Postoperative Gastrointestinal Complications Research Articles

Clinical application of early postoperative nutritional support in patients with high-risk valvular heart disease.

The treatment strategy of early nutritional support after cardiac surgery has gradually been adopted. However, there are no scientific guidelines for the timing and specific programs of early nutritional support. A retrospective, single-center analysis (2021-2023) was carried out including elderly patients who were admitted for valvular heart disease (VHD) and received open-heart valve replacement surgery. We designated patients who started the optimized nutritional support after surgery as the EN group and those who received traditional nutritional support as the TN group. The nutritional and immune indexes, postoperative complications, length of hospital stay, and hospitalization cost of the two groups were compared and analyzed. We identified 378 eligible patients, comprising 193 (51%) patients in the EN group and 185 (49%) patients in the TN group. There was no significant difference in hospital mortality between the two groups, but the proportion of nosocomial pneumonia was significantly lower in the EN group than in the TN group (P < 0.001). In the Poisson regression analysis, EN was not associated with an increase in gastrointestinal complications (P = 0.549). The EN group also seemed to have shorter hospital stays and lower hospitalization expenses (P < 0.001). In the comparison of postoperative gastrointestinal complications, fewer patients experienced diarrhea (P = 0.021) and abdominal distension (P = 0.033) in the EN group compared with the TN group. The optimal nutritional support strategy could effectively improve the clinical outcome of high-risk patients with valvular heart disease.

Low-Dose Enteric-Coated and Chewable Aspirin Are Not Equally Effective in Preventing Venous Thromboembolism in Total Knee and Hip Arthroplasty

BackgroundLow-dose aspirin is an effective venous thromboembolism (VTE) prophylactic medication in primary total joint arthroplasty, but the efficacy and safety of the formulations of chewable and enteric-coated aspirin have not been compared. The purpose of this study was to investigate the VTE and gastrointestinal (GI) complication rates of chewable and enteric-coated 81 mg aspirin bis in die for VTE prophylaxis in primary total joint arthroplasty. MethodsA retrospective, single-institution cohort study was performed on patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2017 to 2021. Comparisons were made between 4,844 patients who received chewable, noncoated aspirin 81 mg and 4,388 patients who received enteric-coated 81 mg aspirin. Power analysis demonstrated 1,978 and 3,686 patients were needed per group to achieve a power of 80% for 90-day VTE rates (using inferiority testing) and GI complications (using superiority testing), respectively. Patients had similar baseline characteristics. Statistical analyses were done using t-tests and Chi-squared tests, with statistical significance defined as a P value < .05. ResultsThere were no significant differences in the incidences of postoperative VTE (0.31% versus 0.55%; P = .111) or GI complications (0.14% versus 0.14%; P = 1.000) between patients who received either chewable or enteric-coated 81 mg aspirin bis in die in the overall comparison that included both THA and TKA patients combined, or THA patients alone. However, the VTE incidence for TKA patients alone was significantly lower with chewable than enteric-coated aspirin (0.22% versus 0.62%; P = .037), with no difference in GI complications (0.13% versus 0.19%; P = .277). ConclusionsLow-dose aspirin in enteric-coated formulation is inferior to chewable aspirin for VTE prophylaxis in primary TKA, but not inferior in THA patients. Both formulations have a similar GI complication rate. Therefore, it is reasonable to consider a transition from enteric-coated to uncoated chewable low-dose aspirin.

Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients.

