Postoperative Infection Research Articles

Association of modic changes and postoperative surgical site infection after posterior lumbar spinal fusion.

Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies have reported Modic changes (MC) represent a subclinical infection. This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery. We retrospectively reviewed the records of 424 patients who received posterior lumbar fusion. Preoperative clinical and radiological parameters were recorded. Primary outcome was the rate of postoperative surgical site infection. Covariates included age, body mass index (BMI), sex, hypertension, diabetes mellitus, chronic heart failure, Pfirrmann classification, fused levels, and operation duration. The presence of Modic changes was used as an exposition variable, and adjusted for other risk factors in multivariate analyses. Of the 424 patients, 30 (7%) developed an acute surgical site infection. Infection had no relation to age, sex, BMI, and comorbidities. There were 212 (50%) patients with MC, and 23 (10.8%) had a surgical site infection, compared to 212 (50%) patients without MC in which there were 7 (3.3%) surgical site infections. MC was associated with surgical site infection in univariate analysis (odds ratio [OR] = 3.56, 95% confidence interval [CI]: 1.49-8.50, p = 0.004) and multivariate logistic regression analysis (OR = 3.05, 95% CI: 1.26-7.37, p = 0.013). There was statistically significant between specific type (p = 0.035) and grade of MCs (p = 0.0187) and SSI. MCs may be a potential risk factor for SSI following posterior lumbar spinal intervertebral fusion. Type I and grade C MCs showed a higher infection rate compared with other MC types and grades.

A 5-Year Clinical Experience of Pediatric Ophthalmic Ambulatory Surgery Under General Anesthesia From a Chinese Tertiary Children's Hospital

PurposeAmbulatory surgery (same-day or day surgery) is an efficient medical practice. However, there were few reports regarding the safety of ophthalmic ambulatory surgery for children under general anesthesia. This study aims to explore its clinical complications. DesignA retrospective observational study. MethodsThe clinical data of pediatric patients who received ambulatory ophthalmic surgery under general anesthesia at the Children’s Hospital of Fudan University from January 2015 to December 2019 were analyzed retrospectively. Postoperative complications, unplanned reoperation, delayed discharge, and other adverse events were analyzed. FindingsConsecutive patients (N = 4,616) had an average age of 4.6 ± 2.6 years. The primary surgical procedures included chalazion incision and curettage (62.89%), strabismus surgery (18.98%), trichiasis surgery (14.36%), eyelid or orbital mass resection (2.49%), blepharoptosis surgery (0.91%), and other procedures (0.37%). The average operative time was 25.28 ± 20.45 minutes (n = 2,698), while the average length of hospital stay was 8.45 ± 2.61 hours. No serious adverse events or death happened. One case had delayed postoperative hemorrhage, one had a postoperative infection, and two had delayed discharge. The rate of unplanned reoperation was 0.39% 90 days after surgery, with recurrence of chalazion and postoperative complications of ptosis as the primary reasons. ConclusionsPediatric ophthalmic ambulatory surgery under general anesthesia is a feasible and efficient operation mode with few complications for simple procedures with good general conditions. Further randomized controlled studies are needed to provide strong evidence of the safety and socioeconomic efficacy of this mode.

Diagnosis and Treatment of Skin Lesions in Renal Transplant Recipients: A Retrospective Review.

Immunosuppressive therapy is essential for to prevent graft rejection in renal transplant patients; however, it is associated with elevating the risk of several pathologies in these patients particularly infectious and neoplastic conditions. In this study, we explore the diagnosis and treatment of skin lesions in renal transplant patients. A retrospective chart review of 12 renal transplant recipients referred to plastic and reconstructive surgery with skin lesions from 2000 to 2020 was performed. The mean age of the 12 patients was 49.6 years. Time to plastic surgery after renal transplantation ranged between 1 and 16 years. Nine cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, and 1 case of skin and soft tissue infection of the lower extremity and cutaneous extranodal NK/T-cell lymphoma, nasal type was observed. Flaps, skin grafts, and artificial dermis grafts constitute the main reconstructive methods. There were no postoperative infections or wound dehiscence. Cutaneous infections and skin malignancy account for most of the skin lesions developing after renal transplantation. Posttransplant lymphoproliferative disorder warrants equal attention and should not be disregarded. Early diagnosis and treatment significantly improve prognosis as patients with longer duration of transplant were found to have more aggressive tumors. Plastic and reconstructive surgery offers a safe therapeutic method of treatment in these cases.

