Postoperative Respiratory Infection Research Articles

Comparison of two modeling approaches for the identification of predictors of complications in children with cerebral palsy following spine surgery

BackgroundChildren with non-ambulatory cerebral palsy (CP) frequently develop progressive neuromuscular scoliosis and require surgical intervention. Due to their comorbidities, they are at high risk for developing peri- and post-operative complications. The objectives of this study were to compare stepwise and LASSO variable selection techniques for consistency in identifying predictors when modelling these post-operative complications and to identify potential predictors of respiratory complications and infections following spine surgery among children with CP.MethodsIn this retrospective cohort study, a large administrative claims database was queried to identify children who met the following criteria: 1) ≤ 25 years old, 2) diagnosis of CP, 3) underwent surgery during the study period, 4) had ≥ 12-months pre-operative, and 5) ≥ 3-months post-operative continuous health plan enrollment. Outcome measures included the development of a post-operative respiratory complication (e.g., pneumonia, aspiration pneumonia, atelectasis, pleural effusion, pneumothorax, pulmonary edema) or an infection (e.g., surgical site infection, urinary tract infection, meningitis, peritonitis, sepsis, or septicemia) within 3 months of surgery. Codes were used to identify CP, surgical procedures, medical comorbidities and the development of post-operative respiratory complications and infections. Two approaches to variable selection, stepwise and LASSO, were compared to determine which potential predictors of respiratory complications and infection development would be identified using each approach.ResultsThe sample included 220 children. During the 3-month follow-up, 21.8% (n = 48) developed a respiratory complication and 12.7% (n = 28) developed an infection. The prevalence of 11 variables including age, sex and 9 comorbidities were initially considered to be potential predictors based on the intended outcome of interest. Model discrimination utilizing LASSO for variable selection was slightly improved over the stepwise regression approach. LASSO resulted in retention of additional comorbidities that may have meaningful associations to consider for future studies, including gastrointestinal issues, bladder dysfunction, epilepsy, anemia and coagulation deficiency.ConclusionsPotential predictors of the development of post-operative complications were identified in this study and while identified predictors were similar using stepwise and LASSO regression approaches, model discrimination was slightly improved with LASSO. Findings will be used to inform future research processes determining which variables to consider for developing risk prediction models.

Long-Term Results of the Mini Maze Standalone Bi-Atrial Surgical Ablation: A 10-Year Follow-Up.

Background: One way to treat atrial fibrillation is through surgical ablation. However, the literature only provides information on patient follow-up results for up to 5 years. Methods: In order to assess long-term monitoring data over ten years, this retrospective study included 58 patients with paroxysmal or persistent atrial fibrillation who underwent Mini Maze surgical ablation at Santaros Clinics between 1 February 2009 and 1 June 2014. The follow-up time after surgery was 144 ± 48 months. We evaluated the absence of atrial fibrillation, echocardiographic and clinical parameters, and EHRA score. Results: Sinus rhythm remained in 69.4%, 75.5%, 55.6%, and 44.1% of patients with paroxysmal AF, and 68,2%, 59.1%, 50%, and 41.9% of patients with persistent AF (p = 0.681). In the post-operative period, one patient (1.7%) had a transient ischemic attack, and another patient (1.7%) had a thoracotomy for post-operative bleeding. A total of 20% of patients were diagnosed with a post-operative respiratory tract infection. EHRA scores showed that patients' quality of life improved after they underwent Mini Maze surgical ablation. Conclusions: Despite AF recurrences after surgery, quality of life remains better than before surgery, showing that Mini Maze surgery is an effective and safe second-line treatment method for atrial fibrillation.

Evaluating the Emergency Surgery Score (ESS) in Predicting Postoperative Outcomes Following Emergency Laparotomy: Insights From an Indian Tertiary Center.

