Surgery Postoperative Complications Research Articles

Comparative assessment of hemocompatibility of the suture material modified with heparin using different techniques

Postoperative complications in surgery, including thrombosis, are often associated with the suture material. The search for new types of suture materials that reduce the risk of vascular anastomotic complications remains an urgent task. The aim of the study was to compare and evaluate the effectiveness of two types of suture materials modified with heparin in terms of the hemocompatibility. Material and methods. The study involved a thread based on the Prolene 3.0 Polypropylene Suture (Ethicon, USA) that had undergone subsequent modification. The suture was modified with either heparin with polydimethylsiloxane or heparin with polyhydroxybutyrate/oxyvalerate. The consistency and hemocompatibility of the modifying layer were evaluated by scanning electron microscopy, diffuse scattering spectroscopy, hemolysis, platelet adhesion and aggregation. Results and discussion. The modifying layer based on heparin and polydimethylsiloxane was nonhomogeneous, with either thick or completely absent coating layer. The modifying layer based on heparin and polyhydroxybutyrate/oxyvalerate was homogeneous, without signs of thickening. Diffuse reflectance spectroscopy confirmed its presence on the thread surface. Evaluation of the hemocompatibility of the modified thread revealed the absence of hemolysis in all the studied groups. The modifying layer based on heparin and polyhydroxybutyrate/ oxyvalerate significantly reduced the maximum platelet aggregation (46.28 %) compared with the unmodified thread (82.64 %), the thread modification with heparin and polydimethylsiloxane did not influence on the indicator (77.72 %). The number of platelets adhered on the surface of the thread modified with heparin and polyhydroxybutyrate/oxyvalerate was insignificant, consisting of single inactivated platelets, in contrast to a thread modified with polydimethylsiloxane rubber and heparin, on the surface of which a large number of adherent activated platelets were found. Conclusions. The results obtained indicate the promising approach for the prevention of postoperative thrombosis by layer-by-layer modification of thread with heparin and polyhydroxybutyrate/oxyvalerate.

Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis

Postoperative complications of spinal surgery are a common clinical problem, which impose significant economic and clinical burdens on patients and medical staff. Previous studies have suggested a close relationship between low-protein malnutrition and postoperative complications of surgery. However, the relationship between preoperative malnutrition and various orthopedic postoperative complications remains unclear. To investigate the association between protein malnutrition and postoperative complications and outcomes. We conducted a systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases for published research articles between the database inception and February 28th, 2023, that evaluated the association between malnutrition and the risk of postoperative complications and death in spinal surgery patients. Malnutrition was defined as low pre-albumin and albumin levels before surgery. Two evaluators independently extracted study data and assessed the risk of bias in each study. Fixed- or random-effect models were used to calculate the pooled effect estimates. Funnel plots and Egger's tests were used to detect publication bias, and the Trim-and -Fill method was conducted to evaluate the impact of publication bias on the results. A total of 26 studies were included in this meta-analysis, comprising 17 retrospective cohort studies and 9 case-control studies. The study included more than 86,000 participants. Analysis of postoperative complications revealed that the overall incidence of malnutrition-related complications after surgery was 3.17 times higher (OR=3.17, 95% CI 2.69-3.75, z=13.57, P<0.05). The incidence of surgical site infections was 2.08 times higher (OR=2.08, 95% CI 1.66-2.62, z=6.307, P<0.05), and the incidence of postoperative urinary tract infections was 2.55 times higher (OR=2.55, 95% CI 1.80-3.60, z=5.30, P<0.05). The incidence of postoperative sepsis was 3.31 times higher (OR=3.31, 95% CI 2.31-4.75, z=6.51, P<0.05), and the incidence of postoperative pneumonia was 3.02 times higher (OR=3.02, 95% CI 1.331-6.857, z=2.64, P=0.008<0.05). The incidence of postoperative cardiac complications was 4.24 times higher (OR=4.24, 95% CI 2.45-7.35, z=5.15, P<0.05), and the incidence of postoperative renal complications was 4.04 times higher (OR=4.04, 95% CI 2.06-7.93, z=4.05, P<0.05). The incidence of postoperative pulmonary complications was 2.38 times higher (OR=2.38, 95% CI 1.46-3.87, z=6.98, P<0.05), while the incidence of postoperative thrombotic complications was 2.76 times higher (OR=2.76, 95% CI 1.756-4.345, z=4.40, P<0.05). Furthermore, the incidence of transfusion during and after surgery was 1.33 times higher (OR=1.33, 95% CI 1.13-1.56, z=3.40, P=0.001<0.05), the incidence of postoperative readmission was 1.67 times higher (OR=1.67, 95% CI 1.24-2.27, z=3.33, P=0.001<0.05), and the risk of postoperative death was 6.01 times higher (OR=6.01, 95% CI 4.51-8.01, z=12.27, P<0.05). After conducting a publication bias test and Trim-and -Fill method analysis, we found no evidence of publication bias, and the results remained stable. Preoperative low protein malnutrition is closely related to the incidence of postoperative complications and postoperative status. More prospective multicenter studies should be conducted to validate this conclusion. Furthermore, more effective assessment and intervention of preoperative nutritional status should be carried out to prevent the occurrence of postoperative complications and mortality risk.