Postextraction infections, prevention, and treatment.

Postoperative infection is one of the most common complications of tooth extraction. It may manifest as localized infection or develop to systemic infection. Clinically, oral surgeons can prevent postoperative infections by urging patients to strengthen oral hygiene, applying antibiotics in a rational and compliant manner, and choosing appropriate surgical methods for tooth extraction. For the treatment of infection, the oral surgeon should formulate a response strategy on the basis of different diagnoses. For local infections such as dry socket, delayed alveolar osteitis, gap infection, and marginal osteomyelitis of the jaws, the infection can be controlled by local debridement, therapeutic use of antibiotics, and incise and drain if necessary. For patients suspected of necrotizing fasciitis, timely extensive debridement should be made to reduce the area of tissue necrosis. For those who have received radiotherapy or anti-resorptive drugs, tooth extraction should follow the recommendations of the relevant clinical guidelines or expert consensus to minimize the risk of osteonecrosis of the jaws. For patients with poor systemic health or dysfunction of the immune system, attention should be paid to identifying infective endocarditis and intracranial infection to ensure the life safety of patients. In this study, the author intends to combine literature review and clinical experience to tackle postextraction infection and its prevention to provide a reference for colleagues on oral and maxillofacial surgery.

Microbial Etiology, Antimicrobial Resistance, and Risk Factors of Surgical Site Infections in Gestational Diabetes Mellitus Patients Undergoing Elective Pre-Labor Cesarean Deliveries.

Gestational Diabetes Mellitus (GDM) significantly increases the risk of adverse pregnancy outcomes, including elective pre-labor cesarean deliveries. Postoperative surgical site infections (SSIs) pose a significant concern, underscoring the need for a detailed investigation into their causes and preventative measures. The aim of this study is to systematically identify and analyze the microbial etiology and antimicrobial resistance profiles of pathogens responsible for SSIs in GDM patients undergoing elective pre-labor cesarean deliveries. Additionally, this research aims to elucidate the risk factors contributing to SSIs, with a specific focus on operation duration, amniotic fluid contamination, and genital tract inflammation, and their correlation with the incidence of SSIs. A retrospective analysis was conducted at our Hospital between September 2018 and July 2023, involving 150 GDM patients who underwent elective pre-labor cesarean deliveries. Patients were categorized into infected and uninfected groups based on postoperative SSIs. Clinical data were meticulously collected and analyzed using SPSS software (version 27.0). Independent sample t-tests and chi-square tests were employed for statistical analysis. Microbial profiling revealed that Gram-negative bacteria, primarily E. coli, constituted approximately 59.46% of the isolated strains, exhibiting significant resistance to commonly used antibiotics such as ampicillin and cefotaxime. Elevated levels of biomarkers, including Procalcitonin (PCT) and Hemoglobin A1c (HbA1c), were significantly associated with SSIs. Multivariate logistic regression analysis identified operation time ≥1-hour, amniotic fluid contamination, and genital tract inflammation as significant risk factors. This study highlights the microbial etiology, resistance patterns, and risk factors for SSIs in GDM cesarean patients, emphasizing the need for tailored preoperative evaluations.

