Postoperative Albumin Research Articles

Postoperative Course of Serum Albumin Levels and Organ Dysfunction After Liver Transplantation

Background and aimsPostoperative hypoalbuminemia, especially following liver transplantation, can lead to adverse multisystem effects and even death. We investigated the relationship between postoperative albumin levels and organ failure (assessed using Sequential Organ Failure Assessment [SOFA] scores). MethodsSixty liver transplant recipients admitted to the intensive care unit (ICU) from 2012 to 2015 were retrospectively divided into 2 groups: lower albumin (LA) (n=28) and higher albumin (HA) (n=32), using whether serum albumin level fell below 3.0 g/dL during the first postoperative week as the stratifying factor. The SOFA scores (primary endpoint) and associated complications (ascites amount, rejection, re-intubation, abdominal re-operation, thrombosis), additional treatment (dialysis, pleural effusion drainage), and duration of ICU stay (secondary endpoints) of the 2 groups were compared. ResultsAverage serum albumin levels were significantly different between HA and LA groups (3.6 [3.4–3.8] vs 3.1 [2.9–3.3], respectively, P < .05), although the amounts of albumin infused in the 2 groups during the first postoperative week were not different (HA vs LA: 42 [30–71] vs 40 [30–58], respectively, P = .37). Mean daily SOFA scores were not significantly different between the HA and LA groups (8.3 [6.6–9.0] vs 7.2 [6.3–8.6], P = .73), although the HA group had lower mean cardiovascular SOFA sub-scores than the LA group (0.1 [0–0.4] vs 0.4 [0–1.3], P = .032). There were no significant differences between the groups with regard to complication rates and duration of ICU and hospital stays. ConclusionsSerum albumin level might not influence cumulative organ function, but it decreases the amount of hemodynamic support required in liver transplant recipients.

Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis.

Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently. A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle-Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel-Haenszel or inverse-variance methods. Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium. The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery.

Multimodal Nutritional Management in Primary Lumbar Spine Surgery: A Randomized Controlled Trial.

A prospective randomized controlled trial. The purpose of this study was to evaluate the clinical effect and safety of a new multimodal nutritional management (MNM) protocol for patients receiving primary lumbar spine surgery. Poor nutritional status is common in the perioperative period in primary lumbar spine surgery, and may impede recovery after surgery. A total of 187 patients were included in this prospective randomized controlled trial. They were randomly assigned to the MNM group or the control group. Albumin (ALB) infusion, postoperative ALB level, electrolyte disorders, postoperative electrolyte levels, transfusion rate, postoperative hemoglobin level, length of stay (LOS), and complications were compared between the groups. Compared with the control group, the rate and the total amount of ALB infusion were lower in the MNM group, and the postoperative level of ALB in the MNM group was higher on the first postoperative day, and the third postoperative day. The incidence of hypokalemia, hyponatremia, and hypocalcemia were lower in the MNM group. In the MNM group, the postoperative levels of sodium, potassium, and calcium were higher than the control group. The transfusion rate was similar between the two groups. The hemoglobin level was similar between the two groups on first postoperative day, but was higher in the MNM group on third postoperative day. LOS in the MNM group was shorter than in the control group. The incidence of wound drainage was lower in the MNM group. No statistical differences were observed regarding surgical complications between the two groups. The MNM protocol effectively reduced ALB infusion, the incidence of electrolyte disorders, and wound drainage, increased the postoperative levels of ALB, sodium, potassium, and calcium, and reduced the LOS without increasing the rate of postoperative complications. 2.

