Number Of Postoperative Days Research Articles

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

Association of Serum Albumin Level with Wound Healing after Caesarean Section

Background: Hypoalbuminemia, indicative of malnutrition and illness, is associated with a heightened risk of poor post-operative outcomes, particularly impaired wound healing. Pregnancy, characterized by elevated estrogen levels, may further complicate wound healing processes. Objective: To evaluate the association of serum albumin level with wound healing after a caesarean section. Methods: A cohort of 100 pregnant patients undergoing caesarean section at Dhaka Medical College Hospital was included between January and December 2020. Preoperative serum albumin levels were measured, with hypoalbuminemia defined as < 3.5 g/dl. Patients were categorized into groups of hypoalbuminemic (Group I) and normal albuminemic (Group II). Postoperatively, patients were monitored for 60 days to identify surgical site infections and signs of delayed wound healing. Results: The mean preoperative serum albumin level was 2.57±0.35 gm/dl in group I and 4.2±0.4 gm/dl in group II. The difference was statistically significant (p<0.05) between two groups. Out of 19 patients, 9 (47.4%) developed post caesarean wound infection and delayed wound healing in group I. Out of 81 patients, 7(8.6%) developed post caesarean wound infection and delayed wound healing in group II. The difference was statistically significant (p<0.05) with OR=9.51 having 95% CI (2.52-37.32). The number of post-operative days in hospital was 13.11±6.14 in group I and 3.22±1.41 in group II. The difference was statistically significant (p<0.05) between two groups. A subject with serum albumin (<3.5 gm/dl) had 7.626 (95.0% CI 2.324 to 25.02) times increased risk to develop wound infection and delayed wound healing after surgery. Other variables were not significantly associated with delayed wound healing. Conclusion: Hypoalbuminemia is an independent risk factor for the delay in wound healing. Low serum albumin level correlates well with the development of surgical site infection and delayed wound healing contributed to prolonged hospital stay.

Which Factors Are Associated with Distal Pancreatectomy Outcomes' Optimization with the Application of an Enhanced Recovery After Surgery Program?

Background: Distal pancreatectomy (DP) represents the best therapeutic option for patients with body-tail pancreatic neoplasms (PNs). The enhanced recovery after surgery protocol is widely used for treating patients with PN to speed up postoperative recovery. This study aims to describe our institute's experience in the application of fast recovery protocol in a cohort of patients treated with DP, identifying predictors facilitating a decrease in the length of hospital stay. Patient and Methods: Were retrospectively enrolled 60 consecutive cases of DP performed from January 2016 to June 2022 in patients treated with enhanced recovery protocol, 25% of them were treated with spleen preserving procedure. Single-variable logistic regression models were used to evaluate the potential association between patient characteristics and the probability of postoperative complications. Standard linear regression models were used for length of stay, number of postoperative days (PODs) from surgery to full bowel function recovery, and PODs to the interruption of intravenous analgesia administration. Results: Thirty-four (57%) patients underwent open surgery and 26 (43%) laparoscopic surgery. Patients who underwent laparoscopic surgery and spleen-preserving procedures experienced a lower complication rate (P = .037), shorter length of stay, and time of analgesic requirements. With single-variable logistic regression models patients treated with laparoscopic surgery had statistically significant higher recovery times in terms of nasogastric tube removal (P = .004) and early enteral nutrition (P = .001). Conclusion: Continual refinement with enhanced recovery protocol for treating PN patients based on perioperative counseling and surgical decision-making is crucial to reduce patient morbidity and time for recovery.