We investigated in older adult non-cardiac surgical patients whether receipt of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased incidence of postoperative cardiovascular complications. We retrospectively extracted the information for patients with age ≥ 65years who had inpatient non-cardiac surgery with a duration of ≥ 1h from the American College of Surgeons-National Surgical Quality Improvement Program registry data acquired at the University of Washington Medical Center. We compared patients who received NSAIDs perioperatively to those who did not receive NSAIDs, on the two composite outcomes: (1) the incidence of postoperative cardiovascular complications within 30days of the surgery, and (2) the incidence of combined postoperative gastrointestinal and renal complications, and length of postoperative hospital stay. We used separate multivariable logistic regression models to analyze the two composite outcomes and a Poisson regression model for the length of hospital stay. The receipt of perioperative NSAIDs was not associated with postoperative cardiovascular complications (estimated odds ratio (OR), 1.78; 95% confidence interval (CI), 0.97 to 3.25; P = 0.06), combined renal and gastrointestinal complications (estimated OR, 1.30; 95% CI, 0.53 to 3.20; P = 0.57), and length of postoperative hospital stay in days (incidence rate ratio, 1.06; 95% CI, 0.93 to 1.21; P = 0.39). In older adult non-cardiac surgical patients, receipt of perioperative NSAIDs was not associated with increased incidences of postoperative cardiovascular complications, and renal and gastrointestinal complications within 30days after surgery, or length of postoperative hospital stay.

Effect of intraoperative dexmedetomidine on recovery of gastrointestinal function after caesarean section undergoing spinal and epidural anesthesia: A randomized, double blind, placebo-controlled clinical trial

ObjectiveGastrointestinal dysfunction after cesarean section negatively affects postoperative recovery. Dexmedetomidine has been shown to improve postoperative gastrointestinal function in patients undergoing lumbar spinal fusion surgery and laparoscopic gastrectomy, but its role in cesarean section has not been fully elucidated. The study aimed to investigate the effect of dexmedetomidine on gastrointestinal function after cesarean section. Study Design220 pregnant women who underwent elective cesarean section were randomized into group D and group S. Group D patients received a loading dose of 0.5 μg/kg of dexmedetomidine for 10 mins followed by a maintenance dose of 0.5 μg/kg/h intravenously immediately after the umbilical cord was cut intraoperatively, whereas the other group (group S) received an equivalent quantity of normal saline as loading and maintenance dose IV by infusion pump. The primary outcome was time to first flatus after surgery (hours). Secondary outcomes included time to first feces and first bowel sounds (hours), incidence rates of postoperative gastrointestinal complications, and the length of postoperative hospital stay (days). ResultsModified intention-to-treat analysis showed that patients in Group D had a significantly shorter time to first flatus (21 [16 to 28.25] vs. 25 [18 to 32.25] h; P = 0.014), time to first feces (45.5 [35.75 to 55.25] vs. 53 [40 to 60] h; P = 0.019), and time to first bowel sounds (P = 0.010), a lower incidence of abdominal distension (21[20.6 %] vs. 36[34.3 %], P = 0.027), shorter length of postoperative hospital stay (P = 0.010) compared to patients in Group S. ConclusionIntraoperative dexmedetomidine infusion reduces the time to first flatus, the incidence of abdominal distension, and shortens the length of hospital stay, promoting gastrointestinal function after cesarean section.

Development and validation of a risk prediction model for postoperative gastrointestinal complications in patients undergoing aortic arch surgery

Background Postoperative gastrointestinal complications (GICs) were potentially fatal to patients who underwent aortic arch surgery. The aim of this study was to construct a prediction model of GICs. Methods We retrospectively studied the medical records of 3063 patients who underwent aortic arch surgery. Patients were randomly divided into derivation and validation cohorts at a ratio of 4:1. A nomogram was constructed in the derivation cohort. Results A total of 157 patients with GICs were identified. In the derivation cohort, multivariate analysis identified six predictors of GICs including hypertension, ASA classification, preinduction MAP, aortic cross-clamp time, CPB time, and intraoperative transfusion of red blood cells. Compared with the patients without GICs, the patients with GICs had higher mortality, and longer ICU and hospital stays. We also divided the patients into four intervals according to the risk of GICs. Conclusions This study developed a reliable prediction model of GICs after aortic arch surgery. This prediction model had been well verified in our research centre, and further external verification was required before it can be recommended for clinical application.