The Effect of Snakehead Fish (Channa striata) Extract Capsule to the Albumin Serum Level of Post-operative Neurosurgery Patients

To evaluate the Effect of Snakehead Fish (Channa striata) Extract Capsule to the Albumin Serum Level of Post-operative Neurosurgery Patients. This research is a clinical research with Quasi-Experimental method . The experimental design used was one group pre-post test. The research design of one group pretest-posttest was measured using a pre-test which carried out before being given treatment and post-test carried out after being treated. The population of this study was all post-neurosurgical patients that treated at the West Nusa Tenggara General Hospital. Each patient who underwent surgery and included within research criteria was given Snakehead Fish (Channa striata) up to 3 weeks after surgery and the wound has healed. The sample consisted of 37 patients with criteria of over 18 years of age and no kidney disorders (proteinuria). The results of the data distribution of 37 patients stated that there were 12 males (32.4%) and 25 females (67.6%). The most number of diagnosis were abnormalities of meningioma and skull defect (17; 46% and 13; 35,1%). Mostly patients spent 8 – 14 days to control post-operatively (22; 59,4%). It was found that the pre-operative and post-operative albumin serum level had no significant difference (the significance value 0.115). The pre-operative and post-treatment albumin levels had a significant difference (a significance value of 0.003). However, albumin levels in post-operative and post-treatment had significant differences (significance value (0.001). This research is important for several reasons, including therapy in patients with pre-operative or recovery period after surgery. Snakehead fish can increase serum albumin levels in patients after surgery. The experimental design used was one group pre-post test. The research design of one group pretest-posttest was measured using a pre-test which was carried out before being given treatment and post-tests carried out after being treated. The treatment plan could be concisely reported.

Biological secondary contributors to osteoporosis in fractured patients, is an early systematic assay relevant?

To evaluate the prevalence of biological abnormalities leading to secondary osteoporosis in recently fractured patients. Adults older than 50, hospitalized for a non-vertebral fracture from July 2015 to October 2016, were assessed for bone fragility contributors in the orthopedics department. Bone mineral density (BMD) measurements and vertebral fracture assessment (VFA) were performed within 3 months. We assessed the prevalence of biological abnormalities in all the patients with recent fracture and in subgroups. Among 439 hospitalized patients for non-vertebral low trauma fracture, 372 had biological tests (285 women, mean age 77.5 ± 13 years) and 353 (94.6%) had at least ≥ 1 biological abnormality, most frequently vitamin D insufficiency (< 75 nmol/L) (80%). Hypercalcemia was found in 22 (7.7%) patients, explained by possible primary hyperparathyroidism in 6 cases, and by the other causes of hypercalcemia including postoperative low albumin. A high PTH level was observed in 64 (20.8%) patients. We found 3 monoclonal bands. Results were similar in patients with and without vertebral fracture or osteoporosis. Finally, many biological abnormalities can be explained by the postoperative context (low TSH, hypogammaglobulinemia, low albumin, low alkaline phosphatase) and need a control. This study performed in patient with recent low trauma non-vertebral fractures showed that 94.6% of patients had at least one contributor to bone fragility, which was the vitamin D insufficiency in most of cases. We found a high proportion of biological abnormalities which require additional explorations but most of them can be explained by the postoperative context.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.

Early postoperative hypoalbuminaemia is associated with pleural effusion after donor hepatectomy: A propensity score analysis of 2316 donors

Pleural effusion and hypoalbuminaemia frequently occur after hepatectomy. Despite the emphasis on the safety of donors, little is known about the impact of postoperative albumin level on pleural effusion in liver donors. We retrospectively assessed 2316 consecutive liver donors from 2004 to 2014. The analysis of donors from 2004 to 2012 showed that postoperative pleural effusion occurred in 47.4% (970/2046), and serum albumin levels decreased until postoperative day 2 (POD2) and increased thereafter. In multivariable analysis, the lowest albumin level within POD2 (POD2ALB) was inversely associated with pleural effusion (OR 0.28, 95% CI 0.20–0.38; P < 0.001). POD2ALB ≤3.0 g/dL, the cutoff value at the 75th percentile, was associated with increased incidence of pleural effusion after propensity score (PS) matching (431 pairs; OR 1.69, 95% CI 1.30–2.21; P < 0.001). When we further analysed data from 2010 to 2014, intraoperative albumin infusion was associated with higher POD2ALB (P < 0.001) and lower incidence of pleural effusion (P = 0.024), compared with synthetic colloid infusion after PS matching (193 pairs). In conclusion, our data showed that POD2ALB is inversely associated with pleural effusion, and that intraoperative albumin infusion is associated with a lower incidence of pleural effusion when compared to synthetic colloid infusion in liver donors.