1266 Haemostasis Checklists-Are They an Effective Tool?

Abstract Aim Haemostasis checklists have been developed to decrease re-bleeding rates following cardiac surgeries. These checklists aim to identify the most common sites of bleeding, as well as reasons for coagulopathies and prevent them by early identification during surgery. The aim of this study is to Evaluate the effectiveness of the haemostasis checklist as a tool for reducing the rate of Re-exploration for bleeding in Liverpool heart and chest Cardiothoracic Centre. Method Retrospective study carried over the period of 2019 and 2022 (pre and post checklist implementation). This study included all patients who underwent elective cardiac surgery, 614 cases in each year. Data was analysed and classified into 3 categories: Number of Re-exploration cases in each year, Bleeding sites identified and the Number of post-operative days at which re-bleeding was noted. Results Total number of Re-exploration cases for bleeding in 2019 were 39(6.35%), as compared to 14(2.28%) cases in 2022. 60% of the re-bleeding cases in 2019 were identified within first 24 hours post-operative, while 77% were identified in the first 24 hours in 2022. Most common sites of bleeding identified in 2019, were no clear site (38%) and sternal wires (19%). While in 2022, no clear site (46%) and sternal wires (23%) were most identified during re-exploration. Conclusions Significant reduction of 64% was witnessed between the year of 2019 and 2022 after implementation of the checklist, therefore, Haemostasis checklist proved to be an effective tool in reducing the rate of Re-exploration for bleeding in cardiac surgery.

Nurse-delivered patient education on postoperative wound care: a prospective study

Objective: It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. Method: A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. Results: In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (β=–0.776, p=0.013); hospital site (β=–0.702, p=0.025); and number of postoperative days (β=–0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6–10.3% of variance in the postoperative wound care education patients received. Conclusion: Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.

Distal Bypass Improves Skin Perfusion Pressure at the Entire Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischaemia

This study evaluated the tissue blood pressure of the direct revascularised (DR) and indirect revascularised (IR) areas after distal bypass surgery using repeated skin perfusion pressure (SPP) measurements. Twenty-two patients received regular hemodialysis, and all limbs were classified as Rutherford 5. SPP of the direct and indirect revascularization area was measured at 10 time points, including pre- and post-days 3 to 6, 7 to 9, 10 to 12, 13 to 14, 15 to 17, 18 to 20, 21 to 23, 24 to 26, and 27 to 29. Patients were divided into two groups according to the number of postoperative days to the SPP peak at the DR, as follows: group A (n = 14; SPP peak day within 9 days), group B (n = 15; peak day after 10 days). In total, 446 SPP measurements were collected from 58 measurement sites, and the transition of the SPP at the DR was 35.4, 62.5, 59.5, 70.2, 58.2, 62.2, 63.1, 63.6, 63.8, and 73.4 mmHg and IR was 29.4, 53.4, 53.7, 58.8, 51.3, 63.1, 47.9, 62.1, 57.6, and 61.0 mmHg. No significant differences were observed between SPP at the DR and IR except post-days 18 to 20 (Fig 1). Fifteen wounds on the DR (62.5%) and five on the IR (100.0%) healed. The wound healing rate and time were 92.9% and 81 days in group A, 53.3% and 222 days in group B (Fig 2). Distal artery bypass improved SPP in the IR and DR of patients with chronic limb-threatening ischemia. An early SPP peak could be an indicator of wound healing.Fig 2Cumulative incidence curve of wound healing in each group. There was a significant difference in the wound healing rate (P = .01).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of three types of Epilepsy Surgery for the treatment of Refractory Status Epilepticus: A Single Center Experience (P9-1.005)

<h3>Objective:</h3> Comparing outcomes for three categories of epilepsy surgery in Refractory Status Epilepticus Patients (RSE). <h3>Background:</h3> Literature comparing morbidity and mortality outcomes between three types of epilepsy surgery for RSE patients is scarce. Previous case series have focused on one type of surgery or does not directly compare outcomes between the modalities. <h3>Design/Methods:</h3> A retrospective analysis for RSE between 2010 and 2021 was done. Sociodemographic data, semiology and etiology were collected. The patients were deidentified using our institute’s software, and comparison data was extracted from the secure system. Data collected included lag time between diagnosis and surgery, number of anti-seizure medications (ASMs) tried, EEG and imaging data, type of surgery performed, level of post-operative care, number of post-operative days admitted, complications and seizure freedom outcomes. <h3>Results:</h3> The mean age was 35.6 ± 23.5 years, with 4/12 patients being female. Seizure types were primarily generalized tonic-clonic or focal seizures with impaired awareness. A plethora of etiologies were included. The mean number of ASMs tried was 2.3 ± 1.4. Every patient had EEG and MRI Brain with ancillary testing such as grid placement. Out of 12, 6 had resection, 5 disconnections and 2 neuromodulations. 11/12 patients required an ICU admission and mean post-operative days admitted was 12 ± 11.2. Minor to no complications occurred in 33 % of all resection patients, and minor complications occurred in 40 % and 50 % patients of the disconnection and modulation patients. 3/4 and 3/5 of patients that had undergone resections and disconnections respectively had Class 1 outcomes in. Patients that received modulation had a Class 4 outcome and 1 patient death. <h3>Conclusions:</h3> Our study reveals that while there is no substantial difference between resection and disconnection, resections have slightly better outcomes and fewer complications. Modulation had poorer seizure freedom and may only be considered as a temporizing measure. <b>Disclosure:</b> Dr. Khan has received personal compensation for serving as an employee of University of Kentucky. Dr. Mirza has nothing to disclose. Dr. Mathias has received research support from My Epilepsy Society Non Profit Organization.