Smoking is a predictor of complications in all types of surgery: a machine learning-based big data study

Machine learning algorithms are promising tools for smoking status classification in big patient data sets. Smoking is a risk factor for postoperative complications in major surgery. Whether this applies to all surgery is unknown. The aims of this retrospective cohort study were to develop a machine learning algorithm for clinical record-based smoking status classification and to determine whether smoking and former smoking predict complications in all surgery types. All surgeries performed in a Finnish hospital district from 1 January 2015 to 31 December 2019 were analysed. Exclusion criteria were age below 16 years, unknown smoking status, and unknown ASA class. A machine learning algorithm was developed for smoking status classification. The primary outcome was 90-day overall postoperative complications in all surgeries. Secondary outcomes were 90-day overall complications in specialties with over 10 000 surgeries and critical complications in all surgeries. The machine learning algorithm had precisions of 0.958 for current smokers, 0.974 for ex-smokers, and 0.95 for never-smokers. The sample included 158 638 surgeries. In adjusted logistic regression analyses, smokers had increased odds of overall complications (odds ratio 1.17; 95 per cent c.i. 1.14 to 1.20) and critical complications (odds ratio 1.21; 95 per cent c.i. 1.14 to 1.29). Corresponding odds ratios of ex-smokers were 1.09 (95 per cent c.i. 1.06 to 1.13) and 1.09 (95 per cent c.i. 1.02 to 1.17). Smokers had increased odds of overall complications in all specialties with over 10 000 surgeries. ASA class was the most important complication predictor. Machine learning algorithms are feasible for smoking status classification in big surgical data sets. Current and former smoking predict complications in all surgery types.

Diagnostic Options for Postoperative Complications in Surgery

Currently, scientific research is usually carried out in accordance with the postulates of evidence-based medicine in Russia and foreign countries. However, the implementation of these principles requires deep knowledge of surgery and mathematical modeling. Authors: a surgeon and a programmer developed mathematical models involved in the diagnosis of postoperative complications in surgery. In this paper, we investigated a deep, fully connected neural network for the diagnosis of postoperative complications on the clinical example of acute appendicitis. As a training set of parameters, we used a set developed by the authors on the basis of real clinical data, which has a state registration number in the form of a database, and includes a knowledge base. The interquantile range of the F1 measure is proposed for the selection of significant features. An approach to coding composite categorical features, characterized by a compact representation, is proposed. For pre-processing of training data, it is proposed to use a step-up autoencoder. The autoencoder converts the selected functions into a higher-dimensional space, which, according to Kover's theorem, facilitates the classification of features. The neural network is implemented using the Keras and TensorFlow libraries. To train the neural network, the Adam algorithm with adaptive learning speed is used. To reduce the effect of overfitting, a modern regularization method dropout-was used. The analysis and selection of the classifier quality metrics are carried out. To evaluate the characteristics of the neural network, k-block cross-validation was used. The trained neural network showed high diagnostic performance on the test data set.