Surgical site infection after penetrating abdominal trauma with bowel involvement: a comparison between HIV-seropositive and seronegative patients

The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/μl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.

Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute.

Backgrounds/AimsPreoperative nutritional status has been reported to influence patient outcomes after pancreatectomy. The Prognostic Nutritional Index (PNI) is a useful parameter to reflect the outcomes of patients undergoing gastrointestinal surgery. Therefore, the relationship between the PNI and clinicopathological factors, surgical data, and postoperative morbidity were retrospectively evaluated at two academic institutes in a cohort study.MethodsCurative pancreatectomy was performed on 222 patients at the University of Nagasaki between 1995 and March 2015, and 101 at the University of Miyazaki between April 2015and March 2018. The PNI was calculated using preoperative albumin and total cholesterol levels.ResultsThe mean PNI in our series was 39.2±5.4 and the prevalence of PNIs less than 40 was observed in 134 patients (44%). The PNI was not significantly different between normal, hard, and fatty architecture of the pancreatic parenchyma. The PNIs were significantly negatively correlated with higher age (p<0.01), but not with gender, co-morbidity, or habits. The PNI was significantly correlated with levels of hemoglobin, prothrombin activity, choline esterase, total protein, albumin and cholesterol (p<0.01), and with postoperative total protein and albumin levels (p<0.05). Although the preoperative PNI tended to be lower in patients with total postoperative complications, no significant differences for each complication were observed.ConclusionsAlthough the preoperative PNIs reflect the perioperative nutritional status, its predictive usefulness for postoperative complications could not be significantly confirmed.

Is Postoperative Albumin Level Related with Surgical Site Infection?

Is Postoperative Albumin Level Related with Surgical Site Infection?

Enhanced recovery after surgery protocol enhances early postoperative recovery after pancreaticoduodenectomy

BackgroundEnhanced recovery after surgery (ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy (PD). MethodsA total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube (NGT) was removed on postoperative day (POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula (POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications (defined as per the ISGPS definitions). ResultsNGT was removed on POD1 in 45 (90%) patients, abdominal drain removed by POD4 in 41 (82%) and 43 (86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three (6%) patients had delayed gastric emptying (DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay (LOS) with age (P < 0.05) and a marginal relation between LOS and postoperative albumin (P = 0.05). ConclusionsERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.

Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma

IntroductionThe influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks. MethodsThis was a prospective study including 98 patients with small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma. Univariate analysis identified risk factors for the development of anastomotic leak and also investigated the predictive value of the CD4 count for this complication. ResultsOf the 98 patients 23 patients (23%) were HIV-infected. The overall leak rate was 13%. Univariate analysis including all potential risk factors with p-values<0.05 identified six factors leading to a significantly higher rate of anastomotic complications: postoperative CD4 count<250 cells/μl, postoperative albumin <30 g/L, penetrating abdominal trauma index≥25, gunshot wound as mechanism of injury, blood transfusion requirement >6units and delayed anastomosis after damage control surgery. Survival rates were analysed with the χ2 test and did not show a significantly higher mortality rate in patients with low CD4 count. The negative impact of trauma and subsequent surgery on the cell mediated immunity was demonstrated by the fact that 55 (73%) of the HIV-negative patients had a CD4 count less than 500 cells/μl 24 h postoperatively. HIV-infection had no significant influence on the leak rate, however all HIV infected patients that developed an anastomotic leak died. ConclusionA low post-operative CD4 count is a predictor for anastomotic leaks irrespective of HIV-serostatus. Low postoperative serum albumin, high injury severity, gunshot wound as mechanism of injury, blood transfusion requirement >6 units and delayed anastomosis were further risk factors for anastomotic complications. Postoperative CD4 count and serum albumin should be considered in the decision making process of performing an anastomosis or diverting stoma for patients after “clip and drop” of the bowel as part of damage control surgery.