To determine the predictive value of Emergency Surgery Score (ESS) with regard to mortality and morbidity rates of patients undergoing emergency laparotomy. The ESSranging from 0 to 29 is an extensive risk calculator based on 22 variables including important parameters like demographics, preoperative treatment, comorbidities, and laboratory values. Twenty patients who underwent emergency laparotomy were preoperatively assessed and ESS was calculated for each. After establishment of diagnosis and resuscitation, the patient was taken up for emergency laparotomy. Postoperatively, patients were monitored clinically as well as with laboratory and radiological investigations as per case needed till discharge and further followed up physically in OPD/ward or interviewed telephonically for 30 days on a weekly basis. Incidence of mortality and morbidity in terms of postoperative complications, ICU admission, reoperation and readmission among the cases occurring within 30 days of procedure were recorded. ESS correlated well with the outcome in the current study, 10 out of 14 patients with score less than 8 were discharged without any complications. Mean ESS was higher among non-survivors. Ability of ESS to predict postoperative mortality, morbidity and ICU stay was proven statistically with c-statistics of 0.853, 0.84, 0.879 respectively. ESS was found to be a good predictor for the development of postoperative lower respiratory tract infection (LRTI) (c-statistic=0.828), sepsis (c-statistic=0.867), disseminated intravascular coagulation (DIC) (c-statistic=0.805), acute kidney injury (AKI) (c-statistic=0.804). ESS showed poor correlation with reoperation and readmission rates. The current study underscores the critical importance of employing risk stratification throughESSfor patients undergoing emergency laparotomy. By employing ESS, healthcare professionals can accurately anticipate resuscitation requirements and stabilize patients preoperatively. This proactive approach enables the identification and optimization of patients unsuitable for immediate surgery, facilitating informed decisions on targeted treatment, surgical intervention, and postoperative care pathways.

Anesthesia management experience for pediatric day-case PDA ligation under thoracoscopy assisted by a robot: a retrospective study

BackgroundTo summarize the anesthesia management experience for pediatric day-case patent ductus arteriosus (PDA) ligation under robot-assisted thoracoscopy and explore the key points of anesthesia management for this procedure.MethodsThe clinical data of 72 pediatric patients who underwent robot-assisted thoracoscopic day-case PDA ligation at the Children’s Hospital, Zhejiang University School of Medicine from April 2021 to February 2023 were retrospectively analyzed. 0.3% ropivacaine local infiltration combined with S-ketamine 0.2 mg/kg intravenous injection was used for postoperative analgesia The patient’s basic information and intraoperative conditions were analyzed, which included gender, age, weight, surgery time, anesthesia time, extubation time, intraoperative blood loss, MAP before pneumothorax, PaCO2 before pneumothorax, etc. Postoperative conditions were also monitored, such as PACU stay time, agitation during the recovery period, pain, and the incidence of nausea and vomiting. After discharge, the recovery status was assessed.ResultsA total of 70 pediatric patients who met the criteria for day-case PDA ligation were included in this study. Before the occurrence of pneumothorax, the mean arterial pressure (MAP) of these 70 patients was 69.58 ± 12.52 mmHg, and during controlled hypotension, the MAP was 54.96 ± 11.23 mmHg. Before the occurrence of pneumothorax, the partial pressure of carbon dioxide (PaCO2) was 38.69 ± 3.38 mmHg, and during controlled hypotension, the PaCO2 was 51.42 ± 4.05 mmHg. Three cases experienced agitation during the recovery period, and four cases had mild pain, but there was no moderate or severe pain, nausea, or vomiting. Only 1 case of postoperative respiratory tract infection and 1 case of postoperative pneumothorax occurred. Within 30 days after discharge, the unplanned revisit rate, unplanned readmission rate, and surgical wound infection rate were all 0. The residual shunt rate detected by echocardiography was 0 after 1 month.ConclusionsThe children under the robot-assisted thoracoscopic day case PDA surgeries in this study have limited trauma, little bleeding, and little postoperative pain, though still at a risk of respiratory infection and pneumothorax.

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery.

To study the risk factors of poor wound healing after primary cleft palate surgery. In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient's age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor's seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

Complications of prolonged mechanical ventilation after cardiac surgery in children with Down syndrome: A single-center retrospective observational study