Prognostic impacts of categorized postoperative complications in surgery for gastric cancer

BackgroundPostoperative complications generally aggravate postoperative prognosis and are correlated with both cancer-specific death and death from other causes. MethodsSubjects were 197 patients who underwent gastrectomy at Kyoto Chubu Medical Center. Cancer-specific survival (CSS) and non-CSS (NCSS) were compared between cases with and without complications. Major complications were classified into C-com and N-com groups based on their prognostic impact on CSS and NCSS, respectively. Uni- and multivariate analyses were conducted using clinicopathological factors. ResultsDuring the study period, 30 patients (15.2%) died from gastric cancer and 34 (17.3%) died from other causes. The incidence of postoperative complications was 16.8%. Sixteen patients with anastomosis leakage, pancreatic fistula, or organ/space surgical site infection had significantly poorer CSS, whereas 30 patients with pneumonia or passage obstruction had significantly poorer NCSS. These were defined as C-com and N-com cases, respectively. In the uni- and multivariate analyses, C-com was a significant prognostic factor for CSS (p = 0.002, p = 0.039) and N-com was a significant prognostic factor for NCSS (p < 0.0001, p = 0.004). C-reactive protein levels indicated intermediate and severe inflammation in N-com and C-com cases, respectively. ConclusionIn N-com cases, surgical stress caused disruption of essential organ function, whereas damage in C-com cases occurred mostly in the abdominal cavity but was a risk for cancer regrowth. Thus, different postoperative complications worsen patient prognosis after gastrectomy in different ways. To optimize surgical outcomes, improved selection of treatment strategies for different complication types may be important.

The influence of summer closure on serious postoperative complications in bariatric surgery

IntroductionBariatric surgery is an effective method of treating obesity, with gastric bypass and sleeve gastrectomy being the most common techniques used worldwide. Despite the technical challenges in these methods, little is known about the effects of summer closure on the incidence of serious postoperative complications in surgeries performed shortly after summer vacation. This has therefore been studied in our large cohort.Materials and methodsA retrospective cohort study based on data from the Scandinavian Obesity Surgery Registry was conducted. Patients who underwent a primary gastric bypass or sleeve gastrectomy operation between 2010 and 2019 were included. The rate of serious complications within 30 days after surgery for patients who underwent surgery the first month after summer closure was compared to those who underwent surgery during the rest of the year using the χ2 test and adjusted logistic regression.ResultsThe study included 42,404 patients, 36,094 of whom underwent gastric bypass and 6310 of whom received sleeve gastrectomy. Summer closure was associated with an increased risk for serious postoperative complications in gastric bypass surgery (adjusted odds ratio (adj-OR) = 1.17; 95% confidence interval (CI): 1.01–1.36). No statistically significant association was seen for sleeve gastrectomy (adj-OR = 1.17; 95% CI: 0.72–1.91), nor in overall complication rate.ConclusionsSummer closure increases the risk of serious postoperative complications in gastric bypass surgery. No statistically significant association was found for sleeve gastrectomy surgery.

Interleukin-6 Is an Early Plasma Marker of Severe Postoperative Complications in Thoracic Surgery: Exploratory Results From a Substudy of a Randomized Controlled Multicenter Trial.

Postoperative complications in surgery are a significant burden, not only for the patients but also economically. While several predicting factors have already been identified, it is still not well known if increased levels of inflammatory markers in the immediate perioperative phase correlate with a higher incidence of postoperative complications. This study aimed to evaluate which patient characteristics and intraoperative parameters correlate with increased plasma values of monocyte chemoattractant protein 1 (MCP-1) and interleukin 6 (IL-6) of thoracic surgery patients. A second goal was to explore whether MCP-1 and IL-6 are associated with the incidence of postoperative complications. We hypothesized that there is a positive association between inflammatory markers and the occurrence of complications within 6 months after surgery. This is a substudy of a recent randomized controlled trial, which defined the effect of desflurane versus propofol anesthesia on morbidity and mortality in patients undergoing thoracic surgery. MCP-1 and IL-6 were determined in plasma obtained before and 30 minutes after 1-lung ventilation, 6 hours after surgery, and on postoperative days 1 and 2. Complications were recorded for 6 months. Mixed linear models were used to examine factors associated with MCP-1 and IL-6 levels. Logistic regression models and receiver operating characteristic curves were used to determine the association between MCP-1 and IL-6 and postoperative complications. In the original study, 460 patients were included, MCP-1 and IL-6 levels were determined in 428 patients. MCP-1 was positively associated with the duration of surgery (P = .016), whereas IL-6 levels increased with both the length (P < .001) and invasiveness of lung surgery (thoracoscopic wedge resection or lobectomy versus open lobectomy, P = .005; thoracoscopic wedge resection or lobectomy versus pneumonectomy, P = .021). In an exploratory approach, elevated IL-6 plasma peaks were associated with the occurrence of severe complications defined as Clavien-Dindo score grade ≥IVa during the postoperative phase up to 6 months after thoracic surgery (P = .006). In summary, this substudy reveals factors, which correlate with high MCP-1 and IL-6 values. Moreover, higher IL-6 seems to be associated with postoperative severe complications. Perioperative IL-6 monitoring might be helpful for risk estimation in the perioperative setting of patients after lung surgery.

