Potential Post-surgical Complications Research Articles

Biofilm formation by Staphylococcus pseudintermedius on titanium implants

Osteomyelitis often involves Staphylococcus spp. as the isolated genus in domestic animal cases. Implant-related infections, frequently associated with biofilm-forming microorganisms like staphylococci species, necessitate careful material selection. This study assessed biofilm formation by Staphylococcus pseudintermedius on titanium nuts used in veterinary orthopaedic surgery. Biofilm quantification employed safranin staining and spectrophotometric measurement, while bacterial counts were determined in colony-forming units (CFU). Scanning Electron Microscopy (SEM) evaluated the biofilm morphology on the surface of titanium nuts. All samples had CFU counts. Absorbance values that evidence biofilm formation were observed in seven of the eight samples tested. SEM images revealed robust bacterial colonization, and significant extracellular polymeric substance production, and the negative control displayed surface irregularities on the nut. Whole genome sequencing revealed accessory Gene Regulator (agr) type III in six samples, agr IV and agr II in two each. Genes encoding hlb, luk-S, luk-F, siet, se_int, and the icaADCB operon were identified in all sequenced samples. Other exfoliative toxins were absent. Biofilm formation by S. pseudintermedius was detected in all samples, indicating the susceptibility of orthopaedic titanium alloys to adhesion and biofilm formation by veterinary species. The biofilm formation capacity raises concerns about potential post-surgical complications and associated costs.

Gliocova: Predictors of Post-Operative Complications, 30 Day Mortality and Readmission After First Surgical Intervention in Brain Tumour Patients in England Between 2013-2018

Abstract AIMS The Gliocova dataset uses linked English national cancer data on all 51,775 adult primary brain tumour patients diagnosed between 2013-2018. Here we investigate patient safety and post-operative complications after first surgical intervention. METHOD We identified patients undergoing first surgical intervention (surgical debulking or biopsy) and used a modified Delphi approach to identify diagnosis codes indicating potential post-surgical complications. We calculated Elixhauer Comorbidity Index (ECI) weights based on our data and developed regression models to link patient characteristics and ECI with 30-day mortality, readmission and chance of complication. RESULTS 29,258 out of 51,775 patients underwent a surgical intervention (28,173 surgical debulking; and 1,207 biopsy). 11,959 (40.9\%) patients had at least one comorbidity during first intervention admission. In hospital mortality was 0.99\% (N = 289), 30-day mortality was 2.3\% (N = 677) and 30-day readmission was 12.7\% (N = 3,725). 13,137 patients (44.9\%) had at least one complication code from our defined list, either during their first surgical intervention or during a 30-day readmission. Predictors of 30-day mortality, readmission, and risk of complications included age, ECI score, number of complications, type of intervention (biopsy vs surgical debulking), income quintile, and tumour type (i.e., Glioblastoma versus other types of brain tumours). CONCLUSION To our knowledge this is the first study in England to assess post-surgical complications in a large brain tumour patient cohort. Our further work will focus on variation in outcomes between different centres/ centre volumes/ regions and the cost of complications. More information: https://blogs.imperial.ac.uk/gliocova/about-gliocova/.

Postoperative Pharynx and Larynx.

Cancers of the pharynx and larynx are treated using a combination of chemotherapeutic, radiation, and surgical techniques, depending on the cancer type, biology, location, and stage, as well as patient and other factors. When imaging in the postsurgical setting, the knowledge of the type of tumor, preoperative appearance, and type of surgery performed is essential for accurate interpretation. Surgical anatomic changes, surgical implants/devices, and potential postsurgical complications must be differentiated from suspected recurrent tumors.