The impact of bariatric surgery on admissions for gastrointestinal complications and conditions associated with obesity: A nationwide study.

Obesity worsens various gastrointestinal pathologies. While bariatric surgery ameliorates obesity, it substantially modifies the gastrointestinal system depending on surgery type, with limited data on subsequent impact on obesity-related gastrointestinal admissions. Using the 2012-2014 Nationwide Readmission Database, we included individuals with obesity who received vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or hernia repair (HR-control surgery). Our main focus was the adjusted odds ratio (aOR) for gastrointestinal inpatient admissions within 6months following surgery compared to the 6months preceding it, while controlling for several confounding factors. Gastrointestinal admissions were grouped into postoperative complications or obesity-associated gastrointestinal conditions. Our cohort included 140,103 adults with RYGB, 132,253 with VSG, and 12,436 HR controls. Postoperative gastrointestinal complications were most common after RYGB, prominently obstruction (aOR=33.17, 95%CI: 18.01, 61.10), and Clostridium difficile infection (aOR: 12.52, 95%CI: 6.22, 25.19). VSG also saw significantly increased but less frequent similar conditions. Notably, for gastrointestinal conditions associated with obesity, acute pancreatitis risk was higher post-VSG (aOR=6.26, 95%CI: 4.02, 9.73). Post-RYGB patients were most likely to be admitted for cholelithiasis with cholecystitis (aOR: 4.15, 95% CI: 3.24, 5.31), followed by chronic liver disease (aOR: 3.00, 95% CI: 2.33, 3.87). The risk of noninfectious colitis admissions was threefold higher after RYGB and VSG. No gastrointestinal conditions showed an increase after HR. Despite weight loss, bariatric surgery was associated with an increased risk of hepato-pancreatobiliary and colitis admissions related to obesity in the first six postoperative months, with considerable variations in rates of gastrointestinal conditions by surgery type.

Extraperitoneal Versus Intraperitoneal Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis.

This study aimed to compare perioperative and oncologic outcomes of extraperitoneal radical cystectomy (EPRC) and transperitoneal radical cystectomy (TPRC). A systematical search of multiple scientific databases was performed in September 2022. The systematic review and cumulative meta-analysis of the primary outcomes of interest were performed according to the PRISMA and AMSTAR guidelines and registered in the PROSPERO database (PROSPERO [CRD42022359322]). The review and analysis included eight studies with 989 participants. No significant differences were found between EPRC and TPRC in terms of operation time, estimated blood loss (EBL), hospital length of stay (LOS), or transfusion. A shorter exhaust time (standardized mean difference [SMD] - 0.59; 95 % confidence interval [CI] - 0.97 to 0.21; p = 0.002) and time to liquid intake (SMD, - 0.56; 95 % CI - 1.07 to 0.04; p = 0.03) were associated with EPRC. No clinically meaningful difference was observed in terms of postoperative infection, wound complications, postoperative genitourinary complications, late postoperative complications, early major complications, or late major complications. However, EPRC was related to lower incidences of early postoperative complications (odds ratio [OR], 0.66; 95 % CI 0.51-0.86; p = 0.002), gastrointestinal complications (OR 0.28; 95 % CI 0 0.17-0.46; p < 0.00001), and postoperative ileus (OR 0.38; 95 % CI 0.25-0.59; p < 0.0001). A higher incidence of postoperative lymphocele was associated with EPRC (OR 3.05; 95 % CI 1.13-8.25; p = 0.03). No clinically meaningful difference was found in terms of positive surgical margin (PSM), local recurrence, distant metastasis, or OS. Although EPRC had a higher incidence of lymphoceles than TPRC, it was found to have similar oncologic outcomes and fewer early complications, particularly in terms of postoperative gastrointestinal complications and ileus. These results suggest that EPRC is a safe option both functionally and oncologically.