Background: Patients with Down syndrome (DS) are known to have an increased risk of congenital heart diseases, which can be a predictor of prolonged mechanical ventilation (PMV) after cardiac surgery. PMV is a factor that enhances postoperative complications and morbidities. Thus, we aimed to explore the risk factors of the PMV, and relevant complications associated with it. Subjects and Methods: This retrospective study included 94 patients with DS who underwent 97 cardiac repair surgeries between 2010 and 2022. Patients were dichotomized into two groups. The first group was with the patients on mechanical ventilation (MV) for &lt;72 h and the PMV group with MV for more than ≥72 h. Results: We reviewed the association between various risk factors and PMV in patients with DS. The presence of seizure disorder (P = 0.028), preoperative administration of prostaglandin (P = 0.028), and continuous positive airway pressure (CPAP) (P = 0.043) had significantly increased risk of PMV. We found a significantly increased incidence of sepsis (P = 0.009), delayed sternal closure (P = 0.01), feeding intolerance (P = 0.014), prolonged intensive care unit (ICU) stay (P = 0.0001), and pulmonary collapse (P = 0.001) in patients with PMV. There was no difference in the incidence of pulmonary hypertension, postoperative respiratory infection, pneumothorax, and chylothorax between children between the two groups. Conclusions: The presence of seizure disorder, preoperative usage of prostaglandin, and CPAP were significant risk factors for PMV. Incidence of sepsis, delayed sternal closure, feeding intolerance, prolonged ICU stay, and pulmonary collapse was significantly higher with PMV.

Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study.

Respiratory infections are frequent and life-threatening complications of surgery. This study aimed to evaluate the clinical, microbiological and treatment characteristics of severe postoperative pneumonia (POP) and tracheobronchitis (POT) in a large series of patients. This single-center, prospective observational cohort study included patients with POP or POT requiring intensive care unit admission in the past 10 years. We recorded demographic, clinical, microbiological and therapeutic data. A total of 207 patients were included, and 152 (73%) were men. The mean (SD) age was 70 (13) years and the mean (SD) ARISCAT score was 46 (19). Ventilator-associated pneumonia was reported in 21 patients (10%), hospital-acquired pneumonia was reported in 132 (64%) and tracheobronchitis was reported in 54 (26%). The mean (SD) number of days from surgery to POP/POT diagnosis was 6 (4). The mean (SD) SOFA score was 5 (3). Respiratory microbiological sampling was performed in 201 patients (97%). A total of 177 organisms were cultured in 130 (63%) patients, with a high proportion of Gram-negative and multi-drug resistant (MDR) bacteria (20%). The most common empirical antibiotic therapy was a triple-drug regimen covering MDR Gram-negative bacteria and MRSA. In conclusion, surgical patients are a high-risk population with a high proportion of early onset severe POP/POT and nosocomial bacteria isolation.

Elevated serum albumin-to-creatinine ratio as a protective factor on outcomes after heart transplantation.

The purpose of this study was to investigate the prognostic significance of serum albumin to creatinine ratio (ACR) in patients receiving heart transplantation of end-stage heart failure. From January 2015 to December 2020, a total of 460 patients who underwent heart transplantation were included in this retrospective analysis. According to the maximum Youden index, the optimal cut-off value was identified. Kaplan-Meier methods were used to describe survival rates, and multivariable analyses were conducted with Cox proportional hazard models. Meanwhile, logistic regression analysis was applied to evaluate predictors for postoperative complications. The accuracy of risk prediction was evaluated by using the concordance index (C-index) and calibration plots. The optimal cut-off value was 37.54 for ACR. Univariable analysis indicated that recipient age, IABP, RAAS, BB, Hb, urea nitrogen, D-dimer, troponin, TG, and ACR were significant prognostic factors of overall survival (OS). Multivariate analysis showed that preoperative ACR (HR: 0.504, 95% = 0.352-0.722, P < 0.001) was still an independent prognostic factor of OS. The nomogram for predicting 1-year and 5-year OS in patients who underwent heart transplantation without ACR (C-index = 0.631) and with ACR (C-index = 0.671). Besides, preoperative ACR level was a significant independent predictor of postoperative respiratory complications, renal complications, liver injury, infection and in-hospital death. Moreover, the calibration plot showed good consistency between the predictions by the nomogram for OS and the actual outcomes. Our research showed that ACR is a favorable prognostic indicator in patients of heart transplantation.

Respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors.