OS14.6.A GlioCova: Defining patient safety events for brain tumour patients undergoing neurosurgery

Abstract BACKGROUND Surgery is associated with a risk of adverse events (e.g. venous thrombosis). These have been used to define the OECD Patient Safety Event (PSE) indicators (41 diagnostic codes), but not in the brain tumour population. The GlioCova project uses English linked national cancer data on all 51,775 adult primary brain tumour patients (2013–2018). MATERIAL AND METHODS We identified all glioblastoma patients having surgery for their tumour and noted the 100 most common ICD-10 diagnostic codes within 30 days of surgery, excluding previous medical conditions, brain tumour diagnosis codes and OECD-defined codes. Potential post-surgical complications were reviewed by a group of experienced clinicians. We reviewed these “novel PSE codes” in all brain tumour patients re-admitted after surgery. We looked at the co-occurrence between our novel and OECD codes and combined them to form the final PSE list.Patients readmitted within 30 days were divided into those without codes (“PSE-free”), and those with at least one PSE code during admission or readmission. We examined age, length of stay, in-hospital and 30-day mortality and assessed statistical significance using Welch’s t-test and a two sample Z-test for proportions. RESULTS 29,135 patients underwent neurosurgery, of whom 8,361 (28.7%) were readmitted within 30 days. We identified 32 novel PSE codes. 1,319 (16%) patients had an OECD code, 5,524 (66%) had a novel code, and 2,098 (25%) patients were PSE-free. 83% of patients who had an OECD PSE code also had a novel code. Patients in the PSE group were older (median age = 60 years) than the PSE-free group (57 years). Length of stay was longer in patients who had a PSE after surgery (median = 7 days) and after readmission (5 days) compared with PSE-free after surgery (4 days), at readmission (0 days). More patients died in hospital after readmission in the PSE group (4.7%) compared with no-PSE (2.7%). 30-day mortality after surgery was similar in both groups (2.5% PSE-free, 3.1% PSE group). All differences were highly statistically significant (p<0.0001). CONCLUSION We identified 32 novel patient safety event codes following surgery in the brain tumour population. Patients with these diagnostic codes had an elevated LOS and in-hospital death rate. Using brain tumour specific PSE codes captures many more events than the existing list of OECD codes.

Vaccination against GnRH as a prelude to surgical castration of horses.

Surgical castration is one of the most frequently performed surgeries in horses and is associated with various post-surgical complications ranging in severity. We investigated the effects of administering an anti-GnRH vaccine to colts for reduction of testis size on the incidence of complications associated with their subsequent surgical castration. Randomised open controlled trial. Nineteen colts were randomly assigned to one of the three groups. Treatment Groups V1-57 and V2-100 received two treatments of Improvac® (Zoetis, South Africa) before their castration in the field on either Day 57 or Day 100 following first treatment, respectively. Controls similarly received placebo treatments followed by castration on Day 57. Serial measurements of testicular dimensions and serum samples for measuring serum testosterone concentrations (STCs) and anti-GnRH antibody titres (ABTs) were obtained pre- and post-vaccination and on the day of castration. Clinical data recorded for 10days determined post-surgical complications. All vaccinated colts showed a baseline STC concentration at castration with a strong ABT response. Mean testicular volume of Groups V1-57 and V2-100 reduced by 49.7% and 30.8%, respectively, on Day 57 and this further reduced in Group V2-100 by 63.9% at castration on Day 100. Testis size was significantly correlated with post-surgical preputial (P=0.001) and scrotal (P=0.025) swelling. A study population of young light horse breed colts and a relatively small sample size limited this pilot study. Administering two doses of Improvac® in colts 28days apart prior to castration effectively reduced their testicular volumes with associated significant post-surgical improvement in both the incidence and degree of local swelling. These results may inform mitigation of potential post-surgical complications associated with castration in the field.

Total and Subtotal Parathyroidectomy in Young Patients With Multiple Endocrine Neoplasia Type 1-Related Primary Hyperparathyroidism: Potential Post-surgical Benefits and Complications.