Analysis of pathogen distribution and sTREM-1 and miR-126 levels in patients with pulmonary infection after craniocerebral injury.

sTREM-1H and miR-126 play crucial roles in inflammation and immune responses, yet their involvement in patients with pulmonary infection following cranial injury remains understudied. The distribution of pathogens causing infection in patients with pulmonary infection after craniocerebral injury was explored, and the changes in the levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and miR-126 in peripheral blood were analyzed. In this study, 60 patients (study group) with postoperative lung infection in craniocerebral injury treated from January 2019 to December 2, 2021, and 60 patients without lung infection were selected as the control group. The study group received anti-infection treatment. The infection pathogen of the study group was tested, and the changes of sTREM-1 and miR-126 levels in the peripheral blood of the study and control groups were recorded to explore the diagnosis and predictive Value of prognostic death. 66 pathogens were detected, including 18 gram-positive bacteria, 42 gram-negative bacteria, and 6 fungi. The sTREM-1 level was higher than the control group, and the miR-126 level was lower than the control group. By ROC curve analysis, the diagnostic AUC values of both patients were 0.907 and 0.848, respectively (P< 0.05). Compared to those in the study group, patients had decreased sTREM-1 levels and increased miR-126 levels after treatment (P< 0.05). Compared with the survival group, patients in the death group had increased sTREM-1 levels and decreased miR-126 levels, and ROC curve analysis, the predicted AUC death values were 0.854 and 0.862, respectively. Gram-negative bacteria, with increased peripheral sTREM-1 levels and decreased miR-126 levels. The levels of sTREM-1 and miR-126 have specific diagnostic and prognostic Values for pulmonary infection after craniocerebral injury. However, the study's conclusions are drawn from a limited sample and short-term data, which might limit their broader applicability. Future studies with larger populations and longitudinal designs are required to confirm these findings and determine these biomarkers' robustness across different settings. Further research should also explore how these biomarkers influence patient outcomes in craniocerebral injuries.

The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial

BackgroundWhile numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. ObjectiveThis study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. DesignA prospective randomized double-blinded trial. SettingThe First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. ParticipantsPatients aged 18 – 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. InterventionsPatients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measuresPrimary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. ResultsInitial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 – 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. ConclusionPerineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registrationchictr.org.cn, ChiCTR2200059424.

Successful prophylactic measures for the eradication of Staphylococcus aureus infections in elective hip primary and revision arthroplasty

IntroductionStaphylococcus aureus stands as the predominant etiological agent in postoperative acute prosthetic joint infections (PJI), contributing to 35–50% of reported cases. This study aimed to evaluate the efficacy of dual prophylaxis incorporating cefuroxime and teicoplanin, in combination with nasal decolonization utilizing 70% alcohol, and oral and body lavage with chlorhexidine. Material and methodsWe conducted a retrospective review of electronic health records regarding primary and revision arthroplasties conducted at our institution from 2020 to 2021. Relevant variables linked to prosthetic joint infections (PJI) were documented until the latest follow-up. ResultsA total of 539 operations (447 primary arthroplasties and 92 revision arthroplasties) were performed on 519 patients. There were 11 cases of postoperative acute PJI, resulting in infection rates of 1.6% for primary arthroplasties and 4.3% for revision surgeries. Infections were more prevalent in male patients, individuals with an ASA classification>II, and those undergoing longer operations (>90min). S. aureus was not isolated in any of the cases. ConclusionThe prophylactic measures implemented in our institution have exhibited a high efficacy in preventing postoperative acute PJI caused by S. aureus.

Do preoperative glucose levels predict risk of complications in orthopaedic surgery?

Post-operative hyperglycemia is a known risk factor for post-surgical complications. The predictive value of pre-operative blood glucose levels, however, is less understood. This study aimed to determine if pre-operative screening blood glucose levels affect the rate of post-operative infection or wound complications. We also investigated if case urgency or anatomic location alters this relationship. A single-institution retrospective chart review was performed to evaluate patients treated between 2018 and 2021. Subjects ≥ 18years with closed, non-infected orthopaedic diagnoses requiring surgery were included. Case urgency, demographics, comorbidities, blood glucose level within twelve h prior to surgery, and hemoglobin A1c level within 3months of surgery, were collected. Infections and wound complications were recorded as outcomes. A total of 775 subjects with a mean age of 61 (range 18-96) were identified, including 543 elective and 232 trauma patients, with a mean pre-operative fasting glucose value of 127.7mg/dL (range, 49-388mg/dL) and average HbA1c of 6.9%. The odds of infectious complications were increased by a factor of 1.01 for every 1-point increase in blood glucose (95% CI 1.01-1.02; p < 0.01). Pre-operative blood glucose levels greater than 137mg/dL were associated with an increase in wound complications, but not deep infections. Infection rates stratified by anatomic site and case urgency were not impacted by pre-operative glucose levels. The increased risk of poor wound healing in patients with pre-operative hyperglycemia demonstrates that day of surgery point-of-care blood glucose screening can be a useful risk stratification tool.