We aimed to explore the respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors. A total of 494 patients receiving oral and maxillofacial surgery under general anesthesia with tracheal intubation were assigned to a non-infection group (n=469) and an infection group (n=25). Another 494 healthy people undergoing physical examination in the same period were enrolled to establish a classification tree model. The distribution of pathogens, drug resistance of main pathogens, and related influencing factors of postoperative respiratory tract infection were analyzed. The influencing factors of respiratory tract infection were screened by logistic regression analysis. After construction of the classification and regression tree (CART) model based on the influencing factors, the accuracy was evaluated by plotting receiver operating characteristic (ROC) curve. Pseudomonas aeruginosa was highly resistant to cefazolin and more sensitive to cefoperazone, ciprofloxacin, norfloxacin and imipenem. Staphylococcus aureus was highly resistant to gentamicin and more sensitive to vancomycin. Age ≥ 60 years old, history of lung diseases, operation time ≥ 4 h, anesthesia ventilation time ≥ 120 min, and orotracheal intubation were independent influencing factors of respiratory tract infection (p< 0.05). The results of the gain chart, index map, and Risk value indicated a high predictive value of the CART model for the risk of postoperative respiratory tract infection. The area under the ROC curve was 0.869 [95% confidence interval: 0.795-0.947]. The CART model has a high predictive value and may reduce the risk of postoperative infection.

Expression profiles of sporulation genes in multidrug-resistant Bacillus species isolated from intensive care units of Ghanaian hospital.

Sporulating bacteria such as Bacillus spp. have contributed to severity of opportunistic hospital acquired infections, including postoperative wounds and respiratory tract infections. This study determines the expression profiles of sporulation markers in multidrug-resistant Bacillus spp. isolated from Ghanaian hospital environments. Antimicrobial resistance (AMR) profiles of the bacteria were determined with disk diffusion and broth microdilution. Primer-specific polymerase chain reaction (PCR) amplification was used to profile the sporulation markers, and quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used for the expression of the sporulation markers at different antibiotic concentrations. The strains are multidrug resistant (70-100%) to at least two of the eight classes of the antibiotics tested including cephalosporins, penicillin, aminoglycosides, and glycopeptide. The strains showed different resistance patterns to all the tested antibiotics, which might indicate diverse resistance mechanisms. Common (spoVK spoVE, spoJ, and sigF) and not commonly (sigJ, soJ, yrbC, and yjcE) reported sporulation markers were detected in the strains. The study showed an association of the sporulation markers with AMR as indicated by their expression profiles.

In-hospital mortality of patients requiring unplanned postoperative ventilatory support: a multicenter observational study

BackgroundMost patients who are admitted non-intubated to surgery are extubated at surgery conclusion. Yet, 1–2% require unplanned postoperative ventilatory support. The outcome of these patients has not been thoroughly evaluated to date and is the focus of the present study.MethodsTwo-center observational study assessing characteristics and outcomes of surgical patients with unplanned mechanical ventilation during PACU stay between 2017 and 2019. Patients who arrived intubated to the operating room or were transferred directly to the intensive care unit (ICU) were excluded. The co-primary aims were to assess overall in-hospital mortality and to compare mortality between patients who were extubated in PACU and those who were discharged from PACU still intubated. The secondary aims were to compare postoperative respiratory infection and unplanned admissions to the ICU. Multivariate logistic regression was used to compare the groups and adjust for potential confounding variables.ResultsOverall, 698 patients were included. Of these, 135 died during hospital stay (mortality rate 19.3%, compared with 1.0% overall postoperative in-hospital mortality). Patients who still required ventilatory support at PACU discharge were significantly sicker, majority needed emergency surgery, and had more complicated surgical course compared to those who were extubated in PACU. In addition, their mortality rate [36% vs. 9%, adjusted OR (95% CI) 5.8 (3.8–8.8), p < 0.001], postoperative respiratory infection, and unplanned admission to ICU rates were also significantly higher.ConclusionUnplanned postoperative mechanical ventilation is associated with noteworthy morbidity and mortality, with significantly higher rates in those of need for protracted (vs. short) mechanical ventilation. The remarkable mortality rate in patients extubated shortly after arriving to the PACU emphasizes the need for further studies to explore prompting factors and whether we can intervene to improve patients’ outcome.

Outcomes of liver transplantation for mitochondrial respiratory chain disorder in children.

