and reducing its protective properties that accompanied the advent of pathogenic microorganisms. In our study probiotics demonstrated statistically significant improvements in the qualitative and quantitative composition of microflora.

Preoperative miRNA-208a as a Predictor of Postoperative Complications in Children with Congenital Heart Disease Undergoing Heart Surgery.

Major perioperative cardiovascular events are important causes of morbidity in pediatric patients with congenital heart disease who undergo reparative surgery. Current preoperative clinical risk assessment strategies have poor accuracy for identifying patients who will sustain adverse events following heart surgery. There is an ongoing need to integrate clinical variables with novel technology and biomarkers to accurately predict outcome following pediatric heart surgery. We tested whether preoperative levels of miRNAs-208a can serve as such a biomarker. Serum samples were obtained from pediatric patients immediately before heart surgery. MiRNA-208a was quantified by RQ-PCR. Correlations between the patient’s clinical variables and miRNA levels were tested. Lower levels of preoperative miRNA-208a correlated with and could predict the appearance of postoperative cardiac and inflammatory complications. MiRNA-208a may serve as a biomarker for the prediction of patients who are at risk to develop complications following surgery for the repair of congenital heart defects.

Possible dose dependent effect of perioperative dexamethasone and laparoscopic surgery on the postoperative systemic inflammatory response and complications following surgery for colon cancer

BackgroundPerioperative dexamethasone is associated with attenuation of the postoperative systemic inflammatory response and fewer postoperative complications following elective surgery for colorectal cancer.This study examined the impact of different doses of dexamethasone, given to reduce postoperative nausea and vomiting (PONV) after elective colonic resection for cancer, on the postoperative Glasgow Prognostic Score (poGPS) and morbidity. MethodsPatients from a single centre were included if they underwent potentially curative resection of colonic cancer from 2008 to 2017 (n = 480). Patients received no dexamethasone (209, 44%), or either 4 mg (166, 35%), or 8 mg (105, 21%), intravenously during anaesthesia, at the discretion of the anaesthetist. The postoperative Glasgow Prognostic Score (poGPS) on day 3 and 4, and complication rate at discharge were recorded. ResultsWhen patients were grouped by surgical approach (open or laparoscopic) and dexamethasone dose (0 mg, 4 mg or 8 mg), there was a statistically significant linear trend toward a lower postoperative systemic inflammatory response (day 3 poGPS) with the use of minimally invasive surgery and higher doses of dexamethasone (p < 0.001). Furthermore, this combination of laparoscopic surgery and higher doses of dexamethasone was significantly associated with a lower proportion of postoperative complications (p < 0.001).At multivariate Cox regression, dexamethasone was not significantly associated with either improved or poorer cancer specific or overall survival. ConclusionsHigher doses of perioperative dexamethasone are associated with greater reduction in postoperative systemic inflammation and complications following surgery for colonic cancer without negative impact on survival.

The impact of infectious complications on long-term prognosis after curative resection for gastric cancer.

122 Background: Several studies have reported that postoperative complications such as anastomotic leakage affect long-term prognosis after gastric cancer surgery. This study aimed to determine whether or not long-term outcomes were affected by the postoperative inflammatory complications in patients who underwent curative resection for gastric cancer. Methods: The patients were retrospectively selected from the medical records of consecutive patients who underwent curative gastrectomy with nodal dissection for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015. Inflammatory complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) was compared between postoperative inflammatory complications (IC) and no-complication (NC) groups. Results: A total of 2,254 patients were eligible for inclusion in the present study. One hundred seventy-five patients had IC group, while 2,079 patients had not. Operation time (p &lt; 0.001), blood loss (p &lt; 0.001) was significantly greater in the IC group. The incidence of postoperative inflammatory complication grade 2 or higher was 8.5% in which, pancreatic fistula (2.8%), anastomotic leakage (1.8%) were occurred. The mortality rate was 0.18%. The five-year OS rates of the IC and NC groups were 74.9% and 83.2%, respectively. The difference was statistically significant (p = 0.015). Multivariate Cox’s proportional hazard analyses demonstrated that the postoperative inflammatory complications were a significant prognostic factor for OS. Conclusions: Postoperative inflammatory complications have an obvious impact on the OS in curatively resected gastric cancer patients. It is necessary to reduce the incidence of postoperative complications.

A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery.

Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N=136) or coronary artery bypass grafting (CABG)(N=2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor-18-(18F)-deoxyglucose positron emission tomography and associated with RDW using linear regression models. In total, 43(31.6%) and 73 patients (3.3%) suffered from inflammatory complications after AAA-repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6% in the lowest to 48.9% in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95%CI:1.08-5.14] P=0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8% to 5.3% with an adjusted RR of 1.95 ([95%CI:1.02-3.75] P=0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG-PET scans showed associations of RDW with tissue activity in the spleen (B=0.517 [P=0.001]) and the lumbar bone marrow (B=0.480 [P=0.004]). Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low-grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.