Outcomes of extracorporeal membrane oxygenation cannulation strategy in lung transplantation: A retrospective cohort study

ObjectivesExtracorporeal membrane oxygenation (ECMO) with different cannulation strategies is determined according to surgical position and patient condition. However, no cannulation guidelines have been proposed. This retrospective study assessed the outcomes of diverse ECMO cannulation strategies in patients undergoing lung transplantation (LTx). MethodsData of patients undergoing intraoperative veno-arterial ECMO-assisted LTx were retrospectively collected from December 1st, 2015 to October 31st, 2021. Patients were classified into three groups based on the different cannulation strategies: femoral artery-femoral vein (F–F)-ECMO, axillary artery-femoral vein (A-F)-ECMO, and ascending aorta-femoral vein (AAO-F)-ECMO. The F-F-ECMO, A-F-ECMO, and AAO-F-ECMO groups comprised 34, 44, and 30 patients, respectively. Main resultsThe AAO-F-ECMO group exhibited a significantly shorter duration of postoperative ECMO therapy (3 vs. 2 vs. 0 days, P < 0.01).the level of postoperative proBNP was lower on the third and seventh days (P < 0.001). AAO-F-ECMO patients had a significantly lower incidence of postoperative infections, heart failure, and bleeding (P < 0.05). Similar outcomes were observed in postoperative survival rates among the three groups (P > 0.05). ConclusionsAscending aorta-femoral vein ECMO can provide sufficient and effective aerobic blood to perfuse organs with fewer side effects than cannulation in the femoral artery-femoral vein or axillary artery-femoral vein.

PET/CT Recognition of Costal Cartilage Infection After Breast Implant Surgery.

Postoperative infection of breast implants can lead to implant removal and other complications. This study aimed to investigate the presence of costal cartilage infection following breast implant surgery and the diagnostic role of PET/CT in identifying this rare complication. A retrospective study included 16 patients with persistent infections after breast implant removal surgery. Patients underwent PET/CT scans before surgery, and surgical plans were made based on PET/CT findings. Surgical procedures were guided by PET/CT, and specimens were collected for pathological examination and microbiological culture. Follow-up assessments were performed at 1, 3, and 12 months postoperatively. Among the 16 patients, 11 were diagnosed with costal cartilage infection, whereas 5 had subcutaneous soft tissue infections. PET/CT accurately identified costal cartilage infection in all cases and localized the infected costal cartilage in the majority of cases. Microbiological culture results showed various pathogens. All patients were cured with one or staged surgery. Costal cartilage infection following breast implant surgery is a significant concern. PET/CT plays a crucial role in the accurate diagnosis and localization of infected costal cartilage, aiding in appropriate surgical management. Patients should be closely monitored for the possibility of costal cartilage infection when experiencing persistent symptoms after breast implant surgery.

From data to practice: brain meningioma treatment in elderly patients – a survey of the Italian Society of Neurosurgery (SINch®) and systematic review and meta-analysis