Impact of three-dimensional printed planning in Paprosky III acetabular defects: a case-control and cost-comparison analysis.

The main challenges in revision total hip arthroplasty (rTHA) are the treatment of the bone loss and the pre-operative planning. 3D-printed models may enhance pre-operative planning. The aim of the study is to compare the intra- and peri-operative results and costs for Paprosky type 3 rTHAs planned with 3D-printed models to ones accomplished with the conventional imaging techniques (X-rays and CT scan). Seventy-two patients with Paprosky type 3 defect underwent rTHA between 2014 and 2021. Fifty-two patients were treated with standard planning and 20 were planned on 3D-printed models. Surgical time, intra-operative blood loss, number of transfused blood units, number of post-operative days of hospitalization, and use of acetabular rings were compared between the two groups. A costs comparison was also performed. The 3D-printed group showed reduced operative time (101.8min (SD 27.7) vs. 146.1min (SD 49.5), p < 0.001) and total days of hospitalization (9.3days (SD 3.01) vs. 12.3days (SD 6.01), p = 0.009). The cost of the procedures was significantly lower than the control group, with an adjusted difference of4183 euros (p = 0.004).No significant differences were found for the number of total transfused blood units and blood loss and the number of acetabular rings. The use of 3D-printed models led to a meaningful cost saving. The 3D-printed pre-operative planning for complex rTHAs seems to be effective in reducing operating time, hospital stay and overall costs.

Early mobilization after esophageal cancer surgery: a retrospective cohort study.

A key component of the Enhanced Recovery After Surgery pathway for esophagectomy is early mobilization. Evidence on a specific protocol of early and structured mobilization is scarce, which explains variation in clinical practice. This study aims to describe and evaluate the early mobilization practice after esophagectomy for cancer in a tertiary referral center in the Netherlands. This retrospective cohort study included data from a prospectively maintained database of patients who underwent an esophagectomy between 1 January 2015 and 1 January 2020. Early mobilization entailed increase in activity with the first target of ambulating 100meters. Primary outcomes were the number of postoperative days (PODs) until achieving this target and reasons for not achieving this target. Secondary outcomes were the relationship between preoperative factors (e.g. sex, BMI) and achieving the target on POD1, and the relationship between achieving the target on POD1 and postoperative outcomes (i.e. length of stay, readmissions). In total, 384 patients were included. The median POD of achieving the target was 2 (IQR 1-3), with 173 (45.1%) patients achieving this on POD1. Main reason for not achieving this target was due to hemodynamic instability (22.7%). Male sex was associated with achieving the target on POD1 (OR = 1.997, 95%CI 1.172-3.403, P= 0.011); achieving this target was not associated with postoperative outcomes. Ambulation up to 100m on POD1 is achievable in patients after esophagectomy, with higher odds for men to achieve this target. ERAS pathways for post esophagectomy care are encouraged to incorporate 100m ambulation on POD1 in their guideline as the first postoperative target.