Background: The choice of surgical treatment for patients with Multiple Endocrine Neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT) remains controversial and it has not been specifically addressed in young patients.Methods: This is a retrospective case series study. The study includes the surgical data and the follow-up of 38 patients younger than 30 years of age, all diagnosed with MEN1, collected and followed-up between 1991 and 2017 at the Regional Referral Center for Inherited Endocrine Tumors of the Tuscany Region, and operated by parathyroidectomy. Genetic and/or clinical MEN1 diagnosis was made before surgery in all patients. Subtotal (9/38 patients) or total parathyroidectomy with auto-transplantation (28/38 patients) were performed in all patients but one, in whom a single mediastinal adenoma was excised from the aorto-pulmonary window. All patients but one, who was operated in 2017, had a post-operatory follow-up of at least 12 months.Results: Total parathyroidectomy (TPTX), with auto-transplantation, was the most frequently adopted operation both as primary (20/38 patients) and secondary (8/38 patients) surgery, followed by subtotal parathyroidectomy (SPTX; 9/38 patients) and limited parathyroidectomy (1/38 patient). At follow-up, lasting a mean of 11.8 ± 6.6 years (range 0–23 years), no persistent PHPT was observed. PHPT recurred in 4/28 TPTX (14%) and in 2/9 SPTX (22%). Permanent hypoparathyroidism showed no statistically significant difference between the procedures (2/9 in SPTX and 5/28 in TPTX).Conclusions: Data from this retrospective study showed the efficacy of TPTX for the treatment of MEN1-PHPT, also in adolescent and young patients, showing, in our series, no risk of PHPT permanence and a longer disease-free period and, subsequently, the possibility to postpone re-intervention with respect to both limited PTX and SPTX. The risk of permanent hypoparathyroidism in TPTX was comparable to STPX, and could be mitigated over the years.

Case review and consideration for imaging and work evaluation of the pregnant bariatric patient

BackgroundThere is an increasing trend toward morbid obesity in women of childbearing age and a subsequent increase in number of weight reduction surgeries in these individuals. As a result, special attention needs to be paid to potential postsurgical complications during pregnancy, particularly after Roux-en-Y gastric bypass (RYGB). We are presenting our small case series and our suggestions for management for the pregnant bariatric patient. The aim of this study is to review our institutional experience and present our algorithm to approach pregnant women presenting with abdominal pain and/or emesis after RYGB. MethodsAfter Institutional Review Board approval, a retrospective chart review was performed at a single center institution between 2010 and 2013. Data regarding clinical presentation, physical exam findings, laboratory values, radiographic studies, intraoperative findings, and clinical outcomes of both mother and fetus were collected and reviewed for pregnant patients with history of RYGB and abdominal distress. ResultsFive patients were identified. Patient age ranged from 22–34 years (mean 28.4). Gestational age ranged from 9–31 months (mean 19.2). Average body mass index at presentation was 30.3 kg/m2. Of the 5 patients, 4 presented with abdominal pain and one with intractable emesis. Four patients were taken to the operating room. One was successfully discharged. Two of the patients had an obstruction from adhesions, and the other 2 were found to have internal hernia. There was no mortality for either fetus or mother. One patient required premature delivery at 28 weeks. ConclusionsPregnant women with history of RYGB who present with abdominal pain should be evaluated urgently for internal hernia or obstruction. A systematic approach is needed to ensure prompt diagnosis.

Malignant anomalous left coronary artery associated with acute coronary syndrome and subsequent post-operative secondary stenosis of the reimplanted anomalous left coronary artery

We present a case of a 14-year-old boy who presented with symptoms resulting from an anomalous left coronary artery. He underwent corrective surgery to reimplant the left coronary artery into the left coronary sinus. After 3 months, he developed new symptoms. On further investigation, a tight ostial stenosis of the left coronary artery was observed and the patient underwent left internal mammary artery to left anterior descending coronary artery bypass graft. This case showcases the importance of multi-modality imaging in the diagnosis of coronary artery anomalies and potential post-surgical complications.

