Major Gastrointestinal Surgery Research Articles

An Age-Stratified Analysis of Early Postoperative Mortality Among Medicare-Eligible Patients With Common Gastrointestinal and Hepato-pancreato-biliary Malignancies.

Background: The frequency of major cancer surgery in the elderly (≥80years) has increased concomitantly with the rise in average age of the population. We assessed early postoperative mortality following hepato-pancreato-biliary (HPB) and gastrointestinal (GI) procedures for common malignancies stratified by age. Methods: The National Cancer Database (2004-2017) was queried for patients who underwent resection for GI (gastroesophageal and colorectal) or HPB (pancreatic adenocarcinoma, biliary tract, and primary liver) cancers. We compared early postoperative mortality (30d and 90d) stratified by age (65-79 vs ≥80years) and procedure, and compared survival outcomes by age and operative vs nonoperative management. Results: A total of 709,358 patients were included. The 30-day mortality ranged from 1.8% to 5.8% among patients 65-79years and from 3.2% to 12.4% among patients ≥80years depending on procedure. The 90-day mortality ranged from 3.6% to 10.6% in patients 65-79years compared to 8.4%-21.0% among patients ≥80years. The overall 90-day mortality was 5.2% for patients 65-79years and 12.0% for patients ≥80years (P < .001). Age ≥80 was associated with worse survival among operatively managed patients with each upper GI, HPB, and lower GI malignancy relative to younger patients on multivariable analysis. However, operative management of patients ≥80years was associated with improved survival relative to nonoperative management. Discussion: Elderly patients suffer higher postoperative mortality after major GI and HPB cancer surgery, but operative management is associated with improved survival among patients ≥80years as compared to nonoperative management. These data are important to contextualize when counseling elderly patients on their treatment options for localized GI and HPB cancers.

Dexmedetomidine versus propofol on intestinal barrier function in patients undergoing major gastrointestinal tract surgery: A prospective randomized comparative trial protocol

Dexmedetomidine versus propofol on intestinal barrier function in patients undergoing major gastrointestinal tract surgery: A prospective randomized comparative trial protocol

ASO Visual Abstract: The Role of Delirium in Short- and Long-Term Postoperative Outcomes After Major Gastrointestinal Surgery for Cancer.

ASO Visual Abstract: The Role of Delirium in Short- and Long-Term Postoperative Outcomes After Major Gastrointestinal Surgery for Cancer.

A commentary on the article "Family caregiver outcomes after participating in a hospital-based family involvement program after major gastrointestinal surgery: a subgroup analysis of a patient preferred cohort study".

A commentary on the article "Family caregiver outcomes after participating in a hospital-based family involvement program after major gastrointestinal surgery: a subgroup analysis of a patient preferred cohort study".

The Role of Delirium on Short- and Long-Term Postoperative Outcomes Following Major Gastrointestinal Surgery for Cancer.

