Postoperative Infectious Complications Research Articles

Blood Transfusion is Associated With Adverse Outcomes in Pediatric Solid Tumor Oncology Patients Following Tumor Resection.

Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown. We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection. Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P =0.031). Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused. Level III.

Surgical site infection in reconstructive and aesthetic breast surgery: A single center retrospective analysis of the association between healthcare workers and infections

Reconstructive and aesthetic breast surgeries are frequently performed procedures, and the consequences of a postoperative infection are devastating both for the patient and the healthcare (HC) system. Over the years, there has been heightened interest in the physical and mental well-being of physicians and HC workers. Little is known about the relationship between HC workers and surgical site infections (SSI), and whether HC workers are at an increased risk for SSI. The aim of this study was to investigate whether women working in the HC system have an increased risk for SSI following reconstructive and aesthetic breast surgery. We conducted a retrospective analysis of all patients who underwent aesthetic and reconstructive breast surgery at our institution between the years 2013-2020. Women who were recognized as HC workers were analyzed in a separate group and compared to those who were not. Records of 378 patients were reviewed, of whom 53 (14%) were identified as HC workers. The overall infection rate was 17.4%. HC workers manifested a higher infection rate than the other group (32% vs. 15.1%, p<0.05) and a significantly higher relative risk for SSI (RR 2.12, p<0.01). Women working in the HC system may have an increased risk of developing postoperative infectious complications following aesthetic and reconstructive breast-related surgery. Further research is needed to corroborate these findings and elucidate the causes.

The Clinical Importance of Preoperative Rectal Swabs in Patients after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background: Surgical site infections are among the most common healthcare-associated infections, especially in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this retrospective study was to examine postoperative infectious complications according to preoperative screening findings of nasal and rectal swabs. Methods: Two hundred four consecutive patients received nasal and rectal swab examination for multidrug-resistant (MDR) bacteria within 30 days before the operation in patients where CRS and HIPEC were planned. Inclusion criteria were as follows: confirmed peritoneal metastases (histologically and/or cytologically); age under 85 years; adequate renal, liver, and bone marrow function; no sign of infection preoperatively; resectable disease; and CRS and HIPEC procedure. If surgical site infection occurred, the microbial spectrum of the site was assessed. One hundred twenty-one patients (63 female [52.1%] and 58 male [47.9%]) met the criteria and were further analyzed retrospectively. Statistical correlations between postoperative complications and risk factors were investigated by univariate and multivariate analysis. Results: Postoperative complications in total were observed in 57 patients (47.1%) with major complications (Clavien-Dindo grades 3–4) in 15 patients (12.4%) and infectious complications in 37 (30.6%) patients. The overall prevalence of nasal MRSA carriage was 3.28%, and the overall prevalence of rectal MDR bacteria carriage was 10.7%. In propensity score analysis, colonized patients compared to noncolonized patients showed increased total complications (CD1–5, p = 0.025), infectious complications (p = 0.028), surgical site infections (p = 0.022) as well as pneumonia (p = 0.016). Multivariate analysis showed that in addition to preoperative rectal colonization, American Society of Anesthesiologists score was a risk factor for postoperative complications. Conclusions: Preoperative 3-MRGN and vancomycin-resistant enterococcus colonization were associated with increased complications and surgical site infections. Special antimicrobial treatment pathways are necessary for these patients to reduce postoperative complications due to colonization.

Safety and Efficacy of Monopolar Cautery in Dissection of Mesoappendix in Laparoscopic Appendectomy in Western Nepal, a Multicentered Cross-Sectional Retrospective Study

Introduction: Different instruments are being used for appendiceal mesentery dissection in laparoscopic appendectomy. The effectiveness and versatility of monopolar cautery for the same makes it a commonly used option. This study aims to observe the safety and efficacy of monopolar cautery in laparoscopic appendectomy for the dissection of mesoappendix.&#x0D; Methods: 424 cases who underwent laparoscopic appendectomy from November 2018 to April 2020 using monopolar cautery for mesoappendix dissection were included in this multi-centered cross-sectional retrospective study. The operating time, intra and post-operative complications and length of hospital stay were evaluated. Measures of central tendency were performed for data analysis. &#x0D; Results: Acute appendicitis was the common indication (96.7%) for the laparoscopic surgery, with 99.1% success rate with a male to female ratio of 1.17:1 and mean age of 21.48+14.80 years. The median operating time and length of hospital stay were 30 mins (range: 15–130 mins) and 3 days (range: 1-15 days), respectively. Moderate intra-operative bleeding was noted in 0.5%. Post-operative complications of wound infection (3.4%) and prolonged ileus (1.7%) were noted.&#x0D; Conclusion: Use of monopolar cautery for dissection of mesoappendix in laparoscopic appendectomy is still safe and efficient even with the advent of newer and more expensive instruments in the present world.

