Perioperative Factor Research Articles

Perioperative hepatocyte growth factor (HGF) infusions improve hepatic regeneration following portal branch ligation (PBL) in rodents.

As hepatic surgery has become safer and more commonly performed, the extent of hepatic resections has increased. When there is not enough expected hepatic reserve to facilitate primary resection of hepatic tumors, a clinical adjunct to facilitating primary resection is portal vein embolization (PVE). PVE allows the hepatic remnant to increase to an appropriate size prior to resection via hepatocyte regeneration; however, PVE is not always successful in facilitating adequate regeneration. One of the strongest trophic factors for hepatocyte regeneration is hepatocyte growth factor (HGF). The purpose of this study was to improve hepatic regeneration with perioperative HGF infusions in an animal model that mimics PVE. Portal branch ligation (PBL) in rodents is equivalent to PVE in humans. We performed left-sided PBL in Sprague-Dawley rodents with the experimental group receiving perioperative HGF infusions. Baseline and postoperative liver volumetrics were obtained with CT scanning methods as performed in clinical practice. Baseline and postoperative liver functions were assessed via indocyanine green (ICG) elimination testing. HGF infused rodents had statistically significant increase in all postoperative liver volumetrics. Most clinically relevant were increased right liver volumes (RLV), 14.10 versus 7.85cm3 (p value 0.0001), and increased degree of hypertrophy (DH%), 159.23 versus 47.11% (p value 0.0079). HGF infused rodents also had a quick return to baseline liver function, 2.38days compared to 6.13days (p value 0.0001). Perioperative HGF infusions significantly increase hepatic regeneration following PBL in rodents. Perioperative HGF infusions following PVE are a possible adjunct to increase the amount of patients able to successfully undergo primary resection for hepatic tumors. Further basic science is warranted in examining the use of HGF infusions to increase hepatic regeneration and translating that basic science work to clinical practice.

Who Is Not a Candidate for a 1-Day Hospital-Based Total Knee Arthroplasty?

BackgroundShort-stay total knee arthroplasty (TKA), defined as a 1-day length of stay (LOS), is feasible in many patients, yet variables identifying who are candidates for a short stay are not well described in literature. With an emphasis on cost-efficiency, we examined preoperative patient characteristics and perioperative hospital factors that correlated with a longer LOS. MethodsA retrospective review of 381 primary TKAs was performed. Clinical measures differentiating a 1-day LOS group from that of a ≥2-day LOS group were identified. ResultsMultiple logistic regression demonstrated older age (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.34-2.77; P < .001), female gender (OR, 4.22; 95% CI, 2.35-7.57; P < .001), American Society of Anesthesiologists score 3 or 4 (OR, 2.00; 95% CI, 1.01-3.95; P = .046), atrial fibrillation (OR, 8.87; 95% CI, 1.81-43.47; P = .007), and prior TKA on the contralateral side (OR, 3.57; 95% CI, 1.27-10.05; P = .016) as significant preoperative characteristics correlating with the ≥2-day LOS group. The most significant hospital perioperative factor associated with longer stays was patients not ambulating on the day of surgery (OR, 4.09; 95% CI, 1.77-9.48; P = .001). Walking 150 ft (93% sensitive, 35% specific) on the day of surgery was predictive of patients in the 1-day LOS group. Hospital costs were US$1873 (P < .001) lower for patients in the 1-day group. ConclusionShorter stays decrease costs associated with TKA, and more refined predictive models are needed to optimize discharge protocols. Preoperative data help allocate limited healthcare resources toward patients more likely to leave in 1 day, while perioperative data facilitate learning to create a more efficient hospital process.

Obstructive Sleep Apnea-a Perioperative Risk Factor.

