Postoperative Infectious Complications Research Articles

Advantages of the Left-handed Ultrasonic Shears Technique for Robotic Gastrectomy.

The aim of this study was to investigate advantages of the left-handed ultrasonic shears technique in robotic gastrectomy for gastric cancer. We retrospectively analyzed 67 consecutive gastric cancer patients who underwent robotic gastrectomy. Fifty-six patients underwent gastrectomy with the left-handed ultrasonic shears technique (the left hand group), and 11 patients underwent surgery with the conventional approach (the conventional group). Intraoperative and postoperative outcomes were compared between the 2 groups. Operative blood loss, morbidity, and mortality were similar between the 2 groups. We observed a trend toward a shorter operation time and higher number of retrieved lymph nodes in the left hand group compared with the conventional group. Console time (docking-gastrectomy) in the left hand group was significantly shorter than in the conventional group (192.20 vs. 218.36 min, P<0.05). In robotic distal gastrectomy, both operation time and console time in the left hand group were significantly shorter than in the conventional group (276.10 vs. 354.80 min, 176.43 vs. 209.20 min, P<0.05 for both). The postoperative intra-abdominal infectious complication (Clavien Dindo≥1) rate in the left hand group was significantly lower than that in the conventional group (0% vs. 20%, P<0.05). Use of the left-handed ultrasonic shears technique is safe and provides a technically superior operative environment with satisfactory postoperative results.

Impact of chest subcutaneous fat on the occurrence of central venous port-related infectious complications in cancer patients

PurposeThere is no concrete evidence to support the association between the amount of subcutaneous fat area (SFA) in the central venous port-insertion site (precordium) and port-related complications. We aimed to investigate the relationship between SFA in the midclavicular line and postoperative infectious complications in patients undergoing port-insertion surgery.MethodsThis was a single-institute and historical cohort study of 174 patients who underwent first central venous port implantation surgery for chemotherapy between January 2014 and December 2018. SFA in the midclavicular line was measured using preoperative computed tomography scans. The patients were divided into three groups according to SFA amount tertiles, and we investigated the association of SFA with infectious and all-cause complication events within 1 year.ResultsWithin a median follow-up of 306 days, the patients with intermediate SFA had significantly higher infection-free survival than those with low and high SFA (low vs. intermediate vs. high: 80.4% vs. 97.7% vs. 83.4%, respectively, p=0.034). In contrast, there was no significant difference in the overall complication-free survival among the groups (low vs. intermediate vs. high: 80.4% vs. 88.9% vs. 81.8%, respectively, p=0.29). Low SFA was independently associated with high risk of infectious complications (hazard ratio, 9.45; 95% confidence interval, 1.07–83.22, p=0.043).ConclusionLow SFA in the midclavicular line was an independent risk factor for infectious complications in the chemotherapy setting. This practical indicator can be useful for optimizing patients’ nutritional status and when considering other types of vascular access to support administration of intravenous chemotherapy.

Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016

BackgroundLack of consensus remains about factors that may be associated with high resource use (HRU) in adult cardiac surgical patients. This study aimed to identify patient-related, hospital, and perioperative characteristics associated with HRU admissions involving elective cardiac operations. MethodsData from the National Inpatient Sample was used to identify patients who underwent coronary artery bypass graft, valve replacement, and valve repair operations between 2005 and 2016. Admissions with HRU were defined as those in the highest decile for total hospital costs. Multivariable regressions were used to identify factors associated with HRU. ResultsAn estimated 1,750,253 hospitalizations coded for elective cardiac operations. The median hospitalization cost was $34,700 (interquartile range, $26,800– to $47,100), with the HRU (N = 175,025) cutoff at $66,029. Although HRU patients comprised 10% of admissions, they accounted for 25% of cumulative costs. On multivariable regression, patient-related characteristics predictive of HRU included female sex, older age, higher comorbidity burden, non-White race, and highest income quartile. Hospital factors associated with HRU were low-volume hospitals for both coronary artery bypass graft and valvular operations. Among postoperative outcomes, mortality, infectious complications, extracorporeal membrane oxygenation use, and hospitalization for more than 8 days were associated with greater odds of HRU. ConclusionsIn this nationwide study of elective cardiac surgical patients, several important patient-related and hospital factors, including patients’ race, comorbidities, postoperative infectious complications, and low hospital operative volume were identified as predictors of HRU. These highly predictive factors may be used for benchmarking purposes and improvement in surgical planning.