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

IntroductionGastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0–1%, and 0.1–1.7%, respectively. The use of enhanced recovery or “fast-track” protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up.Materials and methodsThis is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications. ResultsThe cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%–0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding.ConclusionsThe risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Efficacy of daikenchuto after laparoscopic surgery for perforated appendicitis.

Although many recent studies have scientifically verified the efficacy of the traditional herbal medicine daikenchuto (DKT) for postoperative gastrointestinal function, its efficacy has not been established in children. We retrospectively evaluated the effect of DKT in pediatric patients with panperitonitis associated with perforated appendicitis (PaPA) who underwent laparoscopic appendectomy. Among 34 children with PaPA who underwent laparoscopic appendectomy from May 2012 to May 2021, 19 received DKT (group D) and 12 did not (group C). We compared postoperative gastrointestinal function, complications, and improvement in the inflammatory response between the two groups. Of the evaluation parameters for postoperative gastrointestinal function, the mean ± standard deviation time to first flatus was significantly shorter in group D than in group C (1.21 ± 0.42 and 2.17 ± 0.94 days respectively; p = 0.0005). The time to ingestion of half a meal was also significantly shorter in group D than in group C (8.42 ± 3.69 and 12.50 ± 4.96 meal occasions respectively; p = 0.01). There was no significant difference in complication rates between the two groups. Daikenchuto rapidly and safely improved postoperative gastrointestinal symptoms in children with PaPA. To the best of our knowledge, this is the first study to evaluate the effect of DKT on postoperative symptoms in laparoscopic appendectomy and in children.

The Effect of Preoperative Carbohydrate Intake on Length of Stay and Postoperative Recovery Following Laparoscopic Living Donor Nephrectomy

Enhanced Recovery After Surgery (ERAS) protocols are applied in many surgical procedures and often involve preoperative carbohydrate intake. Research surrounding the utility of ERAS in living donor nephrectomy is limited. The objective of this study was to identify whether living kidney donors who received preoperative oral carbohydrates experienced a difference in length of hospital stay (LOS), duration of time required to resume regular oral food and fluid intake, and incidence of gastrointestinal (GI) complications following laparoscopic nephrectomy compared to historical control donors who underwent preoperative fasting. This study was a retrospective analysis of data from adult subjects at one transplant center who underwent laparoscopic living donor nephrectomy. A total of 55 ERAS subjects who received preoperative carbohydrates and 93 historical control subjects who underwent preoperative fasting were included in the final analysis. The following variables were compared between groups: LOS, time to tolerating a regular oral diet postoperatively, time to meeting 50% of estimated fluid needs by oral intake postoperatively, and incidence of postoperative GI complications. No significant differences between the ERAS and historical control groups in age, weight, body mass index (BMI), sex distribution, or estimated fluid needs were identified. Both groups consisted of predominantly female subjects. ERAS subjects experienced a shorter LOS (2.8 days versus 3.9 days, P < .001), time to tolerating a regular oral diet (36.5 hours versus 68.2 hours, P < .001), and time to meeting 50% of estimated fluid needs (25.3 hours versus 44.6 hours, P < .001) after laparoscopic nephrectomy compared to historical control subjects. No significant difference between groups in the incidence of postoperative GI complications (nausea, vomiting, or ileus) was identified. Our findings demonstrate the advantages of ERAS in living kidney donors undergoing laparoscopic nephrectomy and support ERAS implementation within this patient population.

Association between use of ERAS protocols and complications after radical cystectomy.