Obstructive sleep apnea (OSA) is a common disorder of breathing but is probably underappreciated as a perioperative risk factor. This review is based on pertinent articles, published up to 15 August 2015, that were retrieved by a selective search in PubMed based on the terms "sleep apnea AND anesthesia" OR "sleep apnea AND pathophysiology." The guidelines of multiple specialty societies were considered as well. OSA is characterized by phases of upper airway obstruction accompanied by apnea/hypoventilation, with hypoxemia, hypercapnia, and recurrent overactivation of the sympathetic nervous system. It has been reported that 22% to 82% of all adults who are about to undergo surgery have OSA. The causes of OSA are multifactorial and include, among others, an anatomical predisposition and /or a reduced inspiratory activation of the bronchodilator muscles, particularly when the patient is sleeping or has taken a sedative drug, anesthetic agent, or muscle relaxant. OSA is associated with arterial hypertension, coronary heart disease, and congestive heart failure. It can be assessed before the planned intervention with polysomnography and structured questionnaires (STOP/STOP-BANG), with sensitivities of 62% and 88%. The utility of miniaturized screening devices is debated. Patients with OSA are at risk for perioperative problems including difficult or ineffective mask ventilation and/or intubation, postoperative airway obstruction, and complications arising from other comorbid conditions. They should be appropriately monitored postoperatively depending on the type of intervention they have undergone, and depending on individually varying, patient-related factors; postoperative management in an intensive care unit may be indicated, although no validated data on this topic are yet available. OSA patients need care by specialists from multiple disciplines, including anesthesiologists with experience in recognizing OSA, securing the airway of OSA patients, and managing them postoperatively. No randomized trials have yet compared the modalities of general anesthesia for OSA patients with respect to postoperative complications or phases of apnea or hypopnea.

Perioperative Diastolic Dysfunction in Patients Undergoing Noncardiac Surgery Is an Independent Risk Factor for Cardiovascular Events: A Systematic Review and Meta-analysis.

The prognostic value of perioperative diastolic dysfunction (PDD) in patients undergoing noncardiac surgery remains uncertain, and the current guidelines do not recognize PDD as a perioperative risk factor. This systematic review aimed to investigate whether existing evidence supports PDD as an independent predictor of adverse events after noncardiac surgery. Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, and Google search engine were searched for English-language citations in April 2015 investigating PDD as a risk factor for perioperative adverse events in adult patients undergoing noncardiac surgery. Two reviewers independently assessed the study risk of bias. Extracted data were verified. Random-effects model was used for meta-analysis, and reviewers' certainty was graded. Seventeen studies met eligibility criteria; however, 13 contributed to evidence synthesis. The entire body of evidence addressing the research question was based on a total of 3,876 patients. PDD was significantly associated with pulmonary edema/congestive heart failure (odds ratio [OR], 3.90; 95% CI, 2.23 to 6.83; 3 studies; 996 patients), myocardial infarction (OR, 1.74; 95% CI, 1.14 to 2.67; 3 studies; 717 patients), and the composite outcome of major adverse cardiovascular events (OR, 2.03; 95% CI, 1.24 to 3.32; 4 studies; 1,814 patients). Evidence addressing other outcomes had low statistical power, but higher long-term cardiovascular mortality was observed in patients undergoing open vascular repair (OR, 3.00; 95% CI, 1.50 to 6.00). Reviewers' overall certainty of the evidence was moderate. Evidence of moderate certainty indicates that PDD is an independent risk factor for adverse cardiovascular outcomes after noncardiac surgery.

MP74-10 QUANTIFICATION OF RISK FACTORS IN 500 CONSECUTIVE PATIENTS WITH POSTOPERATIVE URINARY RETENTION (POUR)

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2016MP74-10 QUANTIFICATION OF RISK FACTORS IN 500 CONSECUTIVE PATIENTS WITH POSTOPERATIVE URINARY RETENTION (POUR) Peter Tsambarlis, Benjamin Sherer, Karl Godlewski, Rebecca Deal, and Leslie Deane Peter TsambarlisPeter Tsambarlis More articles by this author , Benjamin ShererBenjamin Sherer More articles by this author , Karl GodlewskiKarl Godlewski More articles by this author , Rebecca DealRebecca Deal More articles by this author , and Leslie DeaneLeslie Deane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1707AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our institution established a nurse-driven protocol for early postoperative catheter removal in an effort to minimize catheter associated urinary tract infections (CAUTIs). This led to an increase in POUR (9.8% of 20,455 surgical patients in FY2013) and subsequent traumatic catheterizations. An Institutional Quality and Safety Initiative to reduce POUR and improve patient safety indicators (PSIs) was undertaken. The aim of this study was to identify the number of risk factors present in patients with POUR while examining the prevalence of those risk factors individually. METHODS A retrospective review of our institution's surgical database was performed to identify 500 consecutive cases of POUR between July 1, 2013 and July 1, 2014. POUR was defined as the inability to void postoperatively with bladder scan volumes >450ml and subsequent need for catheterization with output >450ml. These records were individually reviewed for 15 known independent risk factors for urinary retention (see results). Patients with incomplete records or preoperative baseline urinary retention requiring catheterization were excluded. RESULTS Of the 500 consecutive patients with POUR, 288 (57.6%) were male and 212 (42.4%) were female. At the time of void trial, all 500 patients with POUR (100%) had at least 1 perioperative risk factor identified and over 75% had 6 or more (Mean 6.88, Median 7, Range 1-12). See figures. CONCLUSIONS Multiple perioperative risk factors are present in the vast majority of patients with POUR. Many of the risk factors are modifiable and represent an opportunity for intervention. This could ultimately lead to a risk profile which could be used to optimize timing of postoperative void trials improving patient care (improve PSIs and patient comfort, and reduce trauma) while maintaining low rates of CAUTI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e973 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Peter Tsambarlis More articles by this author Benjamin Sherer More articles by this author Karl Godlewski More articles by this author Rebecca Deal More articles by this author Leslie Deane More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics

BackgroundPreoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed. MethodsRisk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120). ResultsForty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis. ConclusionsThis multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.

Living donor liver transplantation for hemophilia with special reference to the management of perioperative clotting factor replacement

Living donor liver transplantation for hemophilia with special reference to the management of perioperative clotting factor replacement

Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients

In recent years, supra-aortic rerouting and thoracic endovascular aortic repair (TEVAR) for treating aortic arch pathology have emerged as a less invasive option for high-risk patients. This study aimed to assess our strategy for preventing stroke and improving late outcomes after supra-aortic rerouting and TEVAR. Between July 2008 and July 2015, we performed 280 cases of TEVAR for arch pathologies, using manufactured stent grafts. This study reviewed 101 patients who underwent supra-aortic rerouting and TEVAR for degenerative distal arch aneurysms (80 men, mean age 73.1 years, Zone 1/Zone 2 = 48/53). Since 2011, we have routinely used the brain protection method, which comprises blocking native forward flow from the left common carotid artery (LCA) and left subclavian artery (LSA) for zone 1 cases and the LSA for zone 2 cases before TEVAR. The mean operation time was 178 ± 65 min. The stroke and 30-day death rates were 3 and 1%, respectively. Before the brain protection method was introduced, the perioperative risk factor for stroke was atheroma Grade ≥III (P = 0.035). Proximal landing zone (P = 0.58) and LSA sacrifice (P = 1.00) were not risk factors for stroke. No strokes occurred after using the brain protection method (before protection: 6% and after protection: 0%). Regarding late results, the rate of freedom from aorta-related death at 1 and 4 years was 97 and 95%, respectively. The rate of freedom from aortic events at 1 and 4 years was 91 and 86%, respectively. During follow-up, no type Ia endoleak developed and one type A dissection was observed. Our strategy for supra-aortic rerouting and TEVAR showed satisfactory early and late results. The chief risk factor for perioperative stroke was atheroma, and blocking native forward flow from the LCA and the LSA prior to the TEVAR procedure helped prevent stroke.

Management of perioperative tumour necrosis factor α inhibitors in rheumatoid arthritis patients undergoing arthroplasty: a systematic review and meta-analysis.

Tumour necrosis factor α inhibitors (TNFis) are widely used in RA patients who undergo surgery, and optimal perioperative management must balance the risk of infection with the risk of post-operative flare. The purpose of this study is to examine the impact of TNFi exposure on surgical site infections (SSIs) in RA patients undergoing elective orthopaedic surgery by systematic review and meta-analysis. A systematic review of the literature and meta-analysis were performed using PUBMED, EMBASE and the Cochrane Central Register of Controlled Trials, through May 2014. Two independent reviewers screened titles and abstracts, and analysed selected papers in detail. Included studies assessed RA patients with or without TNFi exposure prior to orthopaedic surgery, and described post-operative infections. Study quality was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. Meta-analyses of the individual study odds ratios (ORs) were conducted, and each pooled OR was calculated using a random effects model. Eight observational studies and three case control studies met inclusion criteria; risk of bias was low in eight studies and moderate in three. Publication bias was not apparent. These studies represent 3681 patients with recent exposure to TNFis (TNFi+) and 4310 with no recent exposure to TNFis (TNFi-) at the time of surgery. The TNFi+ group had higher risk of developing SSI compared with patients in the TNFi- group (random effects model: OR 2.47 (95% CI 1.66, 3.68); P < 0.0001). Data from the available literature suggest that there is an increased risk of SSIs in RA patients who use or have recently used TNFis at the time of elective orthopaedic surgery. Prospective studies to confirm these findings and establish the optimal withhold and restart time of TNFis, in the context of other risk factors for infection in RA patients such as higher disease activity, corticosteroid use, smoking and diabetes, are needed.