Necessity of Antibiotics to Reduce Inflammatory Complications after Third Molar Extractions: A Prospective Study.

Aims and Objectives:To determine the relationship between the usage of antibiotics postoperatively and inflammatory complications following third molar extractions.Materials and Methods:The sample was derived from Saudi Arabia private practitioners who were oral surgeons and was randomly categorized into two groups: group A, who took postoperative antibiotics, and group B, who have not taken antibiotics. The observed primary variable was the occurrence of inflammatory complications subsequent to removal of third molar.Results:The data were obtained from 35 oral surgeons, who gave details about 725 patients in whom 965 third molars were removed. A total of 455 (62.75%) patients have taken antibiotics postoperatively. The mean age was 28 ± 14.8 years. We noticed a very high male preponderance of 543 (74.89%). Mean body mass index was 26.7 ± 6.3 kg/m2. The mean Preoperative Disease Severity Score and Operative Difficulty Score was 2.13 ± 2.1 and 12.1 ± 6.3, respectively.Conclusion:Fewer postoperative inflammatory complications were observed in subjects who have taken antibiotics after third molar removal.

THE RESULTS OF THE APPLICATION OF LYMPHOTROPIC THERAPY IN PATIENTS LUNG CANCER

Objectives. To evaluate the results of the application of the developed method of lymphotropic therapy in patients operated on for lung cancer. Methods. Examined 280 patients aged from 39 to 75 years, operated on for lung cancer during the period from 2010 to 2016, Completed: pneumonectomy or forehead - and bilobectomy, lymph node dissection. The patients were divided into three groups. In the first group (n=206) used only standard therapy. In the second group (n=44) in conjunction with standard therapy was performed with an interspinal lymphotropic injections of drugs at the level of Th2 - Th3, Th3 - Th4, Th4 - Th5. In the third group (n=30) in conjunction with standard therapy was performed lymphotropic introduction of medicines by the developed technique (patent RF №2561832). Results. Frequent complications in the first group and 20.4% in the second, 11.4% of patients were inflammatory. Bronchopleural fistula occurred in the first group, 17 % of patients in the second - 4.5%, in the third - from 3.3 percent. Indicators leukocyte index of intoxication on the 2nd day of 3.2±0.2 and on the 6th day 2,6±0,1 significantly smaller in patients in the third group (p&lt;0,05) compared to first and second groups. Conclusion. The proposed method lymphotropic administration of drugs in patients with lung cancer provides the optimal route of administration of drugs to the pathological focus and reduces exudative inflammatory postoperative complications.

The use and evaluation of prevention methods to reduce inflammatory and diffuse septic complications in patients undergoing pancreatic resection

Background:Surgery for chronic pancreatitis and pancreatic neoplasms is associated with a risk of acute destructive pancreatitis and pancreaticojejunal anastomotic leakage in the early postoperative period. Despite the availability of multiple surgical and pharmaceutical approaches to prevent these complications, they continue to be associated with high mortality.Aim:To evaluate the efficacy of the clinical use of our original preventive methods of postoperative pancreatitis and diffuse inflammatory and septic complications in patients undergoing pancreatic resection due to its benign and malignant diseases.Materials and methods: We retrospectively analyzed the results of surgical treatment of 524 patients following pancreatic resection. All patients underwent pancreatic surgery in the Rostov Regional Clinical Hospital (Rostov-on-Don, Russia) from February 2005 to April 2018 for the following indications: complicated chronic pancreatitis in 221 patient, pancreatic and major duodenal papilla tumors in 303 patients. Organ-preserving procedures were performed in 250 patients, and radical extended resections of the pancreas in 274 patients. In 489 patients, the procedures were finalized with the formation of anastomosis between the pancreatic duct and jejunum. In 373 patients, the reconstruction step included enterostomal drainage of the pancreatic duct. To prevent acute postoperative pancreatitis and diffuse septic and inflammatory complications, in 298 patients we used our original techniques, while 226 patients underwent conventional procedures.Results:Among 226 patients, who had underwent conventional procedures, the complications occurred in 75 (33.19%), with septic complications in 29.33% (22 patients). Of 298 patients, in whom any of the original prevention techniques had been used, the complications were seen in 67 (22.48%), with septic complications in 13.43% (9 patients). Seventeen (17, or 11.97% of the total number) patients had to be re-operated, with 15 (6.64%) having been initially operated without additional preventive measures, and 2 (0.67%) with the use of the original prevention techniques. Overall postoperative mortality was 2.48%. The causes of death were: peritonitis in 4 patients, arrosive bleeding from visceral arteries in 4, bleeding from pancreatic head stump into the omental sac in 2, bleeding at the pancreaticojejunal anastomosis in 1, and cardiac disorders in 2.Conclusion:The study results have shown that the use of techniques to prevent the spread of inflammation and septic in the abdominal cavity and decreasing the rates of postoperative necrotic pancreatitis in pancreatic resections allows for a reduction of these complications and related mortality.