Comment on Nathan et al.: lumbar paraspinal compartment syndrome

1. S-T Nathan and his colleagues state that a PubMed search was conducted with the title query, lumbar paraspinal compartment syndrome, which found ten articles. However, only six articles were found besides Nathan’s paper [1] when we performed the same search on September 19, 2012. 2. Was the search for articles thorough? First, two electronic databases (the PubMed and OVID Medical databases) were searched by the authors. But a PubMed, Embase, CINAHL, and Cochrane database search was done using the search strategy recommended by the Cochrane Back Review Group. Second, S-T Nathan and his colleagues only searched medical subject headings, keywords and the title “lumbar paraspinal compartment syndrome”. Based on the above considerations, we think that the search for articles was not thorough. A search strategy report plays an important role in systematic reviews. Sampson et al. [2] considered that critical appraisal is impossible if the search strategy is not thoroughly reported in systematic review. 3. One author selected high yield abstracts and obtained full articles in Nathan’s review. According to the Cochrane Handbook for Systematic Reviews of Interventions [3], in order to reduce the bias, it is most important that the final selection and extraction of studies into the review are undertaken by more than one author. 4. The conclusion of the article showed that the basic trend is to surgically decompress the compartment to avoid long-term functional sequelae in other muscular compartments of the body. We suggest nonoperative treatment options are the first line of management for compartment syndrome. Diebal et al. [4] also suggested that an effective nonoperative management approach could eliminate these potential postsurgical complications for compartment syndrome.

Posttreatment CT and MR Imaging in Head and Neck Cancer: What the Radiologist Needs to Know

In patients with head and neck cancer, posttreatment imaging can be complicated and difficult to interpret because of the complexity of the surgical procedures performed and the postirradiation changes, but such imaging is critical for the evaluation of (a) the response to therapy and (b) tumor control. Posttreatment changes are affected by the type of surgery performed, reconstruction, neck dissection, and radiation therapy. Three types of flaps are used for reconstruction in the head and neck region: (a) the local flap, with geometric repositioning of adjacent tissue; (b) the pedicle flap, with rotation of donor tissue and preservation of the original vascular system; and (c) the free flap, with transfer of tissue that is revascularized by using microvascular surgical techniques. The posttreatment imaging findings in patients with head and neck cancer can be divided into four groups: altered anatomy secondary to surgical reconstruction, tumor recurrence, potential postsurgical complications, and possible postirradiation changes. Potential postsurgical complications are wound infection, abscess, fistula, flap necrosis, hematoma, chylous fistula, and serous retention. Possible postirradiation changes include mucosal necrosis, osteoradionecrosis, radiation-induced vasculopathy, radiation pneumonitis, radiation lung fibrosis, radiation-induced brain necrosis, and radiation-induced secondary malignancies. A familiarity with the imaging characteristics of posttreatment changes and of the potential complications caused by surgery and irradiation and an ability to differentiate these findings from tumor recurrence are essential for posttreatment surveillance and follow-up management of patients with head and neck cancer.

MR Angiographic Evaluation of Complications in Surgically Treated Type A Aortic Dissection

Thoracic aortic dissection is a life-threatening disease with a high mortality rate and an elevated incidence of early and long-term complications. Advances in surgical treatment of ascending (Stanford type A) aortic dissection have helped improve patient survival, but follow-up imaging is critically important for the identification of postsurgical complications. Gadolinium-enhanced three-dimensional (3D) magnetic resonance (MR) angiography, along with multisection computed tomography, is the technique of choice for this purpose. For accurate assessment of 3D MR angiograms, it is important to know what surgical procedure was performed and to be familiar with the appearance of the normal postsurgical anatomy. A thorough understanding of potential postsurgical complications also is essential. Some complications (eg, formation of a periprosthetic hematoma or pseudoaneurysm, stenosis in a graft anastomosis) may derive from the prosthesis. Complications also may occur in the remnant of the native aorta, where persistent dissection distal to the prosthesis is common and may result in false channel thrombosis or aneurysmatic dilatation with collapse of the true lumen. Residual dissection that involves the supra-aortic trunks or the visceral aortic branches may produce neurologic effects or renal and mesenteric ischemia, respectively.