The growing burden of an aging population has raised concerns about demands on healthcare systems and resources, particularly in the context of surgical and cancer care. Delirium can affect treatment outcomes and patient recovery. We sought to determine the prevalence of postoperative delirium among patients undergoing digestive tract surgery for malignant indications and to analyze the role of delirium on surgical outcomes. Medicare claims data were queried to identify patients diagnosed with esophageal, gastric, hepatobiliary, pancreatic, and colorectal cancers between 2018 and 2021. Postoperative delirium, occurring within 30 days of operation, was identified via International Classification of Diseases, 10th edition codes. Clinical outcomes of interested included "ideal" textbook outcome (TO), characterized as the absence of complications, an extended hospital stay, readmission within 90 days, or mortality within 90 days. Discharge disposition, intensive care unit (ICU) utilization, and expenditures also were examined. Among 115,654 cancer patients (esophageal: n = 1854, 1.6%; gastric: n = 4690, 4.1%; hepatobiliary: n = 6873, 5.9%; pancreatic: n = 8912, 7.7%; colorectal: n = 93,325, 90.7%), 2831 (2.4%) were diagnosed with delirium within 30 days after surgery. On multivariable analysis, patients with delirium were less likely to achieve TO (OR 0.27 [95% CI 0.25-0.30]). In particular, patients who experienced delirium had higher odds of complications (OR 3.00 [2.76-3.25]), prolonged length of stay (OR 3.46 [3.18-3.76]), 90-day readmission (OR 1.96 [1.81-2.12]), and 90-day mortality (OR 2.78 [2.51-3.08]). Furthermore, patients with delirium had higher ICU utilization (OR 2.85 [2.62-3.11]). Upon discharge, patients with delirium had a decreased likelihood of being sent home (OR 0.40 [0.36-0.46]) and instead were more likely to be transferred to a skilled nursing facility (OR 2.17 [1.94-2.44]). Due to increased utilization of hospital resources, patients with delirium incurred in-hospital expenditures that were 55.4% higher (no delirium: $16,284 vs. delirium: $28,742) and 90-day expenditures that were 100.7% higher (no delirium: $2564 vs. delirium: $8226) (both p < 0.001). Notably, 3-year postoperative survival was adversely affected by delirium (no delirium: 55.5% vs. delirium: 37.3%), even after adjusting risk for confounding factors (HR 1.79 [1.70-1.90]; p < 0.001). Postoperative delirium occurred in one in 50 patients undergoing surgical resection of a digestive tract cancer. Delirium was linked to a reduced likelihood of achieving an optimal postoperative outcome, increased ICU utilization, higher expenditures, and a worse long-term prognosis. Initiatives to prevent delirium are vital to improve postoperative outcomes among cancer surgery patients.

Family caregiver outcomes after participating in a Hospital-based family involvement program after major gastrointestinal surgery: a subgroup analysis of a patient preferred cohort study

Background: Engaging families in postsurgical care is potentially beneficial for improving cancer patient outcomes and quality of care. We developed a family involvement program (FIP) and in this study, we aim to evaluate the impact of the FIP on family caregiver burden and well-being. Moreover, we aim to assess the fidelity of the program. Materials and methods: This is a preplanned subgroup analysis of a patient-preferred prospective cohort study that included family caregivers of patients who underwent major oncological surgery for gastrointestinal tumors. Only patient-nominated family caregivers could participate in the FIP. Caregivers received structured training in fundamental caregiving tasks from healthcare professionals and then actively participated in these tasks. Caregiver burden and wellbeing were measured four times (at hospital admission, at hospital discharge, and at one and three months post-hospital discharge) using the Caregiver Strain Index+ (CSI+) and the Care-related Quality of Life instrument (CarerQoL-7D). The fidelity of the FIP was assessed by recording completion of care activities. In addition, family caregivers were asked whether they would participate in the FIP again. Results: Most of the 152 family caregivers were female (77.6%), and their mean age was 61.3 years (SD=11.6). Median CSI+ scores ranged between -1 and 0 and remained below the cutoff point of experiencing burden. CarerQoL-7D results indicated no significant differences in family caregivers’ well-being over time. Upon discharge, over 75% of the family caregivers stated that they would recommend the FIP to others. The highest compliance with all fundamental care activities was observed during postoperative days 2 to 4. Conclusion: The family caregivers of oncological surgical patients who participated in the FIP exhibited acceptable levels of caregiver burden and well-being. These findings suggest that the FIP is a valuable intervention to equip family caregivers with the skills to navigate the uncertain period following a patient’s hospital discharge.

Early dynamic changes to monocytes following major surgery are associated with subsequent infections.