Autologous rectus sheath sling for treatment of vault prolapse after hysterectomy.

Objective: Determine the duration and post-operative complications of surgery in patients who underwent rectus sheath sling for correction of vault prolapse. We started doing this novel technique and found it very safe with least side effects so wanted to study it. Study Design: Experimental study. Setting: Nishtar Hospital Multan Pakistan. Period: July 2016 to June 2018. Material &amp; Methods: Patients were applied autologous sling of rectus sheath at Nishtar Hospital Multan and were followed for 2 years. Patients with diabetes mellitus and any other chronic disease were excluded. Patients who had previous surgery for vault prolapse were also excluded from the study. Data were recorded and analyzed using IBM-SPSS version 23.0, percentages are given for previous surgery duration (how long before the previous surgery was done), duration of current surgery, post-operative fever, post -operative urinary tract infection(UTI), duration of stay in the hospital after surgery, parenteral analgesia requirement. Parameters were tested using Pearson Chi Square test with type of previous surgery. Results: The total number of patients in the study were 19.The mean age of the patients was 59.7 years (SD = ±9.7) and mean weight was 59.4kg (SD = ±12.5). The duration of surgery was less than 1 hour in 84 % of patients. Same percentage had less than 36 hours requirement of post- operative parenteral analgesia and thus less than 2 days of post-operative stay in hospital. Postoperatively 31.6 % had fever, 26.3% had Urinary tract infection. On 2 years follow-up of this surgery, no patient had any recurrence of vault prolapse and 85.7% showed no coital difficulty. Conclusion: This surgical procedure is a simple, time saving method with less complications and is best suited for low resource countries like Pakistan.

Perioperative fluid balance and major postoperative complications in surgery for advanced epithelial ovarian cancer

ObjectiveAppropriate fluid balance in the perioperative period is important as both hypo- and hypervolemia are associated with increased risk of complications. Women undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC) may have major fluid shifts. The optimal perioperative fluid balance in these women is yet to be determined. Our objective was to investigate the association between perioperative fluid balance and major postoperative complications. MethodsWomen with advanced stage EOC who underwent surgery at Karolinska University Hospital, Stockholm, Sweden were identified from the institutional database. Women subjected to surgery with curative intent were included in the analysis. Additional data were retrieved from medical records. The association between perioperative fluid balance and major postoperative complications was investigated by multivariable regression and adjusted for predefined confounders. ResultsOf the 270 women identified in the institutional database during 2014–2017, 184 women were included in the analyses. Of these women, 22% (n = 40) experienced a major postoperative complication. The fully adjusted odds of major postoperative complications increased when perioperative fluid balance exceeded >3000 mL, (Odds Ratio (OR) 4.85, 95% Confidence Interval (CI) 1.23–19.2, p = 0.02) and > 5000 mL (OR 33.7, 95% CI 4.13–275, p < 0.01). There was no association between negative fluid balance and major postoperative complications (OR 3.33, 95% CI 0.25–44.1, p = 0.36). ConclusionsFluid balance >3000 mL perioperatively during surgery for advanced EOC increased the odds of major postoperative complications. Management of perioperative fluid balance in advanced EOC surgery remains a challenge.

Invasive and in situ lesions of squamous cell carcinoma are independent factors for postoperative surgical-site infection after outpatient skin tumors surgery: A retrospective study of 512 patients.

Surgical-site infection (SSI) is one of the major postoperative complications in surgery, which can cause significant morbidity. However, factors associated with SSI in dermatological surgery are not well understood. Here, we retrospectively investigated 512 patients who underwent outpatient surgery for skin tumors at the University of Tsukuba Hospital to analyze factors associated with postoperative SSI. The overall incidence of SSI was 28 (5.5%). Univariate logistic regression analysis revealed that SSI was significantly associated with invasive squamous cell carcinoma (iSCC), Bowen's disease (BD), actinic keratosis (AK), longer diameter of defects, presence of ulcer, reconstruction with full-thickness skin graft and local skin flaps, medical history of diabetes mellitus, and use of immunosuppressive agents. However, in the multivariate analysis only iSCC, BD, and AK retained significance. The frequencies of SSI in iSCC, BD, and AK were 22% (13/58 patients), 15.6% (5/32), and 25% (2/8), respectively; however, the frequency of other non-SCC tumors was only 1.9% (8/414). χ2 -Tests revealed that the frequency of SSI in iSCC, BD, and AK were all significantly higher than in non-SCC tumors, with the frequencies being more than eight times higher. These results suggest that invasive and in situ lesions of SCC are independent risk factors of SSI development after outpatient skin surgery.