2155. Elevated Temperature Results in Earlier Diagnosis of Infectious and Inflammatory Postoperative Complications

BackgroundMedical students are taught that wind, water and wound complications occur at specific post-operative times. This may influence the timing of work-up for specific complications. The goal of this study was to investigate the relationship between post-operative temperature curve and time to diagnosis of inflammatory complications.MethodsWe reviewed patients who underwent pancreatectomy at an academic health system from January 2015–February 2018. Clinical data including complications were extracted using definitions set by the National Surgical Quality Improvement Program and temperature was extracted from the Data Warehouse. Time of diagnosis, as determined by labs, microbiologic cultures, radiology and procedures, was extracted for each complication. Group-based trajectory modeling, a technique used to identify distinct clusters of temperature trajectories of patients in the postoperative setting was used to group patients into low- and high-temperature trajectories.ResultsAmong 195 patients who underwent pancreatectomy, 35.5% (69/195) experienced at least one complication within 30 days of surgery. Of the patients who developed complications, 49% (n = 34) and 51% (n = 35) were classified into the low and high temperature trajectory groups based on their temperature trajectory. For most individual inflammatory complications, time to diagnosis was later in the low rather than high temperature groups (Figure 1) and this was significant when averaging all inflammatory complications (12.7d low and 8.6d high; P = 0.002). Time to diagnosis tended to be later in the high rather than low temperature trajectory but this was not statistically significant when averaging all non-inflammatory complications (11.7d low and 11.9d high; P = 0.95).Figure 1.Time to diagnosis by low (L) and high (H) temperature trajectories.ConclusionWe identified earlier diagnosis of inflammatory complications in patients with elevated temperature trajectories. There was no difference in timing of diagnosis for non-inflammatory complications. Temperature trajectory modeling may allow for earlier diagnosis of patients at high risk for inflammatory complications.Disclosures All authors: No reported disclosures.

Пути понижение частоты постоперационных воспалительных осложнений в хирургии катаракты

Пути понижение частоты постоперационных воспалительных осложнений в хирургии катаракты

PREOPERATIVE AND POSTOPERATIVE ANTIBIOTIC PROPHYLAXIS IN GYNECOLOGICAL PATIENTS DEPENDING ON INDIVIDUAL RISK FACTORS

Pelvic inflammatory diseases as complications of invasive diagnostics and surgical treatment occur often enough in patients with gynecological disorders. The risk of infectious complications is always individual and depends on many factors. The implementation of a personified approach and optimization of antibacterial prophylaxis can decrease the incidence of inflammatory reactions and reduce the risk of infectious complications. Objective: to estimate the efficacy and tolerability of combiflox (ornidazole 500 mg + ofloxacin 200 mg) in long-term antibiotic prophylaxis after gynecological and oncological surgeries. Materials and methods. We assessed the results of a 7-day oral course of combiflox after intravenous intraoperative antibiotic prophylaxis (ciprofloxacin 500 mg + metronidazole 500 mg) in 73 women that underwent gynecological or oncological surgeries. All patients were monitored for postoperative complications, including any wound inflammation, low-grade hyperthermia, symptoms of postoperative vaginitis, endometritis, limited peritonitis, adnexitis. Results. We found that 43.8 % of patients were at high risk of developing postoperative inflammatory complications; in most of the cases, it was associated with obesity (body mass index &gt;30 kg/m2). Three out of 32 overweight patients (9.3 %) developed postoperative complications, whereas none of the 41 patients with minimal risk factors had such events. No combiflox-related adverse effects were observed during the study. All patients reported good tolerability and high convenience of the drug. Conclusion. The need for long-term antibiotic prophylaxis depends on the type of surgery and individual risks for infectious complications. Low-cost oral therapy with combiflox (ornidazole + ofloxacin) during the postoperative period reduces the risk of infectious complications, especially among patients with a body mass index &gt;30 kg/m2, since they are particularly prone to wound complications.

The impact of preoperative dexamethasone on long-term survival following surgery for colorectal cancer.