A High Postoperative Serum C-reactive Protein Level Has a Negative Impact on Long-term Survival, Regardless of Postoperative Infectious Complications, in Patients Who Undergo Laparoscopic Surgery for Colorectal Cancer.

We previously showed that an elevated postoperative serum C-reactive protein (CRP) level has a negative impact on long-term survival outcomes, regardless of the occurrence of infectious complications in colorectal cancer. However, the cause of postoperative inflammation could not be properly evaluated, because patient background factors, such as the surgical approach (open/laparoscopic), were not unified. A total of 277 patients who underwent laparoscopic surgery for stage II/III colorectal cancer were enrolled. The high-CRP group had lower relapse-free and overall survival rates in comparison to the low-CRP group. A high postoperative serum CRP level was significantly associated with a larger tumor diameter and longer operation time, and tended to be associated with a higher T stage and larger amount of bleeding. Larger tumor volume, longer operation time and larger amount of bleeding were associated with the promotion of postoperative inflammation, which worsened long-term survival outcomes in colorectal cancer.

Clinical Comparison of Mini-Percutaneous Nephrolithotomy with Vacuum Cleaner Effect or with a Vacuum-Assisted Access Sheath: A Single-Center Experience

Purpose: To compare outcomes of two different miniaturized percutaneous nephrolithotomy (PCNL) techniques: minimally invasive PCNL (MIP) with the vacuum cleaner effect and vacuum-assisted mini-PCNL (vmPCNL). Materials and Methods: Data from 104 (66.7%) patients who underwent vmPCNL and 52 (33.3%) patients who underwent MIP at a single tertiary referral academic center between January 2016 and December 2019 were analyzed. Patient demographics and peri- and postoperative data were recorded, and propensity score matching was performed. Descriptive statistics and linear regression models were used to identify variables associated with operative time (OT) and patient effective dose. Logistic regression analyses were used to identify factors associated with infectious complications and stone-free (SF) status. Results: Patient demographics and stone characteristics were comparable between groups. vmPCNL was associated with shorter OT (p < 0.001), fluoroscopy time, and patient effective dose (4.2 mSv vs 7.9 mSv; p < 0.001). A higher rate of infectious complications was found in the MIP group (25.0% vs 7.7%, p < 0.01). Linear regression analysis showed that stone volume, multiple stones, and MIP procedure (all p values ≤0.02) were associated with longer OT. Similarly, OT and the MIP procedure (p ≤ 0.02) were associated with higher patient effective dose. Logistic regression analysis revealed that the stone volume, positive preoperative bladder urine culture, and MIP procedure (all p values ≤0.02) were associated with postoperative infectious complications. vmPCNL was not associated with the SF rate. Conclusions: Mini-PCNL performed with continuous active suction is associated with lower rates of infectious complications, shorter OT, and lower patient effective dose than MIP.

Does speed matter? A look at NSQIP-P outcomes based on operative time

BackgroundAppendicitis is a common pediatric surgical condition, comprising a large burden of healthcare costs. We aimed to determine if prolonged operative times were associated with increased 30-day complication rates when adjusting for pre-operative risk factors. MethodsPatients <18 years old, diagnosed intraoperatively with acute uncomplicated appendicitis and undergoing laparoscopic appendectomy were identified from the NSQIP-P 2012–2018 databases. The primary outcome, “infectious post-operative complications”, is a composite of sepsis, deep incisional surgical site infections, wound disruptions, superficial, and organ space infections within 30-days of the operation. Secondary outcomes included return to the operating room and unplanned readmissions within 30 days. Logistic regression models were used to assess associations between operative time and each outcome. A Receiver Operating Characteristic (ROC) curve was generated from the predicted probabilities of the multivariate model for infectious post-operative complications to examine operative times. ResultsBetween 2012 and 2018, 27,763 pediatric patients with acute uncomplicated appendicitis underwent a laparoscopic appendectomy. Over half the population was male (61%) with a median operative time of 39 min (IQR 29–52 min). Infectious post-operative complication rate was 2.8% overall and was highest (8%) among patients with operative time ≥ 90 min (Fig. 1). Unplanned readmission occurred in 2.9% of patients, with 0.7% returning to the operating room. Each 30-min increase in operating time was associated with a 24% increase in odds of an infectious post-operative complication (OR=1.24, 95% CI=1.17–1.31) in adjusted models. Operative time thresholds predicted with ROC analysis were most meaningful in younger patients with higher ASA class and pre-operative SIRS/Sepsis/Septic shock. Longer operative times were also associated with higher odds of unplanned readmission (OR=1.11, 95% CI=1.05–1.18) and return to the operating room (OR=1.13, 95% CI=1.02–1.24) in adjusted models. ConclusionThere is a risk-adjusted association between prolonged operative time and the occurrence of infectious post-operative complications. Infectious postoperative complications increase healthcare spending and are currently an area of focus in healthcare value models. Future studies should focus on addressing laparoscopic appendectomy operative times longer than 60 min, with steps such as continuation of antibiotics, shifting roles between attending and resident surgeons, and simulation training. Level of EvidenceLevel III, retrospective comparative study