Perioperative Mortality Prediction Using Possum in Patients with Gastrointestinal Tumors: Do Immunological Variables Affect Individual Predictive Mortality Risk?

Abstract The aim of this study was to evaluate whether the addition of immunological variables to the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system improves the predictability of postoperative mortality. One hundred and thirty-two consecutive patients who underwent moderate, major or major-plus elective surgical interventions for gastrointestinal tumors were scored using the POSSUM mortality risk analysis. Patients were placed in one of the two groups based on their POSSUM mortality rates which were either lower or higher than 5%. An additional 26 pre-operative and post-operative metabolic and immunological variables were measured and mortality-dependent variables were selected. Regression analysis with backward elimination of twelve pre-operative and post-operative variables correlating with POSSUM score revealed that post-operative neopterin, IL-6 and albumin were significantly dependent on the predicted mortality rates. According to these selected variables, the number of patients with a POSSUM predicted mortality rate higher than 5% increased from 64 to 88, but the percentage of the mean mortality decreased. Statistical differences between the original POSSUM and modified scoring system was highly significant (p&lt;0.0001). The sensitivity and specificity of the modified scoring system was calculated to be 52.9% and 87.5%, respectively.

Status and risk factors of postoperative hemorrhage in patients undergoing surgery

Objective To investigate the incidence and related factors of postoperative hemorrhage, so as to provide data support for preventing its occurrence and developing reasonable risk assessment tools. Methods The retrospective analysis of clinical data of 50 patients with postoperative hemorrhage after surgical operation in a 3A hospital in Shanghai from January to December 2016 was conducted. A 1∶2 matching case-control study was conducted to explore the risk factors of postoperative bleeding in surgical patients by univariate and multivariate regression analysis. Results The total number of surgical operations (excluding obstetrics and gynecology, five senses) was 18 942. Postoperative hemorrhage occurred in 50 cases, including 6 deaths. The incidence of postoperative hemorrhage was 0.26% and the mortality rate was 12%. The incidence of postoperative bleeding in the top four departments were gastrointestinal surgery (13 cases) , hepatobiliary and pancreatic surgery (11 cases) , cardiac surgery (10 cases) , neurosurgery (9 cases) . The statistical analysis of binary Logistic in the case group and the control group showed that postoperative albumin<35g/L, postoperative AST abnormality, postoperative ALT abnormality, postoperative hypertension were independent risk factors of postoperative bleeding. Conclusions The incidence of postoperative bleeding in this hospital is relatively low, but the mortality is relatively high. Medical staff should pay more attention to the patients undergoing gastrointestinal, liver, pancreas, heart and brain surgery. It is also necessary to pay more attention to the blood pressure, albumin and liver function of the patients after operation, and establish the evaluation of prevention of hemorrhage, which has a certain early warning effect on the prevention of postoperative hemorrhage. Key words: Postoperative hemorrhage; Bleeding incidence; Risk factors; Risk assessment

Meaning of C-reactive protein around esophagectomy for cStage III esophageal cancer.

The prognosis of esophageal cancer is dismal, and the 3-year overall survival of cStage III does not reach 50.0%. C-reactive protein (CRP) is a well-known protein that reflects the short- and long-term operative outcomes of esophageal cancer. However, since elevated CRP levels are often observed in cStage III esophageal cancer, whether or not CRP still reflects the prognosis is unclear. Eighty-four patients who were diagnosed with cStage III esophageal cancer and underwent R0/1 operation from January 2007 to December 2014 were retrospectively evaluated. The mean age was 66.8years, and the majority of patients were male. The median preoperative and postoperative CRP levels were 0.15 and 1.47mg/dl, respectively. A majority of the patients underwent thoracoscopic surgery, and the median blood loss and operation duration were 456ml and 11.6h, respectively. Forty-six patients (54.8%) died during the observation period, and the 3-year overall survival was 52.4%. A multivariate analysis showed that the preoperative CRP level, postoperative albumin level, blood loss, and complications were independent prognostic factors. A multiple linear regression analysis showed that an elevated postoperative CRP level was affected by the operation duration and preoperative CRP levels. These findings suggest that the preoperative CRP level is a prognostic factor for cStage III esophageal cancer and that postoperative elevation in the CRP level is affected by the operation duration.