Implementation of enhanced recovery protocols in cystectomy patients has significantly changed the perioperative course of this major operation. This paper summarizes evidence based interventions to enhance the postoperative course of radical cystectomy. A comprehensive search of PubMed and Embase databases was performed and also the results of our institutional enhanced recovery protocol were discussed. One of the major advantages of such changes is the reduced rate of postoperative gastrointestinal (GI) complications especially postoperative ileus which could be contributed to several components of these protocols. However, Alvimopan is the only component which its use is supported by level I evidence. Although there are some evidence suggesting the decreased rate of urinary tract infection with the use of prophylactic antibiotics and wound complications by the use of negative wound pressure devices, their clear benefit is yet to be shown. Although robotic approach has proven advantages in intraoperative blood loss and postoperative blood transfusion rate, surgical team's experience and dedicated infrastructure seem to be more influential in optimized outcome than just the surgical approach. current evidence suggests that such protocols have not only reached the goal of maintaining complication rate while decreasing length of hospital stay, but it might have caused a decrease in the rate of low-grade complications, especially GI complications.

Personalized Health Care Technology in Managing Postoperative Gastrointestinal Surgery Complications: Proof of Concept Study

Background: Advances in three-dimensional (3D) printing technology have allowed the development of customized medical devices. Endoscopic internal drainage (EID) is a novel method to facilitate drainage of an abscess cavity into the lumen of the gastrointestinal tract by placing a double pigtail biliary stent through the fistula opening, originally designed for biliary drainage. They are available in manufacture-determined sizes and shapes. The aim of this study is to explore the feasibility of 3D printing personalized internal drainage stents for the treatment of leaks following gastrointestinal surgery over a sequential period. Methods: We retrospectively identified patients who underwent gastrointestinal anastomotic surgery complicated by postoperative leaks and underwent serial EID for treatment. Computerized Tomography scans were reviewed over a period of time, abscess cavity dimensions and characterizations were evaluated, and 3D reconstructions were obtained. The stents were designed, their shape and size were customized to the unique dimensions of the abscess and lumen of the patient. Stereolithography (SLA) 3D printing technique was used to produce the stents. Results: A total of 8 stents were produced, representing 3 patients. These stents corresponded to 2 or 3 stents per patients. Each patient underwent several endoscopic treatments, before resolution of leak. Conclusions: Customized stents may improve drainage of intra-abdominal abscesses after gastrointestinal surgery, if based on unique anatomy. This proof-of-concept study is a real-world application of personalized health care, which introduces the novel description of customizable 3D printed stents to manage complications following gastrointestinal surgery and may advance therapy for this complex clinical condition. Research Ethics Committees (REC) number is A-2021-012.

Effects of chronic kidney disease on perioperative and 180-day complication rates after total shoulder arthroplasty

BackgroundChronic kidney disease (CKD) is associated with increased risk of complications in total hip arthroplasty and total knee arthroplasty. Despite this known association, there are little data regarding the effect of outcomes in patients undergoing total shoulder arthroplasty (TSA). The purpose of this study is to identify the effects of CKD on patient outcomes after TSA. MethodsThe National Readmissions Database was queried from 2010 to 2017 to identify all primary TSA patients (n = 62,455). CKD was identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes. Chi-squared analysis and multivariate regression were used to analyze differences in outcomes and the impact of CKD stage. ResultsCKD patients had higher rates of 180-day readmissions, 180-day mortality, acute renal failure (ARF), transfusions, urinary tract infections (UTI), acute respiratory distress syndrome (ARDS), pneumonia, and gastrointestinal (GI) complications. Stage 3 CKD (odds ratio [OR] = 1.378; P = .002), stage 4 CKD (OR = 1.805; P = .027), and unspecified CKD stage (OR = 1.787; P < .001) were at increased odds of 180-day readmission. Stage 4 CKD (OR = 10.647; P = .034) was associated with increased odds of 180-day mortality. Stage 2 CKD had increased odds of GI complications (OR = 8.365; P = .004). Both stage 3 CKD (OR = 1.463; P = .038) and stage 4 CKD (OR = 2.465; P = .033) had increased odds of UTI. Stage 5 CKD (OR = 36.143; P < .001) had increased odds of ARDS. Stage 2 CKD had increased odds of thrombosis (OR = 7.869; P = .007). Stage 2 (OR = 4.826; P < .001), stage 3 (OR = 5.724; P < .001), stage 4 (OR = 11.162; P < .001), stage 5 (OR = 31.328; P < .001), and unspecified CKD stage (OR = 4.801; P < .001) were associated with increased odds of ARF. Stage 2 CKD (OR = 12.809; P = .014), stage 3 (OR = 7.351; P = .001), and stage 4 (OR = 39.684; P < .001) were associated with increased odds of transfusions. ConclusionCKD is associated with increased risk of complications, including postoperative ARF, transfusions, UTI, ARDS, pneumonia, and GI complications. Patients with CKD also have increased 180-day readmission rates and 180-day mortality rates. Increasing stage of CKD is associated with increasing odds of 180-day readmission, postoperative ARF, and transfusions. Surgeons should consider these increased risks in the decision-making process during preoperative evaluation. These complications would likely increase cost, which raises the need for further evaluation and stratification of risk in patients who use bundled payment systems. Level of evidenceLevel III; Case-Control Study