The clinical relevance of perioperative Factor XIII levels in open biliary surgery for obstructive jaundice

The clinical relevance of perioperative Factor XIII levels in open biliary surgery for obstructive jaundice

High Altitude: A Possible Reason for Postoperative Bleeding after Coronary Artery Bypass Graft Operations

Background: This study evaluated the possible hypothesis that high altitude might be a reason of excessive postoperative drainage after coronary artery bypass graft operations (CABG). Methods: 212 patients were operated by the same surgical team and included to the study with retrospective data scan on postoperative bleeding after elective CABG with cardiopulmonary bypass (CPB). Study was derived from two different altitude centers: Group A patients (n = 107) from the center at an altitude of 1985 meters and Group B patients (n = 105) from the center in approximately sea level with 150 meters altitude. Multiple preoperative, intraoperative and postoperative characteristics with postoperative bleeding amounts were reviewed and calculated to determine a result through the aim of our study. Results: Preoperative, operative and intraoperative parameters for both groups were almost identical. Statistically significance occurred on intensive care unit treatment period, total hospitalization days, usage of erythrocyte suspension and fresh frozen plasma among postoperative periods on behalf of Group B. Parameters such as CABG numbers, Cross clamp and CPB time were not significant. High altitude patients were considered to be with a higher outcome in preoperative hematocrit (Htc) levels which did not occur in the study group. Htc levels presented a slight elevation for Group A as in the preoperative values but a statistically significance was not calculated. Postoperative bleeding volumes and calculated mean values were statistically significantly different among both groups in days of 1, 2 and 3. Reoperations for hemorrhage occurred in 9 cases (8.4%) in Group A and 4 cases (3.8%) in Group B. Conclusions: We want to attract attention to the relation between high altitude and postoperative bleeding after CABG surgery. But yet uncertain and unidentified physiological and biochemical conditions can be a reason as an uncontrollable perioperative factor in this patients. Operation at high altitude can be a reason for postoperative excessively bleeding.

No increased bleeding risk for oral surgery in patients with severe congenital bleeding disorders due to intense perioperative management.

In order to evaluate complication rates of dentoalveolar surgery in patients with congenital bleeding disorders, a retrospective case-control study was performed. A collective of patients with congenital bleeding disorders (n = 69), who received common oral surgery procedures in combination with intense perioperative monitoring and coagulation factor substitution at the University Hospital of Bonn between 1992 and 2011, was matched with patients without bleeding disorders by age, sex, and type of surgery. In addition to the rates of perioperative bleeding and other complications, the duration of surgery and the use of local hemostatic agents were compared between both cohorts. There were no significant differences between the two groups regarding the rate of postoperative bleeding (2.9 vs. 1.4%, patients with congenital bleeding disorders vs controls) and the rate of other complications (7.2 vs. 21.7%). Furthermore, no significant difference in operation time (54 min in patients with congenital bleeding disorders vs 45 min in controls) was observed. However, there was a significant difference (p < 0.001) regarding the use of local hemostatic measures, which were applied in all patients with hereditary bleeding disorders but in only one of the controls. All patients with bleeding disorders were inpatients, while all controls were treated in an outpatient setting. If adequate measures are taken, the complication rate following oral surgery in patients with hereditary bleeding disorders can be reduced to that of patients without bleeding disorders. However, these results are reached at significant costs due to coagulation factor replacement and inpatient treatment.

Oral surgery-associated postoperative bleeding in haemophilia patients - a tertiary centre's two decade experience.

Our goal in this research was to evaluate potential and targeted therapy, correlated with haemophilia severity and dental procedural risk, to reduce postoperative bleeding risk. Patients with haemophilia who were treated at the Oral and Maxillofacial Surgery Clinic at Sheba Medical Center between 1996 and 2012 comprised the study cohort. Data collected included disease history and severity, perioperative factor concentrate therapy, local haemostatic agent application, systemic tranexamic acid use and outcome. Bleeding was defined as excessive bleeding during or within 20days following procedure. Dental procedures (n=1968) of 125 patients were studied. Patients' bleeding risk score was evaluated according to the severity of haemophilia with or without the presence of an inhibitor, presence of comorbid coagulopathy and the type of dental procedure. Thirty-four patients undergoing a total of 880 high-risk and 1088 low-risk procedures suffered 40 postoperative bleeding events that necessitated further dental and/or haematological intervention. Among risk factors for delayed bleeding, the use of fibrin glue was significantly (P=0.027) associated with the risk of postprocedural bleed probably as it was applied to high-risk patients and procedures. Earlier treatment period (P=0.055), postprocedure hospitalization (P=0.039) and dental "high-risk" procedures (P<0.0001) also increased bleeding risk. Patients with haemophilia may be safely treated if meticulous haemostasis is applied, along with fibrin glue and systemic therapy as required. Factor transfusions are not mandatory and should be applied considering the procedure-related risk and the patient's calculated haematological risk for bleeding.