The Prevalence and Outcome of Bile Spillage during Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) has a low risk for postoperative infective complications. The incidence of iatrogenic gall bladder perforation leading to spillage of bile and stones seems to be higher ranging between 5 and 40%. Studies have also shown an increased incidence of complications like surgical site infection (SSIs) after bile spillage. This study aims to assess the prevalence and outcome in bile spillage during LC. Methods: A cross-sectional study was conducted at KIST Medical College and Teaching Hospital. All the patients who underwent elective LC from February 2018 to March 2020 were studied. A total of 187 patients were enrolled. The required data was entered in the proforma by reviewing the patient’s medical records. The data was entered and analyzed using the SPSS version 26. Descriptive statistics and chi-square test were carried out. Results: The prevalence of bile spillage was 29.4%. The prevalence of SSIs among the bile spillage and non-bile spillage groups was 10.9% and 8.3% respectively. There was no significant association between SSIs and bile spillages (p value 0.584). There is no significant association post operative use of antibiotics and SSIs among patients with bile spillage (p value = 0.163). Conclusion: The prevalence of bile spillage during LC was higher when compared to other national and international studies. However, the rate of SSIs among bile spillage was lower. Bile spillage during LC doesn’t cause SSIs post-operatively and use of postoperative antibiotics among bile spillage patients doesn’t prevent SSI during elective LC thus use of antibiotics in such cases should be limited.

Impact of postoperative intra-abdominal infectious complications on survival outcomes in patients with gastric cancer who underwent laparoscopic surgery.

Postoperative intra-abdominal infection is known to adversely affect survival outcomes in patients with gastric cancer; however, previous reports have investigated this complication only in open surgery. This adverse effect is expected to be weakened by less invasive surgery, such as a laparoscopic approach, by way of maintaining immune function. This study included 1223 patients with gastric cancer who underwent open (n = 439) or laparoscopic (n = 784) curative surgery between 2010 and 2015. For each approach, patients were divided into two groups based on presence or absence of postoperative intra-abdominal infection of Clavien-Dindo grade II or higher (C-group and NC-group, respectively). Survival outcomes were compared in propensity-matched cohorts to evaluate the impact of the complication. The incidences of Clavien-Dindo ≥ grade II postoperative intra-abdominal infectious complications were 9.7% (43/439) in open surgery and 9.8% (70/714) in laparoscopic surgery. After propensity score matching, 86 patients in open surgery and 138 in laparoscopic surgery were extracted for analysis. The 5-year overall survival rate in the open C-group (n = 43) was worse than that in the open NC-group (n = 43) but with no significant difference (70.9% vs. 82.8%, log-rank P = 0.18). The 5-year overall survival rates were equivalent between the laparoscopic C-group (n = 69) and the laparoscopic NC-group (n = 69) (90.5% vs. 90.4%, log-rank P = 0.99). In general, postoperative intra-abdominal infection adversely affects survival outcomes; however, its impact may be weakened by less invasive surgery. Further evaluation using larger datasets is necessary before reaching definitive conclusions.

Effect of goal-directed haemodynamic therapy guided by non-invasive monitoring on perioperative complications in elderly hip fracture patients within an enhanced recovery pathway