Comparison of simplified and traditional pericardial devascularisation combined with splenectomy for the treatment of portal hypertension.

AIMTo compare the clinical outcomes of patients with portal hypertension (PH) who underwent treatment with splenectomy plus simplified pericardial devascularisation (SSPD) or splenectomy plus traditional pericardial devascularisation (STPD).METHODSWe conducted a single-centre retrospective study of 1045 PH patients treated with either SSPD (S Group, 357 patients) or STPD (T Group, 688 patients) between January 2002 and February 2017. In all, 37 clinical indicators were compared to evaluate the efficacy of SSPD.RESULTSPerioperative indicators in the S Group were significantly better than those in the T Group (P < 0.05). In both groups, the postoperative long-term portal vein diameter and Model for End-Stage Liver Disease score were significantly lower than those in the preoperative and postoperative short-term groups (P < 0.05). The incidence of complications in the S Group was significantly lower than that in the T Group (P < 0.05). Compared to the T Group, postoperative short-term WBC (white blood cell) and platelet counts were significantly lower and the short-term Hb (haemoglobin) level was significantly higher in the S Group (P < 0.05). In the S Group, postoperative long-term total bilirubin, direct bilirubin, alanine transaminase, and aspartate transaminase and postoperative serum creatinine and cystatin C levels were significantly lower than those in the T Group (P < 0.05), and postoperative albumin was significantly higher than that in the T Group (P < 0.05).CONCLUSIONCompared to STPD, SSPD is a simple and easy procedure resulting in less tissue damage. Patients recovered smoothly and steadily with fewer complications. Short-term liver and kidney function damage was less severe, and long-term liver function recovery was better. Therefore, SSPD is worthy of clinical promotion and application for the treatment of PH.

Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery.

A retrospective study. The purpose of this study was to identify the independent risk factors for postoperative surgical site infection (SSI) after posterior lumbar spinal surgery based on the perioperative factors analysis. SSI is one of the most common complications after spinal surgery. Previous studies have identified different risk factors for postoperative SSI after lumbar spinal surgery. However, most of the studies were focused on the patient and procedure-related factors. Few studies reported the correlation between laboratory tests and postoperative SSI. A retrospective study was carried out in a single institution. Patients who underwent posterior lumbar spinal surgery between January 2010 and August 2016 were included in this study. All patients' medical records were reviewed and patients with postoperative SSI were identified. Perioperative variables were included to determine the risk factors for SSI by univariate and multivariate regression analysis. A total of 2715 patients undergoing posterior lumbar spinal surgery were included in this study. Of these patients, 64 (2.4%) were detected with postoperative SSI, including 46 men and 18 women. Diabetes mellitus (P = 0.026), low preoperative serum level of calcium (P = 0.009), low preoperative and postoperative albumin (P = 0.025 and 0.035), high preoperative serum glucose (P = 0.029), multiple fusion segments (P < 0.001), increased surgical time and estimated blood loss (P = 0.023 and 0.005), decreased postoperative hemoglobin (P = 0.008), and prolonged drainage duration (P = 0.016) were found to be the independent risk factors for SSI. Multilevel fusion and a history of diabetes mellitus were the two strongest risk factors (odds ratio = 2.329 and 2.227) for SSI. Based on a large population analysis, previous reported risk factors for SSI were confirmed in this study while some new independent risk factors were identified significantly associated with SSI following lumbar spinal surgery, including preoperative low serum level of calcium, decreased preoperative and postoperative albumin, and decreased postoperative hemoglobin. 4.

Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7.