Infection Risk Stratification in Pancreatic Surgery: Look to the Blood

Some years ago, while on weekend rounds when I was covering our hepato-pancreato-biliary (HPB) service, an enterprising medical student asked why every post-pancreatectomy patient seemed to be on a different perioperative antibiotic regimen. We had likely seen about 10 patients at various postoperative stages with similar recovery trajectories, yet they had been managed very differently with respect to pre-, peri-, and postoperative antibiotic use (not to mention the use of drains… a whole different story!). Although many factors are associated with postoperative infectious complications in pancreatic surgery, 1 Williams G.A. Liu J. Chapman W.C. et al. Length of stay, an outcome measure of postoperative and readmission length of stays in pancreatoduodenectomy. J Gastrointest Surg. 2020; 24: 2062-2069 Crossref Scopus (4) Google Scholar there is a lack of universally accepted preoperative factors that predict infections robustly enough to risk-stratify, guide, and alter guidelines. 2 Petit M. Geri G. Salomon E. et al. Risk factors for surgical site infection after pancreatic surgery. A better postoperative antibiotic strategy is possible. J Hosp Infect. 2020 Sept 24; ([Online ahead of print]) Google Scholar ,3 Elliott I.A. Chan C. Russell T.A. et al. Distinction of risk factors for superficial vs organ-space surgical site infections after pancreatic surgery. JAMA Surg. 2017; 152: 1023-1029 Crossref PubMed Scopus (21) Google Scholar Clearly, the lack of data in this space leads to widespread differences in practice patterns. Impact of Preoperative Occult-Bacterial Translocation on Surgical Site Infection in Patients Undergoing PancreatoduodenectomyJournal of the American College of SurgeonsVol. 232Issue 3PreviewOccult-bacterial translocation (O-BT) has been reported as the condition in which microorganisms are detected in blood or lymph nodes by a highly sensitive method. However, the clinical impact of preoperative O-BT on postoperative complication is unclear. Full-Text PDF

Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database

BackgroundSmoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer. MethodsA total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates. ResultsPostoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers. ConclusionsThe risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.

Simultaneous bilateral or sequential DCR? What to choose?

Dacryocystorhinostomy is used to treat nasolacrimal duct obstruction when conservative measures fail. It may be performed via an external or endoscopic-endonasal approach. The aim of this study was to compare the outcomes of patients with nasolacrimal duct obstruction treated with simultaneous bilateral or unilateral dacryocystorhinostomy. The database of a tertiary medical center was retrospectively reviewed for all patients treated for nasolacrimal duct obstruction in 2012-2017. The study sample was divided into six groups by surgery type and approach: adults (>18 years) - external or endoscopic-endonasal sequential unilateral or simultaneous bilateral dacryocystorhinostomy (four subgroups); children (18 years) - endoscopic-endonasal unilateral or simultaneous bilateral dacryocystorhinostomy (two subgroups). Data were collected on patient age and sex, surgery and anesthesia type and duration, and complications. The cohort included 95 adults and 27 children who underwent 111 and 41 surgical procedures, respectively. Among the adults, the durations of anesthesia and surgery were significantly longer in the external bilateral dacryocystorhinostomy group than the others, but no such differences were found between simultaneous bilateral endonasal dacryocystorhinostomy and unilateral dacryocystorhinostomy by either approach. Among the children, there was no significant between-group difference in surgery duration.In neither age population was bilateral endoscopic surgery associated with an excess of intraoperative or postoperative complications of hemorrhage, infection, and epiphora. The lack of intergroup differences in clinical, surgical, and outcome parameters suggests that in cases of bilateral nasolacrimal duct obstruction in adults and children, simultaneous bilateral endoscopic-endonasal dacryocystorhinostomy may yield excellent therapeutic results.