BackgroundGoal-directed haemodynamic therapy (GDHT) has been shown to reduce morbidity and mortality in high-risk surgical patients. However, there is little evidence of its efficacy in patients undergoing hip fracture surgery. This study aims to evaluate the effect of GDHT guided by non-invasive haemodynamic monitoring on perioperative complications in patients undergoing hip fracture surgery.MethodsPatients > 64 years undergoing hip fracture surgery within an enhanced recovery pathway (ERP) were enrolled in this single-centre, non-randomized, intervention study with a historical control group and 12-month follow-up. Exclusion criteria were patients with pathological fractures, traffic-related fractures and refractures. Control group (CG) patients received standard care treatment. Intervention group (IG) patients received a GDHT protocol based on achieving an optimal stroke volume, in addition to a systolic blood pressure > 90 mmHg and an individualized cardiac index. No changes were made between groups in the ERP during the study period. Primary outcome was percentage of patients who developed intraoperative haemodynamic instability. Secondary outcomes were intraoperative arrhythmias, postoperative complications (cardiovascular, respiratory, infectious and renal complications), administered fluids, vasopressor requirements, perioperative transfusion, length of hospital stay, readmission and 1-year survival.ResultsIn total, 551 patients (CG=272; IG=279) were included. Intraoperative haemodynamic instability was lower in the IG (37.5% vs 28.0%; p=0.017). GDHT patients had fewer postoperative cardiovascular (18.8% vs 7.2%; p < 0.001), respiratory (15.1% vs 3.6%; p<0.001) and infectious complications (21% vs 3.9%; p<0.001) but not renal (12.1% vs 33.7%; p<0.001). IG patients had less vasopressor requirements (25.5% vs 39.7%; p<0.001) and received less fluids [2.600 ml (IQR 1700 to 2700) vs 850 ml (IQR 750 to 1050); p=0.001] than control group. Fewer patients required transfusion in GDHT group (73.5% vs 44.4%; p<0.001). For IG patients, median length of hospital stay was shorter [11 days (IQR 8 to 16) vs 8 days; (IQR 6 to 11) p < 0.001] and 1-year survival higher [73.4% (95%CI 67.7 to 78.3 vs 83.8% (95%CI 78.8 to 87.7) p<0.003].ConclusionsThe use of GDHT decreases intraoperative complications and postoperative cardiovascular, respiratory and infectious but not postoperative renal complications. This strategy was associated with a shorter hospital stay and increased 1-year survival.Trial registrationClinicalTrials.gov NCT02479321.

Impact of preoperative muscle mass and quality on surgical outcomes in patients undergoing major hepatectomy for perihilar cholangiocarcinoma.

This study sought to define the impact of skeletal muscle mass and quality on postoperative outcomes in patients with perihilar cholangiocarcinoma. Patients who underwent major hepatectomy for perihilar cholangiocarcinoma were included. The normalized total psoas area (TPA) (psoas muscle index [PMI]) and average Hounsfield units of the TPA (psoas muscle density [PMD]) were measured using preoperative computed tomography images. The cohort was dichotomized using the following indices: sex-specific lowest tertile (low PMI and low PMD) and other (normal PMI and normal PMD). Intraoperative and postoperative outcomes were compared, focusing on PMI and PMD. A total of 456 patients were analyzed. The intraoperative blood loss (IBL) was 21.3ml/kg in the low PMI group and 17.2ml/kg in the normal PMI group (P=.008). Patients in the low PMI or PMD group experienced postoperative infectious complications more frequently than those in the other groups. The median survival time was 37.8months in the low PMI group and 54.2months in the normal PMI group (P=.027). PMI and PMD were closely associated with IBL and postoperative infectious complications. Additionally, PMI impacted long-term survival. These results suggest an importance of improving muscle mass and quality before surgery.

O103 The relationship between routine pre-operative clinicopathological factors and post-operative infective complications in patients undergoing elective potentially curative colon cancer resection

Abstract Introduction Post-operative complications, in particular infective complications, following elective colon cancer resection remain common. The present cohort study was designed to determine the influence of routinely reported clinicopathological factors on post-operative infective complications in a large regional cohort undergoing potentially curative colon cancer. Methods Patients who underwent elective potentially curative colon cancer resection between January 2011 and December 2014 were assessed for post-operative complications. Clinicopathological data were recorded in a prospectively maintained database. A multivariate binary logistic regression model was used to identify independent risk factors for infective complications. Results A total of 1887 patients were included with 29% of patients developing post-operative infective complications (POI). Multivariate analysis showed that factors associated for both POI complications and surgical site infections (SSI) were higher body mass index (BMI) (POI OR 1.29, 95% CI 1.15–1.46, p&amp;lt;0.001 and SSI OR 1.4, 95% CI 1.23–1.60, p&amp;lt;0.001), diabetes (POI OR 1.45, 95% CI 1.06–1.99, p=0.022 and SSI OR 1.58, 95% 1.12–2.22, p=0.009) and open or laparoscopic converted to open surgical approach (POI OR 0.66, 95% CI 0.52–0.84, p=0.001 and SSI OR 0.70, 95% CI 0.53–0.93, p=0.012). While 30-day mortality was associated with older age, high ASA grade and pre-operative systematic inflammatory grade. Conclusion Elevated BMI and diabetes were independently associated with infective complications and surgical site infections. Therefore, the BMI and diabetes status should be routinely determined in patients undergoing elective surgery for colon cancer. Take-home message Body mass index and diabetes status should be actively determined prior to elective surgical intervention to allow for risk stratification and pre-operative optimisations.