374. THE ROLE OF EARLY MOBILIZATION AFTER ESOPHAGEAL CANCER SURGERY

Abstract A key component of the Enhanced Recovery After Surgery pathway for esophagectomy is early mobilization. Evidence on a specific protocol of early and structured mobilization is scarce, which explains variation in clinical practice. This study aims to describe and evaluate the early mobilization practice after esophagectomy for cancer in a tertiary referral center in the Netherlands. This retrospective cohort study included data from a prospectively maintained database of patients who underwent an esophagectomy between 01-01-2015 and 01-01-2020. Early mobilization entailed increase in activity with the first target of ambulating 100 meters. Primary outcomes were the number of postoperative days (PODs) until achieving this target and the reasons for not achieving this target. Secondary outcomes were the relationship between preoperative factors (e.g. Sex, BMI, ASA-score) and achieving the target on POD1, and the relationship between achieving the target on POD1 and postoperative outcomes (e.g. readmissions, postoperative complications). In total 384 patients were included. The median POD of achieving the target was 2 (IQR 1-3), with 173 (45.1%) patients achieving this on POD1. Main reasons for not achieving the target on POD1 was due to hemodynamic instability (22.7%). Male sex was associated with achieving the target on POD1 (OR = 2.08, p = 0.007); achieving the target on POD1 was not associated with postoperative outcomes. Ambulation up to 100 m on POD1 is achievable in patients after esophagectomy, with men having higher odds for achieving this target. No relationship between early mobilization and postoperative outcomes was found, however it may have effect on other parameters, such as improved long-term recovery, this should be investigated further in a larger patient cohort. ERAS pathways focusing on esophagectomy care are encouraged to incorporate 100 m ambulation on POD1 in their guideline as first postoperative target.

Pharmacokinetic Model Based on Stochastic Simulation and Estimation for Therapeutic Drug Monitoring of Tacrolimus in Korean Adult Transplant Recipients.

Tacrolimus shows high variability in inter- and intraindividual pharmacokinetics (PK); therefore, it is important to develop an appropriate model for accurate therapeutic drug monitoring (TDM) procedures. This study aimed to develop a pharmacokinetic model for tacrolimus that can be used for TDM procedures in Korean adult transplant recipients by integrating published models with acquired real-world TDM data and evaluating clinically meaningful covariates. Clinical data of 1829 trough blood samples from 269 subjects were merged with simulated data sets from published models and analyzed using a nonlinear mixed-effect model. The stochastic simulation and estimation (SSE) method was used to obtain the final parameter estimates. The final estimated values for apparent clearance, the volume of distribution, and absorption rate were 21.2 L/h, 510 L, and 3.1/h, respectively. The number of postoperative days, age, body weight, and type of transplant organs were the major clinical factors affecting tacrolimus PK. A tacrolimus PK model that can incorporate published PK models and newly collected data from the Korean population was developed using the SSE method. Despite the limitations in model development owing to the nature of TDM data, the SSE method was useful in retrieving complete information from the TDM data by integrating published PK models while maintaining the variability of the model.

Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures.

Supracondylar humerus fractures (SCHF) are the most common elbow fracture type in children, and one of the most common pediatric fracture types overall. Excellent outcomes are generally reported with closed reduction and pinning (CRPP), but the technique involves leaving the pins outside the skin. External pins can act as a nidus for infection. We characterize the infection complications from SCHF treatment at a single-centre tertiary children's hospital over 10 years. This is the largest series on infectious outcomes after CRPP of SCHF reported to date. Pediatric patients undergoing CRPP for a type II or type III SCHF from 2011 to 2021 with postsurgical infections within 90 days were identified. Demographic and clinical data were retrieved from medical records. Descriptive statistics were estimated and reported as means or medians with range values or counts with percentages. A total of 18 patients met inclusion criteria, 10 and 8 with type II and III SCHF, respectively. The average age at diagnosis of fracture was 4.7 (2 to 9) years. The average operating time for the index surgery was 29 minutes (12 to 42). The average number of postoperative days until pin removal was 29.8 (18 to 52), and the average number of postoperative days until readmission or visit with symptoms was 38.9 (18 to 77). There was a documented history of a wet cast in 6 patients (33%). Ten (56%) patients presented with fever, and the most common positive culture was methicillin-sensitive Staphylococcus aureus (9, 50%). Thirteen (72%) patients returned to the operating room for incision and drainage. There were no cases with continued complications after the original infection after a median follow-up of 63 days (8 to 559). Infection after CRPP of SCHF is a rare adverse event. In our series, it was most often associated with common pathogens and wet casts. The necessity of return to the operating room will vary with the presentation, but if efficaciously treated afterwards with oral antibiotics, there is a low chance of recurrence or subsequent complications. Patients should be carefully instructed in cast care and demonstrate understanding of risks and complications, and to contact their orthopaedist if their cast demonstrates lack of integrity. Prognostic level IV.