Postoperative serum procalcitonin versus C-reactive protein as a marker of postoperative infectious complications in pancreatic surgery: a meta-analysis.

Aim of this meta-analysis was to compare diagnostic accuracy C-reactive protein and procalcitonin between postoperative days 3 and 5 to predict infectious complications post pancreatic surgery. A systemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of procalcitonin and C-reactive protein to predict infectious complications between postoperative days 3 and 5 following pancreatic surgery. A meta-analysis was performed using random-effect model and pooled predictive parameters. Fifteen studies consisting of 2212 patients were included in the final meta-analysis. Pooled sensitivity, specificity, area under curve and diagnostic odds ratio (DOR) for day 3 C-reactive protein were 62%, 67%, 0.772 and 6.54, respectively. Pooled sensitivity, specificity, area under curve and DOR for day 3 procalcitonin were 74%, 79%, 0.8453 and 11.03, respectively. Sensitivity, specificity, area under the curve and DOR for day 4 C-reactive protein were 60%, 68%, 0.8022 and 11.90, respectively. Sensitivity, specificity and DOR of postoperative day 5 procalcitonin level for predicting infectious complications were 83%, 70% and 12.9, respectively. Pooled sensitivity, specificity, Area Under Receiver Operating Curve and DOR were 50%, 70%, 0.777 and 10.19, respectively. Postoperative procalcitonin is a better marker to predict postoperative infectious complications after pancreatic surgeries.

Intraoperative bile culture helps choosing antibiotics in pancreaticoduodenectomy: Mechanistic profiling study of complex rink between bacterobilia and postoperative complications.

Postoperative complications after pancreaticoduodenectomy (PD) is still a major concern. The aim of this study was to propose how to choose antibiotics, based on bacterial sensitivity profiling involved in postoperative complications after PD. Two hundred and thirty patients underwent PD between 2008 and 2018 at Kumamoto University Hospital. We enrolled 121 patients who had both intraoperative bile culture and drain culture on postoperative day (POD) 3. The clinical impact of the bacterial profile on postoperative outcome was retrospectively analyzed. Multivariate regression analysis revealed that intraperitoneal contamination on POD3 was independently associated with postoperative complications (odds ratio 2.62, P=.02). The bacteria in intraperitoneal drain on POD3 showed 94.9% similarity with those in bile collected during surgery. The major species were Enterococcus (44.6%) and Enterobacter (38.5%). Enterobacter species caused a higher rate of postoperative complications than others (83% vs 54%, P=.04). Three out of five Enterococcus faecium were resistant to carbapenems that were active against all Gram-negative rods. Intraperitoneal contamination on POD3, which had similar bacterial species as bile collected during surgery, was correlated with postoperative complications. The bacterial antibiotic sensitivity profile may help selecting optimal antibiotics against infectious postoperative complications in PD.

Factors Associated With Morbidity Following Total Pancreatectomy and Islet Autotransplantation: A NSQIP Analysis

BackgroundTotal pancreatectomy with islet autotransplantation is a therapeutic surgical option for patients with chronic pancreatitis leading to significant reduction in pain, improvement in quality of life, and potential for preservation of partial to full endocrine function. Data on the factors associated with short-term morbidities are limited. MethodsWe queried the American College of Surgeons National Surgery Quality Improvement Project for patients undergoing total pancreatectomy with islet autotransplantation from 2005 to 2015. We determined 30-day morbidity and mortality and performed univariate and multivariate analysis to determine the preoperative and intraoperative factors associated with development of postoperative infectious complications. ResultsThe rate of 30-day postoperative morbidity in 384 patients undergoing total pancreatectomy with islet autotransplantation was 36% with an overall mortality of 1%. Postoperative infectious complications developed in 29% of patients and were associated with increased operative time (P = .016),and higher postoperative wound class (P = .045). After risk adjustment, only increased operative time was independently associated with increased rates of infectious complications (OR=1.1, 95% CI = 1.01-1.13, P = .02). ConclusionsTotal operative time is independently associated with increased postoperative infectious complications in total pancreatectomy with islet autotransplantation. Future interventions aimed at optimizing islet isolation, surgical approach, and refinement of patient selection criteria present opportunities for reducing operative time and potentially reducing the morbidity of this surgical procedure.