644 Background: Steroids given at the induction of anaesthesia are associated with a reduction in the magnitude of the postoperative systemic inflammatory response and fewer complications following elective surgery for colorectal cancer (McSorley et al. Ann Surg Oncol 2017;24(8):2104-2112). The present study examined their impact on survival. Methods: Patients who underwent elective surgery, with curative intent, for stage I-III colorectal cancer at a single centre between 2008 and 2016 were included. Data on preoperative dexamethasone was obtained from anaesthetic records, and its impact on cancer specific (CSS) and overall survival (OS) assessed using Cox regression in an unmatched (n=556) and a propensity score matched cohort (n=276) (Table 1). Results: After excluding postoperative mortalities (n=3), there were 98 deaths (18%), with 57 (10%) due to cancer. Of those alive at censoring, the median follow up was 47 months (range 16-110). In the unmatched cohort, there was no significant association between dexamethasone and CSS (HR 0.90, 95% CI 0.52-1.53, p=0.688) or OS (HR 0.95, 95% CI 0.63-1.43, p=0.804). In the propensity score matched cohort, there was no significant association between dexamethasone and CSS (HR 1.18, 95% CI 0.55-2.53, p=0.668) or OS (HR 1.21, 95% CI 0.67-2.17), p=0.532). Conclusions: These results suggest that whilst preoperative steroids are associated with improved short term outcomes following surgery for colorectal cancer, they have no negative effect on long term outcomes. [Table: see text]

Surgeon specific effects on the postoperative systemic inflammatory response and complications following surgery for colorectal cancer.

799 Background: The present study examined the impact of surgeon specific differences on the postoperative systemic inflammatory response (SIR) as measured by postoperative C-reactive protein (CRP), and complications, following elective surgery for colorectal cancer. Methods: 684 patients who underwent elective colorectal cancer resection performed by 10 consultant surgeons at single centre between 2008 and 2016 were included. Exceeding the established C-reactive protein (CRP) threshold of 150mg/L on postoperative days (POD) 3 and 4 was used to identify outliers by funnel plot analysis. Surgeons with significant differences in the proportion of patients exceeding POD 3 CRP 150mg/L were compared. Significantly different perioperative variables amongst surgeons, and the surgeons themselves, were then entered into a multivariate binary logistic regression model to asses association with POD 3 CRP. Results: Perioperative factors were compared between 3 surgeons with the highest volumes and greatest difference in the proportion of patients exceeding POD 3 CRP 150mg/L (Figure 1); (35% of 137, 50% of 117, 60% of 92, p &lt; 0.001). Amongst the 3 surgeons there were significant differences in comorbid state (p = 0.042), the proportion of patients undergoing minimally invasive surgery (p &lt; 0.001), or surgery lasting over 4 hours (p &lt; 0.001), requiring blood transfusion (p = 0.038), epidural anaesthesia (p &lt; 0.001), and receiving perioperative steroids (p &lt; 0.001). When those factors which were significantly different between surgeons were entered into a multivariate binary logistic regression model to predict exceeding the POD 3 CRP threshold of 150mg/L, only perioperative dexamethasone (OR 0.40, 95% CI 0.19-0.82, p = 0.012), and postoperative complications (OR 2.22, 95% CI 1.14-4.32, p = 0.018), remained independently associated whilst the surgeons themselves were not significantly associated (OR 1.16, 95% CI 0.59-2.30, p = 0.663). Conclusions: This study suggests that surgeon specific difference in the magnitude of the postoperative systemic inflammatory response are related to differences in surgical approach, anaesthetic technique and complications.

СТРУКТУРА ВНУТРИБОЛЬНИЧНЫХ ИНФЕКЦИОННО-ВОСПАЛИТЕЛЬНЫХ ОСЛОЖНЕНИЙ ПОСЛЕ АБДОМИНАЛЬНОГО РОДОРАЗРЕШЕНИЯ

Objective: Analysis of the frequency and structure of postoperative infectious and inflammatory complications in the puerperae after abdominal delivery, which were under treatment in the specialized department of the third-level hospital for 2017. Methods: s: Examined and treated of 66 parturient women with infectious complications after cesarean section. The spectrum of nosocomial microflora and resistance to antimicrobial agents determined using an automatic microbiological analyzer based on mass spectrometry. Results: The main recorded nosological form was infection of the area of surgical intervention. In 3% of cases, postoperative metroendometritis complicated by the inconsistency of sutures on the uterus with the development of obstetric peritonitis, and in 7.6% by sepsis. The structure of isolated microflora in postoperative infection was different after planned and emerged delivery, which should be taken into account when developing a local form of perioperative antibiotic prophylaxis and therapy. Conclusion: At present, there is an underestimation of the severity of metroendometritis after cesarean section with premature discharge or a belated transfer from the maternity hospital to the specialized observatory department of the multi-profile hospital. One in five postoperative metroendometritis caused by multidrug-resistant hospital microflora. Keywords: Caesarean section, infectious complications, observational department, obstetric wound infection, postnatal metroendometritis, postpartum sepsis, obstetric peritonitis.