Post-operative infections are a common cause of morbidity following major surgery. Little is understood about how major surgery perturbs immune function leading to heightened risk of subsequent infection. Through analysis of paired blood samples obtained immediately before and 24 h following surgery, we evaluated changes in circulating immune cell phenotype and function across the first 24 h, to identify early immune changes associated with subsequent infection. We conducted a prospective observational study of adult patients undergoing major elective gastrointestinal, gynecological, or maxillofacial surgery requiring planned admission to the post-anesthetic care unit. Patients were followed up to hospital discharge or death. Outcome data collected included mortality, length of stay, unplanned intensive care unit admission, and post-operative infections (using the standardized endpoints in perioperative medicine-core outcome measures for perioperative and anesthetic care criteria). Peripheral blood mononuclear cells were isolated prior to and 24 h following surgery from which cellular immune traits including activation and functional status were assessed by multi-parameter flow cytometry and serum immune analytes compared by enzyme-linked immunosorbent assay (ELISA). Forty-eight patients were recruited, 26 (54%) of whom developed a post-operative infection. We observed reduced baseline pre- and post-operative monocyte CXCR4 and CD80 expression (chemokine receptors and co-stimulation markers, respectively) in patients who subsequently developed an infection as well as a profound and selective post-operative increase in CD4+ lymphocyte IL-7 receptor expression in the infection group only. Higher post-operative monocyte count was significantly associated with the development of post-operative infection (false discovery rate < 1%; adjusted p-value = 0.001) with an area under the receiver operating characteristic curve of 0.84 (p < 0.0001). Lower monocyte chemotaxis markers, higher post-operative circulating monocyte counts, and reduced co-stimulatory signals are associated with subsequent post-operative infections. Identifying the underlying mechanisms and therapeutics to reverse defects in immune cell function requires further exploration.

Morbidity and mortality of patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundThe purpose of this study was to record the incidence, and identify the prognostic variables of morbidity and mortality in patients with peritoneal malignancy undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsThe files of patients with peritoneal malignancy who underwent CRS + HIPEC from 2015–2022 were retrieved. Morbidity and hospital mortality were recorded and correlated to a variety of clinical variables.ResultsA total of 44/192 (22.9%) patients were recorded with postoperative complications. Grade 3 and 4 complications were 12.5%. The possible prognostic variables of morbidity were the extent of peritoneal malignancy and the number of suture lines. The mortality rate was 2.5% (5 patients). The number of FFP units, and peritonectomy procedures were identified as possible prognostic variables of hospital mortality.ConclusionsThe morbidity rate in patients undergoing CRS + HIPEC is acceptable compared to morbidity of previous publications or major gastrointestinal surgical operations. The possible prognostic variables of morbidity are the extent of peritoneal malignancy, and the number of suture lines. The mortality rate is low. The possible prognostic variables of mortality are the number of FFP units, and the number of peritonectomy procedures.

80 Venous thromboembolism diagnosis definition in claims data: implications for research

OBJECTIVES/GOALS: Venous thromboembolism (VTE) is a major cause of morbidity and mortality. Due to its relatively low incidence, prospective studies are limited. This makes administrative claims a promising data source to study VTE. We sought to examine the reproducibility of results using different VTE definitions from the published literature. METHODS/STUDY POPULATION: We conducted a retrospective analysis of a random 10% sample of the 2010-2022 IQVIA LifeLink PharMetrics Plus™ database, an administrative claims database representative of the commercially insured population of the United States. We selected cancer patients undergoing major gastrointestinal surgery, who have a higher risk for postoperative VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]). VTE was defined using ICD-9-CM and ICD-10-CM codes using definitions from 4 individual published studies. We compared the 4 definitions with respect to the incidence of VTE and factors associated with post-discharge VTE using standard univariate and multivariable logistic regression models. The same logistic regression models were used for each of the 4 definitions. RESULTS/ANTICIPATED RESULTS: There were substantial differences in VTE coding among the 4 definitions (range 107 to 225 ICD-9/10 codes for DVT and 12 to 24 codes for PE). The eligible population comprised 2,360 patients (49% female) with a median age of 49 years (interquartile range 47-52 years). During the index surgery hospitalization, a total of 58, 62, 63, and 83 patients developed VTE using the 4 definitions. In the 2,126 patients eligible for VTE prophylaxis, a total of 108, 68, 73, and 107 patients developed post-discharge VTE (range for DVT 35 to 81, range for PE 39 to 76). On multivariable analysis, factors independently associated with VTE included age using 1 of 4 definitions, esophageal surgery type using 3 of 4 definitions, and liver surgery type and Elixhauser score using all 4 definitions. DISCUSSION/SIGNIFICANCE: The incidence of VTE is directly affected by differences in ICD-9/10 codes used. Definitions for important clinical outcomes should be standardized when using administrative claims data in order to improve reproducibility of findings.