A study of clinical utility of peri operative c- reactive protein testing in general surgery at tertiary care centre

Background and objectives Clinical diagnosis of infections, inflammatory diseases, and response monitoring can be done by C reactive protein (CRP), an acute-phase protein. CRP measurement in the perioperative period was studied, and patterns of change were analyzed, for elective general surgical patients. Study aimed to test the efficacy of C - reactive protein as a predictor for surgical stress and diagnostic accuracy to detect early postoperative infectious complications. Objective of this study was to estimate perioperative serum C - reactive protein level in patients undergoing elective surgeries. 1. To find out the relation between serum C-reactive protein level and severity of surgical stress. 2.To find out diagnostic accuracy of C-reactive protein to detect early postoperative infectious complications.

The Effectiveness of Preoperative Antibiotic Prophylaxis in Ulnar Nerve Release at the Cubital Tunnel.

Although the literature supports not using preoperative antibiotic prophylaxis for clean soft tissue procedures around the hand, there is limited data for soft tissue procedures around the elbow, such as cubital tunnel release. Complications of postoperative infection include scarring, stiffness, and rarely, amputation. The purpose of this study is to determine if preoperative antibiotic prophylaxis decreases the risk of surgical site infection for cubital tunnel release. A retrospective review of 919 in situ, subcutaneous transposition, and submuscular transposition cubital tunnel surgery at a tertiary care center was performed. Patient records were searched to determine preoperative antibiotic status and infection within 30 days of surgery. In addition, comorbidities and demographics such as age, race, sex, and past medical history were also identified. Comorbidities with qualitative variables were analyzed with odds ratio, Chi-squared, and Fisher's Exact test, linear variables analyzed with t-test. There were 5/296 (1.7%) infections in patients without preoperative antibiotics, and 17/623 (2.7%) infections in patients with preoperative antibiotics. Patients who had received preoperative antibiotics had no significant change in infection rate (95% odds ratio: 0.597-1.633). Other variables, such as age, body mass index, race, surgeon, insurance type, diabetes, depression, anxiety, arthritis, concurrent surgeries, and hyperlipidemia were also not significant for risk of infection. Preoperative antibiotics do not demonstrate benefit for patients undergoing uncomplicated ulnar nerve releases at the elbow. Preoperative antibiotics do not significantly decrease the risk for postoperative infections in patients, regardless of patient comorbidities.Type of Evidence: Level 4-retrospective study.

Modified Frailty Index Combined with a Prognostic Nutritional Index for Predicting Postoperative Complications of Hip Fracture Surgery in Elderly

Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI). Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model’s predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed. Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715–0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727–0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705–0.861; P<0.001). Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.

Effect of Perioperative Interleukin-6 and Tumor Necrosis Factor-α on Long-Term Outcomes in Locally Advanced Gastric Cancer: Results from the CLASS-01 Trial.