The management of meningioma in elderly patients (MEP) presents a complex and evolving challenge. Data available offer conflicting information on treatment options and complications. This survey aimed to examine the current approach to MEP, comparing the national profile to data in the current literature. A survey addressing the treatments options and management of meningioma in elderly was designed on behalf of SINch® (Società Italiana di Neurochirurgia) and sent via email to all Chiefs of Neurosurgical Departments. The survey remained open for responses from May 5th, 2022, until November 21st, 2022. A search of the literature published between January 2000 and March 2023, in accordance to PRISMA guidelines, was included. A total of 51 Neurosurgical centers participated in the survey. The caseload profile of each center influences the choice of treatment selection (Stereotactic Radiosurgery versus open surgery) (p = 0.01) and the consolidated practice of discussing cases within a multidisciplinary group (p = 0.02). The pooled meta-analysis demonstrated a significant increased risk in the elderly group for permanent deficits (p < 0.00001), postoperative infections (p = 0.0004) and hemorrhage (p = 0.0001), perioperative mortality (p < 0.00001), and medical complications (p < 0.00001) as compared to the young population. This study presents the initial comprehensive analysis of the existing trends in the surgical management of MEP in Italy. The significant variation in practices primarily stems from the absence of standardized guidelines. While most centers have adopted an integrated approach, there is a need to promote a multidisciplinary care model. Prospective studies are needed to gather robust evidence in this clinical setting.

EFFECT OF PREOPERATIVE WARMING DURING CESAREAN SECTION UNDER SPINAL ANESTHESIA

Background: Postoperative shivering, hypothermia and Surgical site infections (SSIs) are frequently encountered during Cesarean section (C section). Perioperative warming is a must for surgeries performed under spinal anesthesia, however its importance during C section is unclear. We assessed the functional outcomes of preoperative use of warmers and intravenous fluids (i.v) on parturients undergoing C section under spinal anesthesia. Methods: 45 parturients undergoing an elective C section were randomized into three groups. Group D parturients received warmed i.v fluids (40°C). Group I parturients were given forced air warmers. Group V was the control group. Forced air warmers and i.v fluids were both administered for a period of 15 minutes before anesthetic induction. Core (tympanic membrane) and skin (under arm and thigh) temperatures were noted and shivering was graded. Results: The Core temperature at 45 mins decreased less in Groups D and I than Group V (-0.5°C ± 0.3°C vs -0.6°C ± 0.4°C vs -0.9°C ± 0.4°C, respectively P = 0.004). The under arm temperature at 15 mins and 30 mins exhibited a greater increase in Group I than Group D and Group V (P = 0.001 and P = 0.012, respectively). Thigh temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group I and Group D than Group V (20%, 13.3%, and 53.3%, respectively P = 0.035). Conclusion: Preoperative use of air warmers and warm i.v fluids averts hypothermia and shivering and also reduces the rate of SSIs due to higher core and wound temperature.

Modified Open Technique for First Port Insertion in Laparoscopic Surgery

Laparoscopy has become the method of excellence for abdominal surgeries in modern age. The significance of a secure and dependable approach for the initial trocar insertion cannot be overstated in this surgical procedure. Our preferred method involves employing a modified open technique to access the peritoneal cavity. This study was conducted to evaluate the laparoscopic surgery of modified open technique. This cross sectional follow-up study was conducted in the Department of General Surgery Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to December 2022. The umbilicus was everted to make it tubular, an infra-umbilical incision was given to cut the linea alba for making an opening and advanced bluntly to introduce the first port. A total of 197 patients were studied after completion of surgery. Cholecystectomy was the most common surgical indication. The mean entry time was 3.1±0.6 minutes. Regarding the postoperative complication port site infection was 2.03% and port site hernia was 1%. There was no incidence of pre-peritoneal placement of port, port site seroma, haematoma. No mortality was found during the hospital stay of patients. Modified open technique is a quick and safe procedure for insertion of the first port in laparoscopic surgery. Bangladesh Med J. 2023 May; 52(2): 11-14

Preliminary experience of surgery after neoadjuvant immunotherapy combined with chemotherapy for stage-IIIB non-small cell lung cancer.