Road of recovery in gastrointestinal surgery: From ERAS to FRAS

Enhanced recovery after surgery (ERAS) starts mainly with colorectal surgery and has been shown to improve clinical outcomes and cost savings in almost all major surgical specialties during the implementation and development for more than two decades. On the basis of improving medical quality and perioperative safety strengthened by ERAS, we propose the concept of fastest recovery after surgery (FRAS) and bring it into clinical practice to achieve fastest recovery for patients undergoing elective major gastrointestinal surgery. In this article, we introduce the definition, superiorities, perioperative protocol, and future directions with regard to the practice of FRAS in gastrointestinal surgery.

Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery.

We sought to define surgical outcomes among elderly patients with Alzheimer's disease and related dementias (ADRD) following major thoracic and gastrointestinal surgery. A retrospective cohort study was used to identify patients who underwent coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Individuals were identified from the Medicare Standard Analytic Files and multivariable regression was utilized to assess the association of ADRD with textbook outcome (TO), expenditures, and discharge disposition. Among 1,175,010 Medicare beneficiaries, 19,406 (1.7%) patients had a preoperative diagnosis of ADRD (CABG: n=1,643, 8.5%; AAA repair: n=5,926, 30.5%; pneumonectomy: n=590, 3.0%; pancreatectomy: n=181, 0.9%; and colectomy: n=11,066, 57.0%). After propensity score matching, patients with ADRD were less likely to achieve a TO (ADRD: 31.2% vs. no ADRD: 40.1%) or be discharged to home (ADRD: 26.7% vs. no ADRD: 46.2%) versus patients who did not have ADRD (both p<0.001). Median index surgery expenditures were higher among patients with ADRD (ADRD: $28,815 [IQR $14,333-$39,273] vs. no ADRD: $27,101 [IQR $13,433-$38,578]; p<0.001) (p<0.001). On multivariable analysis, patients with ADRD had higher odds of postoperative complications (OR 1.32, 95% CI 1.25-1.40), extended length-of-stay (OR 1.26, 95% CI 1.21-1.32), 90-day readmission (OR 1.37, 95% CI 1.31-1.43), and 90-day mortality (OR 1.76, 95% CI 1.66-1.86) (all p<0.001). Preoperative diagnosis of ADRD was an independent risk factor for poor postoperative outcomes, discharge to non-home settings, as well as higher healthcare expenditures. These data should serve to inform discussions and decision-making about surgery among the growing number of older patients with cognitive deficits.

Acute postoperative pain management techniques, their efficacy and complications after major gastrointestinal and hepato-pancreato-biliary cancer surgeries: An observational study.

Patients undergoing major gastrointestinal (GI) surgery including hepato-pancreato-biliary (HPB) surgeries have large incisions, which cause severe acute postoperative pain that, if untreated, is associated with a higher incidence of postoperative morbidity and delayed recovery. Our study included all patients who underwent elective major upper GI and HPB surgeries from 1 January 2018 to 31 December 2018. The patients were divided into two groups: the epidural and the non-epidural group. The average and worst pain scores at rest and movement were compared between both groups. We also studied the effect of pain relief in the two groups and associated postoperative outcomes, resumption of feeding, ambulation, hospital stay and intensive care unit stay. A total of 566 patients were included in the study, out of which 490 received epidurals, and the rest, 76, belonged to the non-epidural group (transversus abdominis plane, rectus sheath block or no regional analgesia technique). The median average pain score at rest and movement was 2.0 and 3.0, respectively, in the epidural and non-epidural groups. The postoperative outcomes showed no statistical difference. The epidural group and the non-epidural group had similar pain scores, and the postoperative outcomes were also comparable.