BIOLOGICS BEFORE SURGERY FOR IBD: ARE THEY ASSOCIATED WITH POST-OPERATIVE INFECTIOUS COMPLICATIONS? RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM INFLAMMATORY BOWEL DISEASE COLLABORATIVE IN >1500 PATIENTS

We aimed to utilize the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative, which includes disease-specific variables, to assess the association between preoperative biologic exposure and post-operative infectious complications in the largest cohort reported to date.

Systematic Review and Meta-Analysis: Preoperative Vedolizumab and Postoperative Complications in Patients with IBD.

The effect of vedolizumab on postoperative outcomes in patients with inflammatory bowel disease (IBD) remains unclear. We aimed to determine the relation between preoperative vedolizumab and early postoperative complications in patients with IBD undergoing abdominal surgery. A search of databases and abstracts from gastroenterology conferences was performed. Primary outcomes included overall and infectious postoperative complication rates as well as surgical site infections. Studies that compared Crohn disease, ulcerative colitis, or patients with IBD-undefined with preoperative vedolizumab treatment undergoing abdominal surgery with controls with preoperative antitumor necrosis factor-α (anti-TNF-α) treatment or no preoperative biologic treatment were included. A meta-analysis was completed using the Mantel-Haenszel and DerSimonian and Laird models. Six studies totaling 1201 patients were included; 281 patients were treated preoperatively with vedolizumab, 327 patients were treated preoperatively with anti-TNF-α agents, and 593 patients were not treated preoperatively with any biologics. There was no significant difference in overall complications (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.48-2.24, P = 0.92, I2 =77%) between the vedolizumab and no-biologic groups. There also was no significant difference in infectious complications (OR 1.00, 95% CI 0.37-2.69, P = 1.00, I2 = 78%), which persisted after sensitivity analysis (OR 0.71, 95% CI 0.31-1.60, P = 0.41, I2 = 46%). Furthermore, there was no significant difference in overall complications (OR 0.77, 95% CI 0.24-2.46, P = 0.66, I2 = 85%) and infectious complications (OR 0.89, 95% CI 0.20-3.94, P = 0.87, I2 = 86%) between the vedolizumab and anti-TNF-α groups. After sensitivity analysis, differences in overall and infectious complications remained insignificant (OR 0.54 and 0.50, 95% CI 0.24-1.17 and 0.22-1.15, P = 0.12 and 0.10, I2 = 39% and 18%, respectively). Vedolizumab was also not associated with a significant increase in surgical site infections compared with the no-biologic (OR 1.45, 95% CI 0.33-6.32, P = 0.62, I2 = 75%) and anti-TNF (OR 1.30, 95% CI 0.22-7.60, P = 0.77, I2 = 81%) groups. Preoperative treatment with vedolizumab in patients with IBD undergoing abdominal surgery is not associated with increases in overall or infectious postoperative complications compared with preoperative anti-TNF-α treatment and no preoperative biologic treatment. Large, prospective studies are needed to further assess the impact of preoperative vedolizumab treatment on postoperative complications, particularly with respect to IBD subtype.

Efficacy of unilateral hemilaminectomy for intraspinal tumor resection: a systematic review and meta-analysis

To evaluate, via a meta-analysis, the clinical effect of unilateral hemilaminectomy for intraspinal tumor removal. PubMed, Springer, Wanfang Data, CBM, CNKI, and other databases were searched for relevant randomized controlled trials (RCT), in Chinese and other languages, that involved comparisons of unilateral hemilaminectomy with other techniques for intraspinal tumor removal. Thirteen RCTs were finally included, with a total of 1,424 patients. Unilateral hemilaminectomy for intraspinal tumor removal was found to reduce the amount of intraoperative hemorrhage (Z =45.67, P<0.00001), operative time (Z =55.35, P<0.00001), length of hospital stay (Z =111.67, P<0.00001), and inbed time (Z =142.08, P<0.00001) of patients. Compared with the traditional operative methods, unilateral hemilaminectomy for intraspinal tumor removal can improve the cure rate of patients [odds ratio (OR) =3.84; 95% confidence interval (CI), 2.1-7.01; Z =4.38; P<0.001) and reduce the incidence of spinal deformities (OR =0.11; 95% CI, 0.04-0.34; Z =3.83; P=0.001). It does not increase the risks of postoperative cerebrospinal fluid leak (OR =0.63; 95% CI, 0.21-1.88; Z =0.82; P=0.41), postoperative infection (OR =0.74; 95% CI, 0.31-1.77; Z =0.67; P=0.50), pain (OR =0.29; 95% CI, 0.07-1.18; Z =1.73; P=0.08), myasthenia (OR =-0.04; 95% CI, -0.07 to 0.01; Z =2.29; P=0.02), and other complications. Unilateral hemilaminectomy for the microsurgical removal of intraspinal tumors has the advantages of minimal operative trauma, fast recovery, and better postoperative stability of the vertebral column.