Reducing hyperglycaemia post-kidney and liver transplant: a quality improvement initiative.

BackgroundIn-hospital glycaemic management can reduce post-transplant morbidity, but is not always part of transplant care.ObjectiveWe aimed to reduce the mean number of postoperative days in hyperglycaemia (≥2 blood glucose >12 mmol/L in 24 hours) in kidney and liver transplant recipients by 30%. We also aimed to reduce the mean number of days between transplant admission to endocrine consult by 2.0 days.Design, setting, participantsWe conducted a quality improvement project in liver and kidney transplant recipients admitted to an academic transplant unit in Canada between 1 March 2019 and 1 May 2021.InterventionWe developed a bedside algorithm to monitor post-transplant capillary blood glucose; the algorithm also included thresholds for nursing-initiated inpatient endocrinology consultation.Main outcome and measuresWe examined outcome (postoperative days in hyperglycaemia, days to inpatient endocrine consultation), process (nursing documentation of postoperative blood sugars) and balancing measures (nursing workload, postoperative days in hypoglycaemia) following implementation of our algorithm. We used Plan-Do-See-Act cycles to study three iterations of our algorithm, and used box plots to present outcomes before and after algorithm implementation.ResultsIn the pre-intervention period, 21 transplant recipients spent a mean of 4.1 (SD 2.4) postoperative days in hyperglycaemia before endocrine consultation. The mean number of days between hospital admission to endocrine consult was 10.7 (SD 13.0) days.In the post-intervention period, we observed a 62% reduction in postoperative days in hyperglycaemia. The mean number of days between admission and endocrine consult was reduced by 6.3 days (59% reduction).ConclusionsImplementation of a simple, bedside algorithm for postoperative glucose monitoring and detection of hyperglycaemia in transplant patients, reduced the mean number of postoperative days in hyperglycaemia and time to inpatient endocrine consultation. Our algorithm continues to be used in our academic transplant unit.

Oral Aversion in Infants With Congenital Heart Disease: A Single-Center Retrospective Cohort Study.

Neonates undergoing cardiac surgery are at risk for oral aversion (OA). OA is not well described outside of the index hospitalization and impacts patients and families. We evaluated the prevalence of OA at 1 year old after neonatal cardiopulmonary bypass (CPB) surgery. Retrospective cohort study. Single quaternary care hospital. Our cohort included 157 neonates who underwent CPB surgery from 2014 to 2017 and had follow-up data available at 1 year old. None. Three feeding experts reviewed the medical record to define children with OA; 30% of charts were evaluated in triplicate for validation. Neonates with and without OA were compared in univariate analysis, and risk factors for OA were explored in a limited multivariable analysis. OA was present at 1 year in 37 patients (23.6%) and other feeding difficulties were present in an additional 29 patients (18.5%). Thirty-eight patients (24.2%) had a feeding tube, including 12 (7.6%) with a gastrostomy tube. Factors associated with OA at 1 year included total ICU days, duration of mechanical ventilation, total number of nil per os days, and number of postoperative days (PODs) until oral feeding initiation (all p < 0.0001). Number of POD until oral feeding initiation remained independently associated with OA at 1 year in multivariable analysis (adjusted odds ratio, 1.08; 95% CI, 1.04-1.12; p < 0.0001). Infants with any oral intake at discharge had lower odds of OA at 1 year (0.21; 95% CI, 0.08-0.5; p = 0.0003). At hospital discharge, 132 patients (84.1%) were taking some oral feeds, and 128 patients (81.5%) received tube feeding. OA and other feeding difficulties are common at 1 year old in neonates undergoing CPB surgery. Delayed exposure to oral intake may be a modifiable risk factor for OA and efforts to improve early oral feeding could lead to better functional outcomes.