Impact of common surgical and anaesthetic strategies for pain control after elective gastrointestinal surgery: cohort study

Introduction: Poor pain control after surgery is associated with chronic pain and opioid dependence. This study aimed to determine the incidence of patient reported pain control failure following gastrointestinal surgery, and to evaluate the impact of common preventative surgical and anaesthetic strategies.&#x0D; Methods: Data were extracted from an electronic health record that linked real-time, ward-based pain scores with prescribing data. Adults undergoing major elective gastrointestinal surgery in 2011-18 were included. The primary endpoint was early pain control failure (≥1 instances of moderate or severe pain on postoperative days 0-2). Secondary outcomes were late (postoperative days 3-5) and persistent (both early and late) pain control failure.&#x0D; Results: Of 2238 patients, half underwent planned open surgery (50.3%, 1126/2238). Patient controlled analgesia (PCA) was initially used in 49.7% (1113/2238) and epidural in 35.0% (784/2238). Early (54%, 1211/2238), late (33.7%, 755/2238), and persistent (24.9%, 557/2238) pain control failures occurred frequently. In multivariable analyses, minimally invasive surgery was associated with fewer early, late, and persistent pain control failures than open surgery. There was no association between initial epidural analgesia and early or persistent pain control failure, but there was an association with increased late failure (OR 1.37, 95% CI 1.08-1.73, p=0.009). Of patients with initial epidural analgesia, 39.3% (308/784) were subsequently converted to PCA.&#x0D; Conclusion: Epidural analgesia offered no advantage over PCA, with pain control failure common irrespective of analgesic strategy. Increasing the uptake of minimally invasive surgery, through medical advances to down-stage disease, may offer a path to effectively improve postoperative pain failure.

Effect of Oxycodone-Based Multimodal Analgesia on Visceral Pain After Major Laparoscopic Gastrointestinal Surgery: A Randomised, Double-Blind, Controlled Trial.

Oxycodone is a potent μ- and κ-opioid receptor agonist that can relieve both somatic and visceral pain. We assessed oxycodone- vs sufentanil-based multimodal analgesia on postoperative pain following major laparoscopic gastrointestinal surgery. In this randomised double-blind controlled trial, 40 adult patients were randomised (1:1, stratified by type of surgery) to receive oxycodone- or sufentanil-based multimodal analgesia, comprising bilateral transverse abdominis plane blocks, intraoperative dexmedetomidine infusion, flurbiprofen axetil, and oxycodone- or sufentanil-based patient-controlled analgesia. The co-primary outcomes were time-weighted average (TWA) of visceral pain (defined as intra-abdominal deep and dull pain) at rest and on coughing during 0-24 h postoperatively, assessed using the numerical rating scale (0-10) with a minimal clinically important difference of 1. All patients completed the study (median age, 64 years; 65% male) and had adequate postoperative pain control. The mean (SD) 24-h TWA of visceral pain at rest was 1.40 (0.77) in the oxycodone group vs 2.00 (0.98) in the sufentanil group (mean difference=-0.60, 95% CI, -1.16 to -0.03; P=0.039). Patients in the oxycodone group had a significantly lower 24-h TWA of visceral pain on coughing (2.00 [0.83] vs 2.98 [1.26]; mean difference=-0.98, 95% CI, -1.66 to -0.30; P=0.006). In the subgroup analyses, the treatment effect of oxycodone vs sufentanil on the co-primary outcomes did not differ in terms of age (18-65 years or >65 years), sex (female or male), or type of surgery (colorectal or gastric). Secondary outcomes (24-h TWA of incisional and shoulder pain, postoperative analgesic usage, rescue analgesia, adverse events, and patient satisfaction) were comparable between groups. For patients undergoing major laparoscopic gastrointestinal surgery, oxycodone-based multimodal analgesia reduced postoperative visceral pain in a statistically significant but not clinically important manner. Chinese Clinical Trial Registry (ChiCTR2100052085).