Mitochondrial respiratory chain disorder (MRCD) can cause acute liver failure (ALF), which may necessitate liver transplantation (LT). However, MRCD is often difficult to diagnose before LT and the indications of LT are controversial due to the likelihood of progressive neurological disease. The present study further characterized the patient population and described the outcomes. Thirteen patients who underwent LT for MRCD from November 2005 to May 2020 were enrolled in this study. Six of 13MRCD patients were diagnosed with a mitochondrial inner membrane protein 17-related mitochondrial DNA depletion syndrome (MTDPS). Overall, nine survived with a median follow-up of 1.8years (IQR, 1.3-5.1years); four died within 2years. In the long-term, seven survivors showed no progression of hypotonia after LT and attended a normal kindergarten or primary school. Neurological abnormalities were observed in two survivors, including vison loss related to Leber's hereditary optic neuropathy in one patient and psychomotor retardation related to Leigh syndrome in the other. Three non-survivors after LT were diagnosed with MTDPS and died of severe pulmonary hypertension, which had developed at 8, 9, and 18months after LT (n=1 each). The remaining patient died of postoperative respiratory infection with respiratory syncytial virus. The long-term results support the performance of LT in patients with MRCD, although a genetic diagnosis is preferable for determining the accurate indications for LT in these patients. Furthermore, care should be taken to avoid complications due to mitochondrial dysfunction during the long-term follow-up.

Early laparoscopic cholecystectomy in very elderly patients: a propensity score-matched analysis of a nationwide registry

Background: The role of early laparoscopic cholecystectomy (ELC) in very elderly patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥85-year-old patients. Methods: Multicentric retrospective analysis of patients who underwent ELC for ACC between 2013-2018. Patients ≥85-year-old were assigned to group 1, those younger to group 2. The two groups were compared before and after propensity-score matching (PSM). The main outcomes were post-operative complications, length of stay, and readmissions. Results: The study included 1670 subjects. The unmatched comparison revealed a selection bias towards group 1, that was associated with higher Charlson Comorbidity Index (5 vs 1, p<0.001), more ASA III/IV patients (54.2% vs 19.3%, p<0.001), diabetes mellitus (36.8% vs 19.1%, p<0.001), previous abdominal surgery (39.6% vs 27.4%, p=0.010), previous percutaneous cholecystostomy (13.2% vs 2.4%, p<0.001), perforated gallbladder on preoperative imaging (14.4% vs 6.3%, p=0.005) and grade II/III ACC (80.1% vs 69.1%, p=0.016). Group 1 patients also required more conversion to open surgery (20% vs 10.3%, p=0.005) and subtotal cholecystectomy (9.3% vs 3.4%, p=0.012). After the PSM (n=206 patients) the two groups were comparable in terms of baseline characteristics and intraoperative outcomes, with a model exhibiting good discrimination and calibration. No significant differences were observed in total postoperative complications, bile leak, incisional, intrabdominal, urinary and respiratory tract infections, length of stay, and readmissions. Conclusions: ELC for ACC seems safe in selected ≥85-year-old patients. Age itself should not be regarded as a contraindication to surgery with ELC.

Evaluation of effects of perioperative oral care intervention on hospitalization stay and postoperative infection in patients undergoing lung cancer intervention.

This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p= 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.

Viral Respiratory Infection, a Risk in Pediatric Cardiac Surgery: A Propensity-Matched Analysis.