Timing of urinary catheter removal after radical hysterectomy for cancer of the cervix and uterus: A single-institution observational study

BACKGROUND AND OBJECTIVE: Radical hysterectomy remains to be the first surgery for early-stage cervical and selected stage 2 endometrial carcinoma. Functional disorders of the lower urinary tract are the foremost common complications following radical surgery necessitating catheterization. This study was undertaken to determine the number of postoperative days (POD) of the removal of urinary catheters after hysterectomy and assess the practicability of earlier removal of the catheter without compromising the bladder function.METHODOLOGY: A descriptive observational study of patients who underwent Type 2 or 3 hysterectomy for cervical or endometrial carcinoma. Clinical, intraoperative, and anesthesia records and results of the histopathologic reports of every patient were reviewed. Demographic, clinical, and histopathologic data needed during this review were recorded. Descriptive statistics were used.RESULTS: Between January 2016 and December 2019, a complete 45 patients underwent radical hysterectomy (43 patients for cervical cancer and a pair for endometrial carcinoma), with a median age of 50 years. The mean operative time is 2.5 h and also the average blood loss is 500 ml. The mean size of the cervical tumor was 2.2 cm, the mean length of the vagina was 2.5 cm, and the mean lateral width of parametria was 3.6 cm. Catheters were removed between the 3rd and 20th (mean = 6 days) POD. All patients had adequate spontaneous void within 6 h after removal. Five patients had their catheters removed beyond 7 days, 3 patients between POD 8 and POD 14, and 2 patients between days POD 15 and POD 20. All patients were able to return to bladder function within 3 weeks of catheterization.CONCLUSION: The outcome showed that earlier removal of catheter seems to be a practical and safe option compared to long-term catheterization for patients who underwent radical hysterectomy without causing morbidities.

Empiric antibiotic therapy in early periprosthetic joint infection: a retrospective cohort study.

Periprosthetic joint infection (PJI) is a devastating complication following total knee or total hip arthroplasty (TKA/THA). Appropriate empiric antibiotic treatment, initiated directly after debridement and implant retention (DAIR), is suggested to contribute to treatment success. The aim of this study was to describe the microbiology and the antibiotic susceptibility in early PJI to guide future empiric treatment in a region with a low incidence of methicillin-resistant Staphylococcus aureus (MRSA). Consecutive patients who underwent DAIR within 3months after primary unilateral TKA or THA between January 2011 and December 2018 were retrospectively identified from the hospital electronic health records. Data on causative pathogens, antimicrobial susceptibility and the number of post-operative days until cultures demonstrated bacterial growth were collected. One hundred and eleven early PJIs were identified of which 65 (59%) were monomicrobial and 46 (41%) polymicrobial. Among all isolated pathogens, Staphylococcus aureus (n = 53; 29%) was the most commonly identified pathogen in early PJI without any involvement of MRSA. 72% of PJIs were susceptible to vancomycin which could be increased to around 90% by adding gram-negative coverage. On the 5th postoperative day, bacterial growth was observed in 98% of cases. All gram-negative bacteria demonstrated positive tissue cultures on the 4th postoperative day. Vancomycin combined with ciprofloxacin or a third generation cephalosporin provided the highest antimicrobial coverage of allresponsible pathogens identified in early PJI. Empiric treatment of gram-negative treatment can be safely terminated in the absence of gram-negative pathogens after 4days of culturing in cases without preoperative antibiotic treatment.

Comparison of surgical difficulty in patients with resectable non-small cell lung cancer under different neoadjuvant treatment modes: a retrospective cohort study.