Two-stage pancreaticoduodenectomy: a case report

Pancreaticoduodenectomy is one of the major gastrointestinal surgeries and still has significant complication rates. Although most complications appear postoperatively, severe intraoperative difficulties and complications can occur in certain circumstances. Here, we presented the management of two cases who underwent two-stage pancreaticoduodenectomy due to intraoperative problems. Two patients have become hemodynamically unstable during an elective pancreatic resection combined with both arterial and venous reconstructions. All the gastrointestinal reconstructions were postponed to second sessions for damage control surgery. A two-stage pancreaticoduodenectomy is an option to be considered in a hemodynamically unstable patient during elective pancreaticoduodenectomy.

Evaluation of Use of Fast Track Surgery

Despite surgical and anesthetic advances, many studies show complications after major gastrointestinal surgery in a subset of patients. Studies have also shown that the main focus must be developing new therapies for postoperative benefit. Studies have shown interest in the FTS pathway but need to be more precise. Our literature review shows that very little FTS pathway data is available from India. Thus, we investigated FTS use in our study. We performed 70 elective abdominal surgical procedures. Comorbidities and other variables that may affect surgery were assessed for patients. Each individual learned about FTS and its benefits. After counseling, written informed consent was obtained. Each individual received an appropriate workout program and behavior change strategy. We found that FTS reduced postoperative ileus and NG tube usage. Hence, FTS is superior to traditional surgery when utilized appropriately during surgery.

Severe Hypomagnesemia-induced Cerebellar Ataxia after Major Gastrointestinal Cancer Surgeries: A Report of Two Cases

Severe Hypomagnesemia-induced Cerebellar Ataxia after Major Gastrointestinal Cancer Surgeries: A Report of Two Cases

Implementation of a preoperative pathway for patients undergoing major oncologic gastrointestinal surgery

Background: In recent year, a constant increase in life expectancy has occurred in the Western world, leading more elder and frail patients to require major abdominal surgery. These frail patients are more prone to develop postoperative complications and are at higher risk of postoperative mortality. A multimodal, multidisciplinary approach has the potential to improve the perioperative care of these patients. Methods: A cohort of consecutive frail patients undergoing major abdominal surgery for pancreatic and esophago-gastric malignancies between March 2015 and February 2016 was selected and retrospectively evaluated using the modified Frailty Index. Surgical outcomes of this group (experimental group) were compared to a control group of frail patients selected according to main diagnosis, surgical procedures, and surgical team, who underwent major abdominal surgery before the introduction of the multidisciplinary approach (March 2013 to February 2014). Results: Between March 2015 and February 2016, 41 frail patients undergoing major abdominal surgery were identified (experimental group) and compared to similar frail patients receiving similar procedures between March 2013 and February 2014 (control group). The two groups were similar in terms of baseline characteristics (age, gender, American Society of Anesthesiology score, and comorbidities, all P &gt; 0.050), main surgical interventions (P = 0.156), main diagnosis (P = 0.060), and tumor stage (P = 0.420). Modified frailty index and other frailty parameters were similar between the two groups (all P &gt; 0.050). Thirty-days and 3-months mortality rates were lower in the experimental group (0% vs. 14% and 0% vs. 28%, P = 0.010 and P &lt; 0.001 respectively). Similarly, patients in the experimental group showed a lower rate of postoperative overall (41% vs. 74%, P = 0.005) and severe (17% vs. 43%, P = 0.020) complications, while postoperative length of stay, readmission rate and post discharge institutionalization were similar between the two groups (all P &gt; 0.05). Conclusion: The development of a multidisciplinary preoperative pathway for frail patients undergoing major oncologic gastrointestinal surgery for esophago-gastric and pancreatic surgery seems to effectively improve postoperative outcomes, with a significant reduction in the rate of postoperative mortality and complications. Furthermore, the implementation of such a pathway could help the perioperative management of these complex patients and facilitates their territorial take in charge.