The Use of Artificial Intelligence on Segmental Volumes, Constructed from MRI and CT Images, in the Diagnosis and Staging of Cervical Cancers and Thyroid Cancers: A Study Protocol for a Randomized Controlled Trial

Rationale and Objectives: Accurately establishing the diagnosis and staging of cervical and thyroid cancers is essential in medical practice in determining tumor extension and dissemination and involves the most accurate and effective therapeutic approach. For accurate diagnosis and staging of cervical and thyroid cancers, we aim to create a diagnostic method, optimized by the algorithms of artificial intelligence and validated by achieving accurate and favorable results by conducting a clinical trial, during which we will use the diagnostic method optimized by artificial intelligence (AI) algorithms, to avoid errors, to increase the understanding on interpretation computer tomography (CT) scan, magnetic resonance imaging (MRI) of the doctor and improve therapeutic planning. Materials and Methods: The optimization of the computer assisted diagnosis (CAD) method will consist in the development and formation of artificial intelligence models, using algorithms and tools used in segmental volumetric constructions to generate 3D images from MRI/CT. We propose a comparative study of current developments in “DICOM” image processing by volume rendering technique, the use of the transfer function for opacity and color, shades of gray from “DICOM” images projected in a three-dimensional space. We also use artificial intelligence (AI), through the technique of Generative Adversarial Networks (GAN), which has proven to be effective in representing complex data distributions, as we do in this study. Validation of the diagnostic method, optimized by algorithm of artificial intelligence will consist of achieving accurate results on diagnosis and staging of cervical and thyroid cancers by conducting a randomized, controlled clinical trial, for a period of 17 months. Results: We will validate the CAD method through a clinical study and, secondly, we use various network topologies specified above, which have produced promising results in the tasks of image model recognition and by using this mixture. By using this method in medical practice, we aim to avoid errors, provide precision in diagnosing, staging and establishing the therapeutic plan in cancers of the cervix and thyroid using AI. Conclusion: The use of the CAD method can increase the quality of life by avoiding intra and postoperative complications in surgery, intraoperative orientation and the precise determination of radiation doses and irradiation zone in radiotherapy.

Prevalence, ocular associations and perioperative surgical complications of pseudoexfoliation syndrome in patients scheduled for cataract surgery

Purpose The aim of this work was to study the prevalence, possible ocular association, and perioperative surgical complications of pseudoexfoliation syndrome (PXF) in patients with age-related cataract scheduled for surgery in Najran district, south Saudi Arabia. Design Retrospective comparative study. Patients and methods In this retrospective comparative study, 681 consecutive patients scheduled for routine cataract surgery were included. All patients were aging 60 years old or more. Full ophthalmological examination including visual acuity, refraction, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, type of cataract, and dilated-pupil fundus examination was performed. Intraoperative and early postoperative complications of surgery were reported and statistical analysis was done. Results Pseudoexfoliation was identified in eyes of 192 patients with overall incidence of 28.19%. It was found unilaterally in 46.87% and bilaterally in 53.13% of patients. The mean age for PXF group was 73.47 ± 22.36 years and 72.36 ± 21.63 years for non-PXF group. The occurrence of pseudoexfoliation was found to be significantly higher with advancement of age. Ocular hypertension and glaucoma were reported in PXF group more than in non-PXF group. Nuclear, hypermature, and cortical cataracts were found to be more frequently associated with pseudoexfoliation compared with those without pseudoexfoliation. Association of PXF with some ocular conditions as well as with perioperative complications was reported and discussed. Conclusion PXF is a common age-related disorder in patients with age-related cataract in Najran area, south Saudi Arabia with overall incidence of 28.19%. PXF was found to be associated with certain types of cataract, glaucoma, other ocular conditions as well as increased incidence of operative complications.