Segment 7 is considered an unfavorable portion for laparoscopic hepatectomy because of technical difficulties in exposure and controlling bleeding. We compared intermittent Pringle with continuous half-Pringle maneuver in laparoscopic liver resections of tumors in segment 7. A retrospective analysis was conducted in a total of 36 consecutive patients with tumors in segment 7 undergoing laparoscopic liver resections between July 2011 and February 2016 (16 in the Pringle group versus 20 in the half-Pringle group). The two groups were well matched in baseline characteristics. The operative time (274.5 ± 34.3 versus 237.6 ± 41.8min), overall declamping time (28.4 ± 8.6 versus 2.3 ± 2.5min), and ischemic duration (69.7 ± 16.5 versus 52.7 ± 13.2min) were significantly longer in the Pringle group (P < 0.05). The amount of intraoperative blood loss (612.5 ± 222.3 versus 417.4 ± 163.8mL) and transfusion (335.2 ± 58.7 versus 224.8 ± 76.2mL) was significantly greater in the Pringle group (P < 0.05). The Pringle group was associated with significantly lower postoperative albumin and higher C-reactive protein levels on postoperative days 1, 3, and 7 (P < 0.05). Laparoscopic hepatectomy for tumors in segment 7 can be performed safely and effectively with successful exposure of surgical field and proper hepatic blood flow occlusion. Continuous half-Pringle maneuver offers the advantages of less operative time and blood loss, less injury, and better recovery.

Early Enteral Nutrition is Associated with Faster Post-Esophagectomy Recovery in Chinese Esophageal Cancer Patients: A Retrospective Cohort Study

ABSTRACTWe retrospectively examined a large cohort of esophageal carcinoma patients who received early enteral nutrition (EEN) to clarify the validity of EEN compared with total parenteral nutrition (TPN). Included were a total of 665 consecutive patients with histologically confirmed carcinoma of the esophagus or esophagogastric junction; and all patients underwent esophagectomy. The patients were divided into two groups: TPN (n = 262) and EEN (n = 403). The TPN group consisted of patients who only received intravenous nutrition support after operation. The postoperative length of hospital stay (PLOS), anastomotic leakage, mortality after surgery, and hospital charges were reviewed and analyzed. Compared with the TPN group, the EEN group had significantly shorter mean PLOS (15.6 days vs. 22.5 days; P < 0.01). Multivariable linear regression analysis revealed EEN to be associated with shorter PLOS even after adjustment for tumor histology, tumor location, type of esophagectomy, and postoperative albumin infusion. Hospital charges were also significantly less for those in the EEN group than the TPN group. There was no significant difference between the two groups regarding the complication of anastomotic leakage and clinical outcome after surgery. These findings suggest that EEN reduces PLOS and hospital charges of Chinese esophageal cancer patients who had an esophagectomy.

Identification of Independent Risk Factors for Complications: A Retrospective Analysis of 163 Fibular Free Flaps for Mandibulofacial Reconstruction

Fibular free flap transfer is a powerful tool available to the reconstructive surgeon when treating oral and maxillofacial defects, but complications still occasionally occur and predictive analysis focusing on this specific flap is limited in terms of risk factors for complication. The purpose of this study was to identify key variables associated with complications in patients undergoing fibular free flap transfer. The data of 163 consecutive patients who underwent fibular free flap surgery at the Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, between 2012 and 2015 were reviewed retrospectively. Patient demographic data, laboratory data, surgical data, and fluid infusion-related data that may have an influence on free flap outcomes were recorded. Univariate and multivariate logistic regression analyses were used to identify relevant risk factors. A total of 163 fibular free flaps were transferred for mandibulofacial reconstruction in 163 patients with a mean age of 50.9years. Postoperative complications developed in 33 (20.2%). Multivariate analysis showed that free flap complications were significantly associated with radiotherapy history (odds ratio [OR], 5.12; P=.001), postoperative anemia (OR, 1.048; P=.041), postoperative hypoalbuminemia (OR, 0.844; P=.002), and prolonged operative time (OR, 1.005; P=.004). Radiotherapy history, decreased postoperative hemoglobin and albumin levels, and prolonged operative time are potential predictors of postoperative complications after fibular free flap reconstruction for mandibulofacial defects.