P31. Preoperative predictors for postoperative gastrointestinal complications in pediatric neuromuscular scoliosis patients

<h3>BACKGROUND CONTEXT</h3> Neuromuscular scoliosis patients have a purportedly higher postoperative complication rate than those with adolescent idiopathic scoliosis. Of these, gastrointestinal (GI) issues are clinically well observed. However, there is limited data on the prevalence of postoperative GI complications, and the preoperative indicators that may predict them. <h3>PURPOSE</h3> The focus of this study is to determine the incidence and risk factors of gastrointestinal complications after neuromuscular scoliosis correction. <h3>STUDY DESIGN/SETTING</h3> Retrospective case review. <h3>PATIENT SAMPLE</h3> Inclusion criteria focused on pediatric scoliosis patients (<18 years of age) with a neuromuscular diagnosis undergoing index procedures. <h3>OUTCOME MEASURES</h3> Radiographic, clinical and hospital stay data was assessed. Patients were compared according to their postoperative gastrointestinal (GI) complication status. PO GI issues were described as either major or minor complications. Minor complications included continued nausea/vomiting, constipation, diarrhea and distention. Major complications included extended paralytic ileus, dysphagia, g-tube infections and gastroparesis based on literature and clinical experience. <h3>METHODS</h3> An IRB approved, retrospective case review of patient records from 2013 – 2019. Data was presented as median and interquartile values in order to avoid the effects of outsider values. Statistically, Fisher's Exact, Kruskal-Wallis and Chi-Squared tests were used. <h3>RESULTS</h3> We included a total of 69 patients, of which, 36 developed PO GI issues. Age and BMI values were similar for both groups of patients (p = 0.367, p = 0.371). Of the patients that developed PO GI complications, the overwhelming majority exhibited minor complications only (94.3%). PO GI patients had a significantly longer length of stay (9 vs 6 days, p = 0.004). While preoperative major Cobb angles were similar, patients that developed PO GI issues had a significantly higher preoperative pelvic obliquity (15.80 cm vs 7.55 cm, p = 0.040). Patients that developed PO GI issues were overwhelmingly classified with ASA scores of 3 or 4 (96.6%), were more likely to have a preoperative gastrostomy tube (p < 0.001), were significantly more likely to be fused to the pelvis (p = 0.009), had longer fusions (17 vs 15, p = 0.018) and had significantly more spastic presentations of their disease (p < 0.001). Both groups had similar preoperative albumin levels (p = 0.344), history of seizures (p = 0.132) and gastroesophageal reflux (p = 0.096). Patients with postoperative GI issues were significantly more likely to have a pre-existing GI such as aspiration, feeding issues and g-tube site complications (p = 0.023). <h3>CONCLUSIONS</h3> Spasticity, the presence of a pre-existing GI issue, presence of a g-tube, and notable pelvic tilt appear to be significant risk factors for postoperative gastrointestinal complications in neuromuscular scoliosis patient. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Bariatric surgery related proximal myopathy: A partially reversible complication