BackgroundPrevious studies have reported on the efficacy and safety of neoadjuvant use of a programmed cell death 1 (PD-1) antibody, sintilimab, in patients with non-small cell lung cancer (NSCLC). This study aimed to further evaluate the difficulty of this surgery and the postoperative complication rates in patients with NSCLC receiving neoadjuvant sintilimab.MethodsPatients who received neoadjuvant sintilimab (200 mg) in the Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital from March 2018 to March 2019 were enrolled in the neoadjuvant immunotherapy group (NI group). Another two cohorts who did not receive sintilimab were retrospectively selected by propensity score matching (PSM) at a ratio of 1:1 in the upfront surgery (M-US) and neoadjuvant chemotherapy (M-NC) groups. The postoperative complication rate, postoperative days (PODs), and other detailed objective indicators were compared by t-test or χ2 test.ResultsThirty-seven patients were enrolled in each group. Postoperative complications were greater in the NI group (37.8%) than in the M-US (10.8%; P=0.013) or in the M-NC group (16.2%; P=0.036). The number of PODs (7) was greater in the NI group than in the M-US group (P=0.005). The total number of dissected lymph nodes was lower in the NI group than in the M-US group (P<0.001) or in the M-NC group (P<0.001). Lymph node dissection (LND) in the NI group was more difficult than in the M-US group (P=0.015), but intrathoracic adhesion, tumor invasion, and whole procedure difficulty were similar.ConclusionsThe administration of neoadjuvant sintilimab increased complications but did not increase the difficulty of surgery. Fewer lymph nodes were dissected in the NI group.

Associations of perioperative characteristics with motor function in preschool children born with esophageal atresia.

BackgroundChildren born with esophageal atresia experience long‐term neurodevelopmental deficits, with unknown origin.AimsTo find associations between perioperative variables during primary esophageal atresia repair and motor function at age 5 years.MethodsThis ambidirectional cohort study included children born with esophageal atresia who consecutively had been operated on in the Erasmus MC‐Sophia Children's Hospital, University Medical Center, Rotterdam, from January 2007 through June 2013. The perioperative data of this cohort were collected retrospectively; the motor function data prospectively.ResultsAfter exclusion of patients with syndromal congenital diseases (n = 8) and lost to follow‐up (n = 10), the data of 53 children were included. The mean (SD) total motor function impairment z‐score at 5 years of age was −0.66 (0.99), significantly below normal (p < .001). In multivariable linear regression analysis, number of postoperative days endotracheal intubation (B = −0.211, 95% CI: −0.389 to −0.033, p = .021) was negatively associated with motor outcome, whereas high blood pressure (B = 0.022, 95% CI 0.001 to 0.042, p = .038) was positively associated. Preoperative nasal oxygen supplementation versus room air (B = 0.706, 95% CI: 0.132 to 1.280, p = .016) was positively associated with motor outcome, which we cannot explain.ConclusionsMotor function in 5‐year‐old esophageal atresia patients was impaired and negatively associated with the number of postoperative days of endotracheal intubation and positively associated with high blood pressure. Prospective studies with critical perioperative monitoring and monitoring during stay at the intensive care unit are recommended.

Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer

BackgroundThe aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer.MethodsWe performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used.ResultsTwo hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001).ConclusionEOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

The importance of laparoscopic surgery for early postoperative course in patients with colorectal carcinoma

Introduction/Objective. The aim of our study was to compare early postoperative recovery in patients operated on using laparoscopically assisted and open method in colorectal carcinoma surgery. Methods. The study involved 60 patients, divided into two groups of 30 patients each, treated with open or laparoscopically assisted colorectal surgery. Three groups of factors were collected and analyzed for all the patients. The first group of factors were as follows: age, sex, the American Society of Anesthesiologists score, preoperative hemoglobin, localization. The second group of factors were the following: intraoperative complications, the duration of operations, blood and blood derivatives? compensation. The third group were as follows: complications, length of stay in intensive care, rate of peristaltic establishment, and the time needed for unobstructed oral intake, number of hospitalization days, analgesic use, and verticalization time. Results. The patients who underwent laparoscopically assisted surgery showed significant advantages in the early postoperative recovery compared with those who underwent open surgery, in terms of the number of postoperative days of hospitalization (p &lt; 0.001), the duration of the operation (p &lt; 0.001), the day of establishment of peristalsis (p = 0.009), and the day of establishment of unobstructed oral intake (p &lt; 0.001), the time of verticalization of the patients (p = 0.001), the use of analgesics (p &lt; 0.001). Conclusion. Laparoscopically assisted surgery has an advantage over open surgery colorectal cancer, as regards of early postoperative recovery of the patient.