EGS P10 A multi-centre prospective cohort study to identify factors predictive of poor functional recovery for older patients facing major gastrointestinal surgery (OCTAGON study): A subgroup analysis of older patients undergoing non-curative procedures or conservative management

Abstract Background Increasing age and frailty are associated with ‘futile’ emergency GI surgery and increased 30-day mortality after elective surgery. Consequently, older patients may be deemed “unfit” for major GI surgery, due to perceived risk of poor outcomes such as prolonged hospitalisation, poor functional recovery or mortality. Little is known about the baseline health characteristics and outcomes of the “unfit” group, with only a small number of studies performed on this patient group to date. This study aimed to comprehensively assess the baseline characteristics and functional trajectories of patients deemed “unfit” for major surgery using validated questionnaires. Methods This prospective, multicentre cohort study included patients aged 65 years or older with a diagnosis of elective or emergency GI pathology amenable to curative major GI surgery. Patients who underwent risk-adapted procedures or conservative management instead of curative major GI surgery formed the “unfit” cohort. Risk-adapted procedures included endoluminal stenting, defunctioning stomas and percutaneous tumour ablation. Baseline patient characteristics were recorded. Patients were followed up at 6 weeks, 3 months, and 6 months to assess survival, patient reported functional recovery using the World Health Organization Disability Assessment Schedule (WHO-DAS) questionnaire and quality of life using EQ-5D-5L. Results 19 patients formed the “unfit” cohort. 10 patients presented electively and 9 presented as an emergency. Within the elective group 30% were classified as frail and 20% required carers, in comparison to 89% and 56% respectively in the emergency group. Baseline WHODAS indicated higher patient reported disability in the emergency group. 6-month mortality was 40% in the elective group and 44% in the emergency group. At 6 weeks, functional status declined in both the elective and emergency groups. Only small numbers of patients completed follow-up at 3 and 6 months due to death prior to follow-up. Conclusions This study comprehensively assessed baseline functional status and quality of life in elective and emergency patients who were “unfit” for major GI surgery. The study found high rates of baseline frailty and functional disability, particularly amongst those who presented via emergency pathways. Over half of patients were alive at 6 months, but with high levels of functional impairment, suggesting that these patients may benefit from early involvement from geriatric and palliative care specialists. Further research is needed to improve outcomes in this understudied surgical population.

INCIDENCE AND PREDICTORS OF SURGICAL SITE INFECTION IN MAJOR ABDOMINAL SURGERIES AT A TERTIARY CARE CENTER IN DELHI

Objective: Surgical site infections (SSIs) are the third commonly stated nosocomial infections, with the prevalence rate of 14–16%. In India, the prevalence of SSIs in elective surgeries ranged from 3.83% to 39% and in cases of emergency surgeries, the prevalence ranged from 12.41% to 26.4%. This study was aimed to measure the occurrence of SSIs amid subjects experiencing major abdominal surgeries at tertiary care center in Delhi and to assess the predictors related to occurrence of SSIs in these subjects. Methods: In this cross-sectional study, data were collected over a period of 1 year at the Department of Surgery, Super Specialty Hospital in New Delhi. The, from January 2017 to January 2018. All major gastrointestinal surgeries were considered. Sociodemographic details, clinical history, and surgical details were taken. Results: Out of total 626 patients, 42 (6.7%) developed SSIs. The positive predictors of SSIs in our study were male gender, American Society of Anesthesiology grade of 2 and above, wound class of two and above, longer duration of surgery, emergency surgery, open surgery, laparoscopic converted to open surgery, presence of comorbidities, presence of hypoalbuminemia, and hypoproteinemia. Conclusion: SSIs seems to be a common source of perioperative morbidity and mortality, leading to increased hospital stay and cost of treatment. Proper planning and accordingly managing such case by case scenarios can lead to decreased incidence of SSIs and help reducing burden to the health system.