Previously, stage-IIIB non-small cell lung cancer (NSCLC) has been considered inoperable. In recent years, neoadjuvant immunotherapy has shown encouraging efficacy in the treatment of advanced stage NSCLC in several trials. However, the effectiveness and safety of neoadjuvant immunotherapy in treating stage-IIIB NSCLC are still unknown. Therefore, we conducted this retrospective study to examine the outcomes of surgery after neoadjuvant immunotherapy combined with chemotherapy for stage-IIIB NSCLC. Thirty patients with stage-IIIB NSCLC who were treated at the Department of Thoracic Surgery of Renji Hospital from January 2019 to September 2021 were analyzed retrospectively. Neoadjuvant immunotherapy combined with chemotherapy was administered prior to surgery. The curative effect was evaluated by imaging and pathological examinations. The objective response rate (ORR) and disease control rate (DCR) of the patients after neoadjuvant therapy evaluated by imaging studies were 70% and 86.7%, respectively. Of the 30 patients, 19 (63%) underwent surgical resection, in which all achieved a complete R0 resection. The median operative time was 168 minutes (range, 75-295 minutes), and the average intraoperative blood loss was 215.3±258.4 mL. The median postoperative hospital stay was 8 days (range, 4-59 days). The major pathological response (MPR) rate was 73.7% (14/19), and the pathological complete response rate was 47.4% (9/19); 2/30 patients (6.7%) had postoperative complications, including two who developed bronchopleural fistulas and one mortality, from a postoperative pulmonary infection. The treatment-related adverse reactions were mainly grades 1-2. Only two patients had grade 3 anemia, and no grade 4 adverse reactions were observed. Neoadjuvant immunotherapy and chemotherapy combined with surgery in patients with stage-IIIB NSCLC is safe and feasible. The patient outcomes and optimal number of neoadjuvant treatment cycles need to be explored and studied further.

Breast cancer patients' postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience.

The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related quality of life (HRQoL) and patients' satisfaction in patients undergoing NSM and breast reconstruction with or without ADM. Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with definitive implant and ADM (Group A), IBR only with definitive prosthesis (Group B), and two-stage breast reconstruction (Group C). The postoperative complications, BREAST-Q outcomes and reoperations were compared. A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8.3% in Group A, 2.9% in Group B and 5.7% in Group C. Postoperative infection occurred in two patients of Group A (5.6%), one patient of Group B (2.9%) and one of Group C (2.9%). Group A reported larger drain volume (1,125±243.5 cc), longer drain period (13.2±2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥50 years presented a higher score in "Satisfaction with breast" (P<0.001) and "Satisfaction with outcome" domains (P<0.05). Performing a bilateral breast reconstruction was associated to higher scores in "Physical wellbeing chest domain" (P<0.05). In addition, patients in Group A and Group B reported higher score in "Satisfaction with the breast" domain (P<0.001) but only in Group B we reported a higher score in "Satisfaction with outcome" (P<0.001). Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The prepectoral placement of ADM could minimize complications and optimize aesthetic results.

Effect of Perioperative Blood Transfusion on Complications Following Emergency Non-trauma Laparotomy in Mulago Hospital: A Prospective Cohort Study.

Background Although blood transfusion may be required during emergency non-trauma laparotomy, several retrospective cohort studies have identified blood transfusion as a significant predictor of postoperative infections and mortality. However, no study has explored such an association in a resource-limited setting. This study aims to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections (SSIs) and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a resource-limited setting. Methodology In this prospective, single-center, cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure status. Transfusion exposure and possible confounders were recorded on entry, while the presence or absence of SSIs and mortality were obtained over 30 days of follow-up. The data were analyzed using Epi Info version 7 and Stata version 14. P-values <0.05 indicated statistical significance. Results All 160 participants recruited, 28 (17.5%) transfusion-exposed and 132 (82.5%) non-exposed, were included in the final analysis. Transfusion exposure (relative risk = 8.16; 95% confidence interval (CI) = 2.73-24.37; p < 0.001) was an independent risk factor for SSI after multivariate logistic regression analysis adjusted for confounders. Inverse probability weighting with regression adjustment (IPWRA) revealed that transfusion exposure significantly increased the incidence of SSI by 36.2% (95% CI = 14.2%-58.2%; p = 0.001). Furthermore, transfusion exposure (hazard ratio (HR) = 3.62; 95% CI = 1.28-10.27; p = 0.015) and age ≥60 years (HR = 5.97; 95% CI = 1.98-18.01; p = 0.002) were independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders. IPWRA revealed that transfusion exposure significantly increased the incidence of mortality by 17.6% (95% CI = 1.4%-33.8%; p = 0.033). Conclusions This study suggests an independent association between perioperative blood transfusion and the occurrence of SSIs and mortality among patients undergoing emergency non-trauma laparotomy. A larger multicenter prospective cohort study considering more confounders and the use of established restrictive transfusion protocols is recommended.