1) To describe the postoperative course and outcomes of cardiac surgery in children with perioperative viral respiratory infection, 2) to evaluate optimal surgical timing for preoperative viral respiratory infection patients, and 3) to define risk stratification. Retrospective study of children undergoing cardiac surgery. Children were tested using a multiplex polymerase chain reaction (respiratory virus polymerase chain reaction) panel capturing seven respiratory viruses. Respiratory virus polymerase chain reaction testing was routinely performed in patients under 2 years old. Those with negative results yet highly suspected of viral respiratory infection after surgeries would be tested again. A pediatric cardiac surgical ICU of pediatric cardiac surgery department at Fuwai Hospital. Children admitted between January 1, 2014, and December 31, 2016, to perform respiratory virus polymerase chain reaction testing and cardiac surgery were included. None. A total of 2,831 patients had respiratory virus polymerase chain reaction testing, and viruses were detected in 91 patients (3.2%), including 35 preoperative and 56 postoperative. Of the 35 preoperative viral respiratory infection patients, there were 29 viral respiratory infection-resolved (patients for whom surgery was postponed until resolution of viral respiratory infection symptoms and negative respiratory virus polymerase chain reaction) and six viral respiratory infection-unresolved (who underwent cardiac surgery before resolution of symptoms and clearance of carriage) patients. Furthermore, there were seven deaths, including one in the preoperative viral respiratory infection-unresolved group and six in the postoperative viral respiratory infection group. A propensity score matching was performed to correct the selection bias and identify the comparable patient groups. Compared to their matched nonviral respiratory infection patients, viral respiratory infection-resolved patients had similar duration of mechanical ventilation and length of stay, while viral respiratory infection-unresolved patients had longer durations of postoperative mechanical ventilation (p = 0.033), PICU (p = 0.028) and hospital length of stay (p = 0.010), and postoperative viral respiratory infection patients had significantly greater duration of postoperative recovery (p < 0.001) and higher mortality (p < 0.001). Earlier diagnosis of postoperative viral respiratory infection was associated with longer mechanical ventilation duration (r = 0.422; p < 0.001). Palliative cardiac surgery was the only variable significantly associated with mortality in multivariate analysis (odds ratio, 12.0; 95% CI, 1.6-87.5; p = 0.014). The preoperative-unresolved and postoperative viral respiratory infection were associated with prolonged postoperative recovery, increased severity, and mortality in children with cardiac surgeries. Our results suggested the optimal surgical timing may be after the resolution of viral respiratory infection symptoms and carriage unless the perceived benefits of early surgery outweigh the risk of death, prolonged ventilation, and PICU length of stay. Palliative surgeries were associated with increasing mortality.

Prediction of postoperative lower respiratory tract infections in tongue cancer patients based on pretreatment swallowing function.

This study investigated the predictive role of pretreatment swallowing function and surgical factors on postoperative and nosocomial lower respiratory tract infections (PN-LRTIs). A retrospective study for predicting PN-LRTIs from January 2017 to December 2018 at Hospital of Stomatology, Sun Yat-sen University. Patients who were newly diagnosed with tongue squamous cell carcinoma (TSCC) were enrolled. Presurgical swallowing function was assessed using water swallow test (WST) and the M.D. Anderson Dysphagia Inventory (MDADI). A total of 83 patients were recruited to the study. Of which 54 were men (65.1%) and 29 were women (34.9%), with the mean age of 51years old. Thirteen (15.7%) developed PN-LRTIs. On univariate analysis, the outcomes of WST, the MDADI scores, T stage, tongue resection range, operative time, segmental mandibulectomy, and type of neck dissection exhibited a statistical significance (p<.05). On multivariate analysis, abnormal group of WST (odds ratio [OR], 15.88; 95% CI, 2.13-118.64) and total glossectomy (OR, 12.20; 95% CI, 2.01-68.32) was demonstrated to be independent risk factors. The WST together with the resection range of tongue can predict the postoperative risk of PN-LRTIs collaboratively. Clinically, preventive measures and intensified care should be taken for patients with abnormal WST outcome before surgery and management of total glossectomy.

Risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection

Objective To investigate the risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection. Methods The clinical data of 128 patients who underwent thoracoscopic mediastinal tumor resection in this hospital from June 2016 to June 2017 were retrospectively analyzed, and the incidence of postoperative respiratory tract infection and related risk factors were analyzed, and intervention measures were formulated. Results The incidence of postoperative pulmonary infection was 20.31% in 128 patients with mediastinal tumor resection under thoracoscopy (26/128). Logistic multivariate analysis showed that age over 60, lymph node dissection, preoperative diabetes mellitus, thoracic drainage indwelling time over 3 days, and postoperative wound contamination were all independent risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection(P<0.05). Preoperative antibiotic prophylaxis and expectoration training were protective factors(P<0.05). Conclusions There are many risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection, and the preoperative preventive application of antibiotics and the preoperative sputum expectoration and discharge training will help to prevent and reduce the incidence of postoperative pulmonary infection. Key words: Thoracoscopy; Mediastinal tumor resection; Postoperative pulmonary infection; Risk factors