Risk of acute myocardial infarction after transurethral resection of prostate in elderly

BackgroundBenign prostatic hyperplasia is a frequent disease among elderly, and is responsible for considerable disability. Benign prostatic hyperplasia can be clinically significant due to lower urinary tract symptoms that take place because the gland is enlarged and obstructs urine flow. Transurethral resection of the prostate remains the gold standard treatment for patients with moderate or severe symptoms who need active treatment or who either fail or do not want medical therapy. Moreover, perioperative and postoperative surgery complications as cardiovascular ones still occur. The incidence of acute myocardial infarction in patients undergoing transurethral resection of the prostate is controversial. The first studies showed an increase in mortality and relative risk of death from myocardial infarction in transurethral resection of the prostate group vs open prostatectomy but these results are in contrast with more recent data.DiscussionGiven the conflicting evidence of the studies in the literature, in this review we are going to discuss the factors that may influence the risk of myocardial infarction in elderly patients undergoing prostate surgery. We analyzed the possible common factors that lead to the development of myocardial infarction and benign prostatic hyperplasia (cardiovascular and metabolic), the stressor factors related to prostatectomy (surgical and haemodynamic) and the risk factors specific of the elderly population (comorbidity and therapies).SummaryAlthough transurethral resection of the prostate is considered at low risk for severe complications, there are several reports indicating that cardiovascular events in elderly patients undergoing this surgical operation are more common than in the general population. Several cardio-metabolic, surgical and aging-related factors may help explain this observation but results in literature are not concord, especially due to the fact that most data derive from retrospective studies in which selection bias cannot be excluded. Subsequently, further studies are necessary to clarify the incidence of acute myocardial infarction in old people.

Recomendaciones sobre el tratamiento farmacológico perioperatorio

Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics.

Social consequences and ethical considerations of postoperative complications of surgery

A certain percent of patients undergoing operative treatment would always run into complications following surgery. With millions of surgeries being performed every day, world over, the number of such patients is indeed quite high and their predicament needs to be appreciated by the surgical fraternity. One of the natural consequences of occurrence of a complication is prolongation of hospital stay in most circumstances. This also means increased financial burden for the family. There are many other implications involving these patients and these also affect the society as well. In our country no support systems exist for helping such patients either financially or socially, inspite of the fact that they are in difficulty. The hardship they are made to face remains unrecognized and even unappreciated most of the times by all concerned. Invariably they are left to suffer on their own. The present communication makes an effort to highlight this aspect of surgical complications, and the adverse effects, occurrence of such complications have on the individual, his/ her family and the society as a whole. An attempt has also been made to draw the attention of surgical fraternity to these happenings with a suggestion that one needs to react to a situation which is largely a creation of our own. As a surgeon, one ought to take this as a challenge to one's professional capabilities and expertise, and make active efforts to perform routine as well as difficult surgery with no or minimum possible complication rates. And if an unfortunate patient does run into difficulty, the surgeon must play a positive role to minimize sufferings and to rehabilitate him/her back into the society.

Studies on the relationship between gastric acidity and the development of MRSA. Especially for the prevention of MRSA enterocolitis

Enterocolitis caused by methicillin-resistant Staphylococcus aureus (MRSA) has recently been recognized as one of the severe postoperative complications in surgery on the digestive organs. This disease often occurs in the early days after gastrointestinal operation, especially after gastrectomy. MRSA enterocolitis seems to occur when MRSA has first infected the naso-pharyngeal mucosa preoperatively, and then moved into the stomach, and subsequently proliferated in the higher pH gastric juices. The aim of this experiment was to reveal the relationship between the acidity of gastric juices and bacterial growth in the stomach during the pre and post operative period in an effort to prevent of MRSA enterocolitis. In vitro, MRSA was cultured for various periods at various pH values, and its proliferation was observed. MRSA did not grow in the culture at pH 1 at all, neither did it grow at pH 2 when cultured for more than 8 hours. This data shows the germicidal effect of high acidity in the stomach. Clinically, twenty patients with cancer in the digestive tract had the bacteria in their gastric juices examined in terms of acidity before and after operation. In cases with an increased pH level in the gastric juices after the operation. S. aureus including MRSA, was isolated frequently from the stomach. In vitro, incubation of MRSA with gastric juices collected from those cases showed no development of MRSA when the pH was below 3.98. In order to prevent the onset of MRSA enterocolitis, the remnant stomachs of ten patients with stomach cancer were filled with hydrochloric acid lemonade just after operative reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Book Review: Postoperative Complications in Surgery

Book Review: Postoperative Complications in Surgery