Cementless total hip arthroplasty for haemophilic arthropathy: follow-up result of more than 10 years.

The improvement of prophylaxis and adequate replacement of clotting factors, the quality of life and natural history of haemophilia have been significantly improved. However, significant functional impairment is inevitable. This study was performed to evaluate over 10 years clinical and radiographic outcomes of cementless total hip arthroplasty (THA) for treatment of haemophilic hip arthropathy. Between 1995 and 2003, 27 cases of cementless total hip arthroplasties were performed in 23 haemophilic patients. A total of 21 cases from 17 patients were available for follow-up analysis over 10 years. Modified Harris hip score, the range of motion of the hip joint, perioperative coagulation factor requirements and complications associated with bleeding were evaluated as part of the clinical assessment. For the radiographic assessment, fixation of component, osteolysis, loosening and other complications were evaluated. Clinically, the mean Harris hip score improved from 57 points before the operation to 94 points at the last follow-up. The mean flexion contracture was 10° preoperatively and 0.9° at the final follow-up. The further flexion improved from 68.4° to 90.5° after surgery. The mean monthly requirement of factor VIII reduced from 3150 units before surgery to 1800 units at the time of the last follow-up. There were three cases of rebleeding. In one case, a progressive haemophilic pseudotumour was found. Reoperation for any reason including revision was performed in three cases. We believe that cementless THA in patient with haemophilic hip arthropathy can bring reliable pain relief and functional improvement for longer than 10 years.

Early identification of patients at increased risk for hepatic insufficiency, complications and mortality after major hepatectomy

ObjectiveTotal bilirubin (TB) of >7mg/dl is an accepted definition of postoperative hepatic insufficiency (PHI) given its association with the occurrence of complications and mortality after hepatectomy. The aim of this study was to identify a surrogate marker for PHI early in the postoperative course. MethodsA single-institution database of patients undergoing major hepatectomy (three or more segments) during 2000–2012 was retrospectively reviewed. Demographic, clinicopathologic and perioperative factors were assessed for their association with PHI, defined as postoperative TB of >7mg/dl or new ascites. Secondary outcomes included complications, major complications (Clavien–Dindo Grades III–V) and 90-day mortality. ResultsA total of 607 patients undergoing major hepatectomy without bile duct reconstruction were identified. Postoperative hepatic insufficiency occurred in 60 (9.9%) patients. A postoperative day 3 (PoD3) TB level of ≥3mg/dl was the only early perioperative factor associated with the development of PHI on multivariate analysis [hazard ratio (HR) = 7.81, 95% confidence interval (CI) 3.74–16.31; P < 0.001]. A PoD3 TB of ≥3mg/dl was associated with increased risk for postoperative complications (75.7% versus 53.9%), major complications (45.6% versus 17.6%), and 90-day mortality (15.5% versus 2.3%). This association persisted on multivariate analysis for any complications (HR = 1.98, 95% CI 1.10–3.54; P = 0.022), major complications (HR = 3.18, 95% CI 1.90–5.32; P < 0.001), and 90-day mortality (HR = 8.11, 95% CI 3.00–21.92; P < 0.001). ConclusionsTotal bilirubin of ≥3mg/dl on PoD3 after major hepatectomy is associated with PHI, increased complications, major complications and 90-day mortality. This marker may serve as an early postoperative predictor of hepatic insufficiency.

Highlights in this issue

Highlights in this issue

Smoking is a perioperative risk factor and prognostic factor for lung cancer surgery.