Background Little is known about the relation between perioperative inflammatory changes and long-term survival in cancer patients. The aim of the study was to assess the association of perioperative serum interleukin-6 (IL6) and tumor necrosis factor-α (TNFα) levels with the 5-year overall survival in locally advanced gastric cancer. Methods The 135 eligible patients in one center of Nanfang Hospital were retrieved from CLASS-01 trial (NCT01609309), an open-label, multicenter, randomized clinical noninferiority trial conducted at 14 centers in China. Serum IL6 and TNFα levels were tested before surgery, and on postoperative day (POD) 1, POD3, and POD5, respectively, referring to IL6_0, IL6_1, IL6_3, and IL6_5 and TNFα_0, TNFα_1, TNFα_3, and TNFα_5. Kaplan-Meier methods and COX models were used for survival analysis. Results High levels of IL6_0 (≥3.67 pg/mL) and TNFα_0 (≥14.8 pg/mL) presented worse disease-free survival (DFS) (P = 0.0057 for IL6_0 and P = 0.0014 for TNFα_0) and overall survival (OS) (P = 0.0021 for IL6_0 and P = 0.0019 for TNFα_0). Both high IL6_0 and high IL6_5 levels indicated worse prognosis than other combinations (P = 0.0045 for DFS and P = 0.0022 for OS). In multivariate analysis, both high IL6_0 and high IL6_5 levels were significantly associated with poor DFS (HR = 4.29, 95% CI: 1.42-12.95, P = 0.01) and OS (HR = 4.11, 95% CI: 1.35-12.49, P = 0.013) after adjustment of tumor stage and TNFα_0. Also, high IL6_5 level was identified as the independent-related factor for postoperative infectious complications (OR = 2.69, 95% CI: 1.03-7.01, P = 0.043). Conclusions Perioperative high serum IL6 and TNFα levels are negatively associated with 5-year survival outcomes in patients with locally advanced gastric cancer, indicating the potential survival benefits from perioperative anti-inflammatory treatment.

Post-Operative Outcomes in Patients Undergoing Abdominal Surgery for Crohn's Disease Treated with Pre-Operative Ustekinumab

Background: Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23 to treat Crohn's disease. Effects on surgical complications and outcomes are not well understood. Objectives: We aimed to assess the impact of pre-operative Ustekinumab on post-operative complications in patients with Crohn's disease undergoing abdominal surgery and compare to anti-tumor necrosis factor inhibitors (Anti-TNFs). Design: Systematic review and meta-analysis. Patient and Methods: We searched Medline (Ovid), The Cochrane Library (Wiley), EMBASE (Elsevier), Web of Science (Thomson Reuters), and Scopus (Elsevier), and CINAHL Plus with Full Text (Ebsco) for studies reporting rates of post-operative complications in Ustekinumab treated patients with Crohn's disease. Main Outcome Measure: Surgical site complications (SSI) and overall infectious complications between patients exposed to Ustekinumab pre-operatively in comparison to patients exposed to anti-TNFs pre-operatively. Sample Size: 6 studies including 650 patients. Results: Four out of six studies reported data for post-operative infectious complications between Ustekinumab and anti-TNFs. Among a total of 107 patients who received Ustekinumab and 543 patients who received anti-TNFs, there was no significant difference between the two groups in terms of total infectious complications (RR 1.30, 95% CI 00.54-3.12; P = 0.55). Three studies, including 102 patients in the Ustekinumab group and 481 patients in the anti-TNF alpha group, reported surgical site infections. No significant difference was observed between the two groups (RR 0.75, 95% CI 0.36-1.58; P=0.45). Conclusion: Pre-operative Ustekinumab use was not associated with reduced post-operative complication rates as compared to anti-TNFs in patients with Crohn's disease undergoing abdominal surgery, but there was substantial heterogeneity between trials. Limitations: Data heterogeneity, incomplete data from some of the studies. Conflict of Interest: None.

Does "no-touch" technique hysteroscopy increase the risk of infection?

Objective:Today, thanks to its many advantages, hysteroscopy with a vaginoscopic approach (no-touch) is increasingly being used more in outpatient diagnoses and treatments. However, there are concerns that the “no-touch” technique increases ascending genital tract infections since a speculum is not inserted, and disinfection of the cervix cannot achieve.Materials and Methods:Between 2011 and 2017, 302 patients who underwent office hysteroscopy with the vaginoscopic approach (group 1) and 254 patients who underwent hysteroscopy with the standard method under anesthesia in the operating room (group 2) were compared in terms of early complications (within two weeks postoperatively). The primary outcome was early postoperative infection, and the secondary outcome was other early complications, such as bleeding and rupture.Results:In this study, the success rate of hysteroscopy with the vaginoscopic approach was 96.4%. According to the visual analog scale scoring system, 88.7% of the patients described mild-to-moderate pain. When group 1 and 2 were compared in terms of postoperative infection (3% and 2.4%, respectively) and other early complication rates (0% and 0.8%, respectively), no statistically significant difference was found (p>0.05).Conclusion:Hysteroscopy with a vaginoscopic approach continues to be the gold standard method that is safe and well-tolerated by patients.