The effect of peroperative erythrocyte transfusion on infectious complications in patients with gastric cancer undergoing curative gastrectomy

Background: In this study, the effect of perioperative blood transfusion on infectious complications in patients undergoing curative surgery for gastric adenocarcinoma was investigated.Methods: The clinicopathological results of 312 patients who underwent curative gastrectomy were retrospectively analyzed. The effect of blood transfusion on the development of postoperative infectious complications were statistically analyzed.Results: In the subgroup of patients with intraoperative transfusion, surgical site infection incidence was found to be significantly higher in patient with 2U above ES transfusions. (p=0.014). In the subgroup of patients with postoperative transfusion, hospital stay (p&lt;0.001), postoperative CRP values (p&lt;0.001), surgical site infection incidence (p=0.049) and anastomosis leakage incidence (p&lt;0.001) were found to be significantly higher in patient with 2U above ES transfusions. In the subgroup of patients with both intraoperative and postoperative transfusion, SSI, anastomotic leakage and any infective complication incidences were found to be significantly higher in patients with 2U and above transfusions. In multivariate analysis, age (p=0.015), BMI (p=0.011), intraoperative transfusion (p=0.011) and both intraoperative and postoperative transfusion (p=0.045) were found to be independent risk factors for infective complications.Conclusions: It was found that performing peroperative ES transfusion is associated with increased rates of infectious complications in patients undergoing curative gastrectomy for gastric cancer by causing immunomodulation.

BIOLOGICS BEFORE SURGERY FOR IBD: ARE THEY ASSOCIATED WITH POST-OPERATIVE INFECTIOUS COMPLICATIONS? RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM INFLAMMATORY BOWEL DISEASE COLLABORATIVE IN &amp;gt;1500 PATIENTS

Abstract Background We aimed to utilize the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative, which includes disease-specific variables, to assess the association between preoperative biologic exposure and post-operative infectious complications in the largest cohort reported to date. Methods Data was obtained from ten IBD centers from 2017 - 2018. Univariate and multivariate analyses were performed, with any biologic use within 60-days of surgery as the primary predictor, adjusting for diagnosis, chronic steroid use, immunomodulator (IMM) use, ostomy construction, anemia, malnutrition, operative length, emergency surgery, and other variables with p&amp;lt;0.05 from the univariate analysis. The primary endpoint was any (composite) infectious complication, and the secondary endpoint was any (composite) surgical site infection. Results A total of 1,562 patients were included, of which 832 (53%) were not exposed to biologics, and 730 (47%) were exposed to biologics before surgery. The biologics group had more preoperative weight loss, lower albumin, more systemic sepsis, more IMM and steroid use, and more had Crohn’s disease (all p&amp;lt;0.001). The biologics group were also more likely to receive a new ostomy and to have a colectomy (vs. proctectomy or small bowel procedure), and fewer had elective surgery (all p&amp;lt;0.001). On univariate analysis (Table 1), compared with no biologic exposure, biologic exposure was not associated with any infectious complications, any surgical site infections, anastomotic leak after colectomy, or other post-operative outcomes, but was associated with increased rate of anastomotic leak after proctectomy (n=423), 6.7% vs. 1.9%, p=0.02. With respect to the primary and secondary outcomes, the results of the multivariate analyses are shown in Table 2. Biologics were shown not to be associated with any infectious complication (OR 0.88, 95%CI 0.54 – 1.42) or any surgical site infection (OR 0.77, 95% CI 0.46 – 1.28), while Crohn’s disease was associated with any infectious complications (OR 2.11 95% CI 1.12 – 4, p=0.02). Conclusions In the largest nationally representative retrospective cohort to date, we found that biologics exposure within 60-days of surgery for IBD, using well-validated methodology and after vigorous adjustment for disease- and surgery-specific covariates, was not associated with post-operative infectious or surgical site infectious complications.

Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-2N0-2 gastric cancer patients: Japan Clinical Oncology Group study JCOG1907 (MONA LISA study).

TPS254 Background: Postoperative complications reportedly affect oncological outcomes in various cancers according to the timing of adjuvant chemotherapy and by influencing the immune function. Particularly, postoperative intra-abdominal infectious complications, including intra-abdominal abscess, pancreatic fistula, and anastomotic leakage, have been identified as prognostic factors for gastric cancer. Given the negative impact of such complications on patient survival, considering the short- and long-term outcomes, it is important to develop surgical procedures with fewer complications. In Japan, laparoscopic gastrectomy is a standard treatment modality for early gastric cancer. Randomized controlled trials have shown that laparoscopic gastrectomy is relatively less invasive and has similar postoperative complications and non-inferior patient survival rates when compared with open gastrectomy. However, several challenges associated with the procedure need to be overcome, such as the limited movement of the forceps. Robot-assisted gastrectomy allows surgeons to perform more meticulous surgical interventions with articulated devices; therefore, reducing the possibility of postoperative complications, as demonstrated by a few prospective studies performed in Japan. However, a non-randomized controlled trial conducted in Korea reported that there were no benefits of robot-assisted gastrectomy in terms of postoperative complications. Furthermore, no randomized controlled trials have directly compared robot-assisted and laparoscopic gastrectomy to provide solid evidence regarding the merits of the former. Methods: To confirm the superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for patients with cT1-2N0-2M0 gastric cancer, we designed JCOG1907 (UMIN000039825) as a multicenter randomized phase III trial. In the standard arm, we performed laparoscopic gastrectomy with lymphadenectomy, while in the experimental arm, we performed robot-assisted gastrectomy with lymphadenectomy. The primary endpoint is the incidence of postoperative intra-abdominal infectious complications of Clavien–Dindo classification grade ≥II. Major secondary endpoints are relapse-free survival, overall survival, overall postoperative complications, and short-term clinical outcomes after gastrectomy. The planned sample size is 1040 participants, with a one-sided alpha of 5% and a power of 70%, with an expected 3% decrease in postoperative intra-abdominal infectious complications (6% vs. 3%). Over the period of 5 years, patients will be enrolled from 35 Japanese institutions. Enrollment has started in March 2020, and as of August 2020, 30 patients have already been enrolled. Clinical trial information: UMIN000039825.

Percutaneous nephrolithotomy with suction: is this the future?

The armamentarium of percutaneous nephrolithotomy (PCNL) and the strategy to perform the procedure is constantly evolving. The innovation and development in techniques lead to further miniaturization in PCNL devices and change the lithotripsy and stone removal strategy. Suctioning in PCNL offers urologist a new conception in renal stone management. The present review evaluates the latest results on efficacy, safety and feasibility of suctioning PCNL techniques. Recent literature reported the outcomes of different suctioning PCNL techniques. Most of these studies demonstrated good efficacy when comparing conventional PCNL. Suctioning PCNL improving the lithotripsy efficiency to enhance the stone-free rate (SFR) and reducing renal pelvic pressure to attenuate postoperative infectious complications. The advantage of suction also helps overcome the limitation of potentially higher intrarenal pressure and prolonged operative time in Mini-PCNL. PCNL with suctioning represents a valuable new tool in the armamentarium of modern endourologists. This innovative approach can offer improved safety and efficacy with lower complications rates and higher cost effectiveness than the traditional PCNL technique.

Medical Management Following Surgical Therapy in Inflammatory Bowel Disease: Evidence from Cochrane Reviews.

Although medical therapy for inflammatory bowel disease (IBD) has greatly improved over the past 2 decades, surgery continues to be an integral part of the management of ulcerative colitis (UC) and Crohn’s disease (CD). This article reviews data from Cochrane reviews relevant to the medical management of IBD in surgical patients including treatment and prevention of pouchitis in UC patients with an ileal pouch-anal anastomosis, the risk of postoperative infectious complications from medical therapies, infertility after IBD surgery, and prevention of recurrence after bowel resection for CD. A summary of the overall certainty of evidence was assessed using Grading of Recommendations Assessment (GRADE; Table 1), and a summary of the results of these reviews is provided in Table 2. Pouchitis is an chronic inflammatory disease that may occur in the ileal pouch after proctocolectomy in patients undergoing...