Risk factor analysis of secondary post-tonsillectomy hemorrhage in children

Objective: To analyze the risk factors of secondary post-tonsillectomy hemorrhage (PTH) in children, and to provide a theoretical basis for reducing complications after tonsillectomy. Method: A retrospective analysis of 354 children underwent tonsillectomy was performed, among which 42 secondary hemorrhage cases were divided into bleeding group, and other 312 cases were divided into non-bleeding group. To analyze the risk factors of secondary PTH and to discusses the pathogenesis of the hemorrhage, statistical analysis was conducted among eight clinical data including gender, age, reason of surgery, degree of tonsil embedding, surgery approach, surgeon' s skill level, intra-operative hemorrhagic volume, and postoperative absence of upper respiratory tract infection. Result: Univariant analysis showed that there was no statistical difference of gender, reason for operation, surgeon' s skill level, intra-operative hemorrhagic volume and postoperative upper respiratory tract infection different between bleeding group and non-bleeding group, while there was significant statistical difference of age, degree of tonsillar embedding, and surgery approach. Further multivariate logistic regression analysis of the three relevant factors showed that there was a significant correlation between the degree of tonsillar embedding and the surgery approach and the hemorrhage. Conclusion: Hemorrhage after tonsillectomy is a common and potentially fatal complication, with risk factors of the degree of tonsillar embedding, and the surgery approach. .

A Clinical Study of Peptic Ulcer Perforation

Background: Perforation is one of the most important complications of a peptic ulcer. In spite of modern management, it is still a life threatening emergency. Operative method is still the treatment of choice and simple closure of perforation with Graham's patch is an established procedure of choice in our institution. Material and Methods: A prospective study was conducted on 30 diagnosed patients of perforated peptic ulcer at Dr. Vasantrao Pawar Medical College, Nashik to study the clinical profile and clinical outcome of peptic ulcer perforation patients post operatively from August 2014 to December 2016. Results: A total of 30 patients were included, majority of patients presented in the 4th decade of life and 88.67% were males, 76.67% of the total patients had positive history suggestive of peptic ulcer disease and 36.66% patients had associated co morbidities, (36.67%) had severe dehydration, 10% patients presented with hypotension, with a systolic blood pressure of less than 90mmHg. In 23.33% of patients surgery was performed within 5 days of onset of acute abdominal pain and 16.67% presented with severe contamination of the peritoneal cavity, 33.33% presented with gastric perforation and 66.67% presented with duodenal perforation. 30% patients suffered from post operative wound infection and 30% patients suffered from post-operative respiratory infections. 16.67% patients presented with post operative sepsis. The mortality rate in this study was 10%. Conclusion: Perforated peptic ulcer is one of the most commonest acute abdominal emergencies. The outcome of the patient depends on the age of the patient, associated co morbidities, time interval between acute abdominal pain and surgery, timely resuscitation, contamination of the abdomen and post operative sepsis.

Effect of Early Ambulation on Reducing Respiratory Tract Infection among Postoperative Elderly Patients with Abdominal Surgeries

Background: Abdominal surgery is one of the most frequent surgical procedures performed in age 65 and more. postoperative respiratory tract infection (RTIs) is the most common serious complication after this type of surgery with reported incidence between 17-88%. Delayed mobilization was associated with a three-fold increase in RTIs. Aim of the study: To evaluate the effect of early ambulation on reducing RTIs among postoperative elderly patients with abdominal surgeries. Research design: Quasi-experimental research design was utilized in the current study. Subjects: Convenient sample including 80 elderly patients male and female, classified equally into two equal groups; study group (n= 40) and control group (n= 40), were collected through one year. Setting: This study was carried out at the general surgery departments (A and C) at Minia University Hospital. Tools of data collection: three tools were utilized in collecting data. Tool I: patient interview structured questionnaire, Tool II: patient's physical and respiratory assessment; Tool III: early ambulation record. Results: current study findings revealed that the 87.5% of the study group were free from postoperative RTIs. In contrast to, 85% of the control group had postoperative RTIs. Conclusion: The current study findings concluded that, early ambulation had a synergetic positive effect on reducing postoperative RTIs, improving respiratory parameters and decreased length of hospital stay among elderly with laparotomy. Recommendations: Hospitals should recommend implementing protocols for postoperative early ambulation as a routine hospital policy among all general surgical patients in all age groups.