Deficiency neuropathies and rhabdomyolysis have previously been reported after bariatric surgery (BS) but never myopathies. We report cases of five patients with morbid obesity who developed within 2 to 4 months of a BS, proximal myopathy following significant and rapid weight loss worsened by postoperative gastrointestinal complications. Muscle weakness concerned lower limbs in particular in quadriceps and less frequently in upper limbs and diaphragm, sometimes mimicked a Guillain–Barré syndrome. Muscle biopsy performed in 1 patient, revealed selective atrophy of type 2 fibers. Weakness slowly decreased with refeeding with vitamins supplementation. We enlarge here the clinical pattern of post-BS complications.

Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes.

The purpose of this study was to investigate the incidence, predictors, and long-term impact of gastrointestinal (GI) complications following adult cardiac surgery. Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A subanalysis of propensity score-matched patients was also performed. A total of 10,285 patients were included, and the overall rate of GI complications was 2.4% (n = 246). Predictors of GI complications included dialysis dependency, intra-aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross-clamp times. Thirty-day (2.6% vs. 24.8%), 1- (6.3% vs. 41.9%), and 3-year (11.1% vs. 48.4%) mortality were substantially higher in patients who experienced GI complications (all p < .001). GI complication was associated with a threefold increased hazard for mortality (hazard ratio = 3.1, 95% confidence interval = 2.6-3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs. 2.5%), new dialysis dependency (31.3% vs. 1.5%), multisystem organ failure (21.5% vs.1.0%), and deep sternal wound infections (2.6% vs. 0.2%; all p < .001). These results persisted in propensity-matched analysis. GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appear warranted.

Is the gut safe? Rare postoperative gastrointestinal complications following cardiac surgery

Is the gut safe? Rare postoperative gastrointestinal complications following cardiac surgery

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis.

About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2days of hospital admission. Of 3246721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) (P-value <.01, respectively). Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

A Randomized Controlled Trial to Study the Effects of Loperamide on the Fluid and Electrolyte Balance in Patients Undergoing an Ileostomy

Ileostomy is an artificial opening in the ileum to divert intestinal contents outside the abdomen. The complications arising from an ileostomy are frequent and range from a mild inconvenience to life-threatening. One of the most troublesome complications is ileostomy diarrhoea, which affects the fluid and electrolyte balance. The aim of the study was to determine the effect of loperamide on stoma output and serum electrolytes in patients with newly formed ileostomy. This study was done as a double-blinded, randomized controlled method. The study included 42 patients who fulfilled the inclusion criteria. All of the patients underwent an ileostomy at the institute. In the post-operative period, patients were given either loperamide or placebo and monitored. The ileostomy output was recorded over every 24 h; renal functions and electrolyte levels were checked every 1, 3, 5, 7, 14 and 28th post-operative days. The concomitant use of antidiarrheals including codeine containing analgesics and anticholinergics was forbidden. There was significant decrease in the stoma output in patients who received loperamide as compared to placebo (p < 0.05). There was no statistical difference between the serum potassium, sodium and creatinine levels. The incidence of post-operative gastrointestinal complications was higher in the loperamide group but not statistically significant and these could be managed conservatively without any change in treatment protocol (47.6% vs 33.34%). The incidence of post-operative stomal complications was higher in the placebo group but with no statistical significance (23% vs 14.2%). Loperamide significantly reduced the stoma output and helped in fluid regulation of patients with a newly formed ileostomy. There was no statistical difference in the electrolyte levels in patients treated with oral loperamide and placebo. The dosage can be altered if gastrointestinal complications are encountered, although they usually are self-limiting and do not require a change in the treatment plan. Oral loperamide may be used in patients with a newly formed ileostomy in the early post-operative period.