The aim of this study was to investigate the smoking status of lung cancer patients and to confirm the risk of smoking for patients undergoing lung cancer surgery. We conducted a retrospective study of patients undergoing lung cancer surgery. Between May 2004 and March 2013, 716 patients underwent lung cancer surgery at our institution. Based on smoking status, the patients were classified into 3 groups: nonsmoker, past smoker, and current smoker. Based on exclusion criteria, a final total of 670 patients were investigated for the association between smoking status and postoperative complications. In addition, we explored the effect of smoking on survival after surgery. There were 254 non-smokers, 246 past smokers, and 170 current smokers. The percent of female patients, adenocarcinoma, and stage IA cancer was highest in the nonsmokers. Respiratory function was significantly impaired in past and current smokers. Respiratory and cardiac complications were found less frequently in non-smokers (11.4%) followed by 17.1% of past smokers and 21.2% of current smokers (p = 0.0226). Univariate analysis showed that smoking was a significantly poor prognostic factor for overall survival. The 5-year survival rates for non-smokers, past, and current smokers were 81.4, 65.4, and 68.8%, respectively (p = 0.0003). Smokers with lung cancer tended to have advanced lung cancer, impaired pulmonary function, and high morbidity after lung cancer surgery. Although multivariate analysis did not show that smoking was associated with poor outcome, non-smokers had significantly better overall survival, even for patients with stage IA lung cancers.

The impact of glycosylated hemoglobin and diabetes mellitus on wound-healing complications and infection after foot and ankle surgery.

The relationship between hyperglycemia and adverse outcomes after surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate whether hemoglobin A1c (HbA1c) level was independently associated with postoperative complications in a retrospective cohort study. Three hundred twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative foot and ankle surgery complications. Bivariate analyses showed that HbA1c level and having at least one comorbidity were associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c level, with each increment of 1% increasing the odds of infection by a factor of 1.59 (95% confidence interval [CI], 1.28-1.99). For postoperative wound-healing complications, bivariate analyses showed that body mass index, having at least one comorbidity, and HbA1c level were significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (odds ratio, 2.03; 95% CI, 1.22-3.37) and HbA1c level (each 1% increment) (odds ratio, 1.25; 95% CI, 1.02-1.53). In this retrospective study, HbA1c level had the strongest association with postoperative foot and ankle surgery complications in patients with diabetes.

The Impact of Glycosylated Hemoglobin and Diabetes Mellitus on Postoperative Wound Healing Complications and Infection Following Foot and Ankle Surgery.

Three hundred and twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative complications following foot and ankle surgery. Bivariate analyses showed that HbA1c and having at least one comorbidity was associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c, with each increment of one percent increasing the odds of infection by a factor of 1.59 (95% CI 1.28-1.99). For postoperative wound healing complication, bivariate analyses showed that BMI, having at least one comorbidity, and HbA1c were the significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (OR = 2.03, 95% CI 1.22-3.37) and HbA1c (each1%)(OR = 1.25, 95%CI = 1.02-1.53). In this retrospective study, hemoglobin A1c had the strongest association with postoperative complications following foot and ankle surgery in patients with diabetes.

Prophylactic Antibiotics for Hemorrhoidectomy

Hemorrhoidectomy is considered by many to be a contaminated operation that requires antibiotic prophylaxis to lower the incidence of surgical site infection. In reality, little evidence exists to either support or refute the use of antibiotic prophylaxis in this setting. This study aimed to determine if antibiotic prophylaxis is associated with reduced incidence of postoperative surgical site infection following hemorrhoidectomy. This is a retrospective database review. This study was conducted at multiple institutions. All patients undergoing hemorrhoidectomy with minimum 3-month follow-up were included. The primary outcome measure was the incidence of postoperative surgical site infection. Eight hundred fifty-two patients met the inclusion criteria (50.1% female; mean age, 50.0 ± 13.7 years). The prevalence of preoperative risk factors for surgical site infection included 7.7% with a smoking history, 2.5% with diabetes mellitus, 0.8% receiving steroids, and 0.2% with Crohn's disease. Surgery was performed predominately for 3-column prolapsed internal and mixed internal/external hemorrhoidal disease. All surgeries performed were closed hemorrhoidectomies. Antibiotic prophylaxis was used in a fewer number of cases (41.3% vs 58.7%). Overall, there were only 12 documented postoperative infections identified, producing an overall incidence of 1.4%. Of those patients who developed postoperative surgical site infections, 9 (75%) did not receive antibiotic prophylaxis (p = 0.25). On multivariate regression analysis, no perioperative risk factor was associated with an increased risk of developing a posthemorrhoidectomy surgical site infection. Conversely, there were no adverse antibiotic-related complications such as Clostridium difficile colitis or antibiotic-associated diarrhea in those receiving antibiotic prophylaxis. This study was limited by the retrospective nature of the analysis. Postoperative surgical site infection is an exceedingly rare event following hemorrhoidectomy. Antibiotic prophylaxis does not reduce the incidence of postoperative surgical site infection, and its routine use appears unnecessary.