Preserved walking function without postoperative reconstruction for pelvic Ewing’s sarcoma: a case report

BackgroundEwing’s sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60–70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing’s sarcoma has the unique problem of leading to high rates of postoperative infection.Case presentationWe present the case of a Japanese 14-year-old boy with left iliac Ewing’s sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis.ConclusionOur case highlights the successful management of a left iliac Ewing’s sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases.

Effect of rapid rehabilitation nursing on improving clinical outcomes in postoperative patients with colorectal cancer.

Surgical resection is the cornerstone treatment for colorectal cancer. Rapid rehabilitation care predicated on evidence-based medical theory aims to improve postoperative nursing care, subsequently reducing the physical and mental traumatic stress response and helping patients who undergo surgery recover rapidly. To assess the effect of rapid rehabilitation care on clinical outcomes, including overall postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction in patients with colorectal cancer. We searched the PubMed, Web of Science, Embase, Elsevier Science Direct, and Springer Link databases from January 1, 2010, to January 1, 2024, to screen eligible studies on rapid rehabilitation care among patients who underwent colorectal cancer surgery. Patients were screened based on the inclusion and exclusion criteria. RevMan 5.4 software was used for statistical analysis of the data. Twelve studies were enrolled, which included 2420 patients. The results showed that rapid rehabilitation care decreased the incidence of overall postoperative complications (OR: 0.44, 95%CI: 0.26-0.74, P = 0.002), anastomotic leaks (OR: 0.68, 95%CI: 0.41-1.12, P = 0.13), wound infections (OR: 0.45, 95%CI: 0.29-0.72, P = 0.0007), and intestinal obstruction (OR: 0.54, 95%CI: 0.34-0.86, P = 0.01) compared to conventional care. Further trials and studies are needed to confirm these results. Rapid rehabilitation care decreased the occurrence of postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction compared to conventional care in patients who underwent colorectal surgery. Therefore, promoting the application of rapid rehabilitation care in clinical practice cannot be overemphasized.

Clinical evaluation of resection of functional area gliomas guided by intraoperative 3.0 T MRI combined with functional MRI navigation

BackgroundIn assessing the clinical utility and safety of 3.0 T intraoperative magnetic resonance imaging (iMRI) combined with multimodality functional MRI (fMRI) guidance in the resection of functional area gliomas, we conducted a study.MethodAmong 120 patients with newly diagnosed functional area gliomas who underwent surgical treatment, 60 were included in each group: the integrated group with iMRI and fMRI and the conventional navigation group. Between-group comparisons were made for the extent of resection (EOR), preoperative and postoperative activities of daily living based on the Karnofsky performance status, surgery duration, and postoperative intracranial infection rate.ResultsCompared to the conventional navigation group, the integrated navigation group with iMRI and fMRI exhibited significant improvements in tumor resection (complete resection rate: 85.0% vs. 60.0%, P = 0.006) and postoperative life self-care ability scores (Karnofsky score) (median ± interquartile range: 90 ± 25 vs. 80 ± 30, P = 0.013). Additionally, although the integrated navigation group with iMRI and fMRI required significantly longer surgeries than the conventional navigation group (mean ± standard deviation: 411.42 ± 126.4 min vs. 295.97 ± 96.48 min, P<0.0001), there was no significant between-group difference in the overall incidence of postoperative intracranial infection (16.7% vs. 18.3%, P = 0.624).ConclusionThe combination of 3.0 T iMRI with multimodal fMRI guidance enables effective tumor resection with minimal neurological damage.