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery.

Aim: This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM).Methods: With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given.Results: An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications.Conclusion: Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.

123. The Impact of Oncoplastic Reduction on Initiation of Adjuvant Radiation and Need for Re-excision: A Database Evaluation

Purpose: Partial breast reconstruction with oncoplastic reduction can provide breast cancer patients with improved aesthetic outcomes following breast conservation therapy. This study evaluates the implications of simultaneous oncoplastic reduction with lumpectomy on complication rates, time to adjuvant radiation therapy, and rates of margin re-excision compared to lumpectomy alone. Methods: The Clinformatics® Data Mart Database is a national deidentified commercial claims data warehouse. From 2003-2020, adult female patients were queried with International Classification of Disease (ICD-9 and ICD-10) codes to identify patients with a breast cancer diagnosis. Among those, common procedural terminology (CPT) codes were used to identify those who underwent lumpectomy alone versus lumpectomy with oncoplastic reduction. Patient demographics, complications, adjuvant oncologic therapies, and need for re-excision were recorded. Patients who were not continuously enrolled for at least six months before and after the index procedure were excluded. Chi squared and multivariable regression tests were used for statistical analysis. Results: Of 53,165 patients meeting criteria (mean age 61.4 ± 11.6 years), 1,552 (2.9%) underwent oncoplastic reduction. Diagnoses of most non-surgical complications (seroma, wound dehiscence, postoperative infection, fat necrosis, tissue necrosis, and non-specified complications of surgical care) were significantly higher in the oncoplastic reduction group, as were rates of some complications requiring surgical intervention (hematoma, seroma, and tissue debridement). However, undergoing oncoplastic reduction did not have an impact on time to adjuvant radiation (p=0.187) and protected against positive margins requiring repeat lumpectomy or completion mastectomy (p less than 0.001). Conclusion: In patients undergoing breast conservation therapy, simultaneous oncoplastic reduction decreased occurrence of positive margins and did not impact time to adjuvant radiation therapy, despite increased rates of surgical and non-surgical complications.

Poor Pre-operative Nutritional Status Is a Risk Factor of Post-operative Infections in Patients With Gastrointestinal Cancer-A Multicenter Prospective Cohort Study.

ObjectiveThis study aimed to assess the prognostic value of the Nutritional Risk Score 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) for post-operative infections in patients with gastric cancer (GC) and colorectal cancer (CRC) who underwent curative surgery.MethodsThis prospective study included 1,493 GC patients and 879 CRC patients who underwent curative surgery at 18 hospitals in China between April 2017 and March 2020. The NRS2002 and PG-SGA were performed on the day of admission. The relationship between the nutritional status of patients before surgery and post-surgical incidence of infection was analyzed using univariate and multiple logistic regression analyses.ResultsAccording to NRS2002, the prevalence of nutritional risk was 51.1% in GC patients and 63.9% in CRC patients. According to the PG-SGA, 38.9% of GC patients and 54.2% of CRC patients had malnutrition. Approximately 4.4% of the GC patients and 9.9% of the CRC patients developed infectious complications after surgery. The univariate and multiple logistic regression analyses showed that the risk of infections was significantly higher in GC patients with a high nutritional risk score (NRS2002 ≥5) than in those with a low score (NRS2002 <3), and the PG-SGA score was identified as a predictor of post-operative infection complications of CRC.ConclusionThe pre-operative nutritional status of patients with GC or CRC has an impact on post-operative infection occurrence. NRS2002 ≥5 was a risk factor for post-operative infection in patients with GC, and the PG-SGA B/C was a predictor of infections in patients with CRC.

Perioperative optimization with nutritional supplements in patients undergoing gastrointestinal surgery for cancer: A randomized, placebo-controlled feasibility clinical trial

BackgroundPerioperative nutritional supplementation may improve outcomes. Trials have not investigated the role of combination strategy using different types of nutritional supplements. MethodsWe conducted a single-site randomized pilot trial, among gastrointestinal cancer patients undergoing surgery, comparing perioperative nutritional supplements versus placebo (1 placebo to each supplement), to determine feasibility of a larger trial. Intervention, administered in sequence, included: protein supplementation (preoperative day 30–6), protein supplementation rich in arginine and omega-6 (preoperative day 5–1, and postoperative day 1–5), and carbohydrate loading (surgery day). Primary outcome was enrollment. Secondary outcomes included participant compliance with study supplements (target ≥70% of total packets). We planned protocol modifications to improve enrollment and compliance. Postoperative complications were described. ResultsOver 18 months, 495 patients were screened, 144 were deemed eligible, and 71 consented to participate, resulting in an enrollment fraction of 71/144 (49%, 95% confidence interval: 41%–57%). ‘Too much burden’ was the most common reason for refusal to participate (34%). Participants’ median overall compliance with study packets was 80%. Protocol modifications (decreasing the interval from enrollment to surgery from 4 to 2 weeks and decreasing length of baseline assessment) did not impact enrollment or compliance. Postoperative complications were similar between control (18/31 [58%, 95% confidence interval: 4–74]), and intervention (22/34 [65%, 95% confidence interval: 48–79]) arms, with a higher proportion of infectious complications in the control arm (16/31, 52% vs 12/34, 35%). ConclusionResults from this pilot suggest a larger phase III trial is feasible. Postoperative infectious complications were common, making this a suitable outcome of interest.

Early mortality and complications following first-time catheter ablation of atrial fibrillation in a nationwide cohort

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most common clinical arrhythmia. Pulmonary vein isolation (PVI) by catheter ablation has become a cornerstone in the treatment of AF. Serious complications to PVI have been reported to be at an acceptable level and risk of death after AF ablation is low. Purpose In a contemporary nationwide cohort of patients undergoing first-time PVI by catheter ablation, we wanted to investigate the 30-day mortality after ablation, and to examine risk and potential risk factors of PVI-related complications. Methods Population-based cohort study in patients who underwent first-time PVI by catheter ablation between 2011-2018 identified from the National Danish Ablation Registry. Primary outcome was early post-procedural mortality, defined as death of any cause within 30 days of index PVI procedure, or in connection to a hospitalization started within 30 days. Secondary outcomes were all-cause rehospitalization and complication, including postoperative infection, cardiac, vascular, neurological, vascular, and pulmonary complications within 30 days. Data on mortality and complications were collected from national health and administrative registries. Binary regression was used to estimate risk ratio (RR) with 95% confidence intervals (CI) for association between selected predictors and any complication, and adjusted gender, age, BMI, prior ablation, calendar period (ablation from 2011-2013, 2014-2016, and &amp;gt;2016). Results We included 8560 patients. Median age was 62, 66% were men, 12% had a history of heart failure, and median CHA2DS2VASc score was 1 (Interquartile range [IQR]; 1-2). Charlton Comorbidity index (CCI) was none in 66%, moderate in 29% and severe in 5%. A total of 10 (0.12%) patients died within 30 days of ablation, of which 4 patients died during initial hospitalization. Median time to death was 20 (IQR, 12 to 29) days. Patients who died were more likely to have experienced a procedure-related complication (40% vs. 4%, P&amp;lt;0.001). Procedure-related complications occurred in 298 (3.5%), and the risk was 4.4%, 3.0% and 3.3% in the time periods between 2011-2013, 2014-2016 and &amp;gt;2016, respectively. Most common complications were postoperative infection (26%), cardiac complication (26%), and vascular complications (18%). Complication risk was increased in patients with higher age (aRR, 65-74 year; 1.67 [1.32-2.11] and &amp;gt;74 years; 2.48 [1.60-3.84]), moderate CCI (aRR 1.45 [1.14-1.83]), cardiovascular disease (aRR 1.52 [1.09-2.11]) and antithrombotic treatment (aRR 1.41 [1.05-1.89]). After first-time PVI, 1.963 (23%) patients were re-hospitalized within 30 days, and most common primary discharge diagnoses were AF (87%) and direct cardioversion was performed in 765 (39%) patients. Conclusion In a nationwide cohort of patients who underwent first-time PVI, number of deaths within 30 days of ablation was low (0.12%). Risk of complication was low and 23% of the patients were re-hospitalized within 30 days.