Preoperative Blood Research Articles

Comparison of endoscopic retrograde cholangiopancreatography with laparoscopic surgery for patients with mild and moderately severe acute biliary pancreatitis

Acute biliary pancreatitis (ABP) is an acute inflammatory reaction that occurs as a result of abnormal reflux of bile into the pancreatic duct, which activates pancreatic digestive enzymes to produce pancreatic auto-digestion. ObjectivesTo explore the advantages of Endoscopic Retrograde Cholangiopancreatography (ERCP) treatment compared with laparoscopic surgery in the management of patients with mild and moderately severe ABP, and to study the risk factors for recurrence of ABP and construct a risk prediction model to assist in resolving clinical decision-making and improving prognosis. MethodsPatients with mild and moderately severe ABP treated at General Hospital of Ningxia Medical University from January 1, 2019 to July 1, 2022 were reviewed. A total of 327 patients were enrolled according to the inclusion criteria and exclusion criteria. According to the different treatment modalities, they were divided into the group treated via ERCP (n = 239) and the group treated via laparoscopic surgery (n = 88). Statistical analyses were performed to compare the differences between the average levels of preoperative and postoperative blood routine and blood biochemical indexes, as well as the time of recovery from clinical symptoms, length of hospital stay, and postoperative complications between the two groups of patients. The 280 patients who participated in the follow-up were divided into the recurrence group (n = 130) and the non-recurrence group (n = 150) according to whether they had recurrence or not. Independent samples t-test and binary logistic regression were used to analyze the causative monofactors and risk factors of recurrent biliary pancreatitis, and then to construct the model and assess the predictive accuracy of the model. ResultsOn postoperative day 2, the incidence of local complications, Balthazar CT score, and the number of analgesia were lower in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001), and the duration of antibiotics, enzyme-suppressing medication, fasting, and hospital stay were shorter in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001). Personal history, gamma glutamyl transpeptidase (GGT), and treatment modality are risk factors for recurrence of biliary pancreatitis. The model constructed by combining GGT, personal history, and treatment modality had the best predictive ability for disease recurrence compared with the model with GGT, personal history, and treatment modality alone (area under the ROC curve 0.815). ConclusionCompared with the laparoscopic surgery group, ERCP treatment can effectively relieve symptoms and restore gastrointestinal function in advance in patients with ABP, and reduce hospitalisation time and related complications. Personal history, GGT, and treatment modality are risk factors for recurrence of biliary pancreatitis. Patients can prevent recurrence by abstaining from smoking and alcohol, eating a healthy diet, and exercising appropriately.

The incidence, clinical features and risk factors for postoperative retropharyngeal hematoma and related dyspnea following anterior cervical discectomy and fusion: a single-center study of 10615 patients

BACKGROUND CONTEXTPostoperative retropharyngeal hematoma (PRH) and related dyspnea are rare but life-threatening complications following anterior cervical discectomy and fusion (ACDF) that require urgent recognition and treatment. However, current knowledge of PRH after ACDF is limited. Meanwhile, whether the morphological features of upper airway are the risk factors of PRH remains unknown. PURPOSEThe study aimed to investigate the incidence, clinical features, and risk factors, especially the morphological features of upper airway, of PRH and related dyspnea following ACDF. STUDY DESIGNA nested case‒control study. PATIENT SAMPLEConsecutive patients who underwent ACDF at a single institute from January 2010 to December 2021 were retrospectively reviewed. OUTCOME MEASURESThe outcome measures included the incidence, clinical features, intervention, outcome and risk factors for PRH and related dyspnea. METHODSAll patients with PRH were classified into the hematoma group. For each PRH subject, 3 control subjects without PRH were randomly selected as the control group. The clinical features, interventions and outcomes of patients were described. Potential risk factors were evaluated, including demographics, comorbidities, surgical characteristics, coagulation function, blood loss, preoperative blood pressure, and the morphological features of upper airway [prevertebral soft tissue thickness (PVT) and location of transverse arytenoid muscle (TAM) and epiglottis]. Univariate tests and multivariable logistic regression analysis were used to determine the risk factors for PRH. Subgroup analysis was also conducted for PRH patients with and without dyspnea. RESULTSAmong the 10615 patients who underwent ACDF, 18 (0.17%) developed PRH. The median time from the index surgery to PRH formation was 8.5 hours (25 and 75 percentile: 4 hours to 24 hours). All the PRH patients initially presented with wound swelling. Twelve (0.11%) patients presented dyspnea due to PRH, 2 of whom received urgent intubation and 1 of whom received emergent tracheotomy. All patients underwent hematoma evacuation, and most of them presented with completely relieved symptoms after evacuation, except for 1 patient who died from ischemic hypoxic encephalopathy. A level between the epiglottis and the TAM (LET) greater than 2, ossification of posterior longitudinal ligament (OPLL) and higher diastolic blood pressure (DBP) before surgery were found to be risk factors for PRH formation. Subgroup analysis revealed that a smaller prevertebral soft tissue thickness at C5 was associated with the development of dyspnea. CONCLUSIONThis study is the largest study to date focusing on the PRH and related dyspnea after ACDF. Our study showed that the incidences of PRH and related dyspnea after ACDF were 0.17% and 0.11%, respectively. The predominant symptoms of PRH were wound swelling and acute dyspnea. Most PRH cases occurred in the acute postoperative period. We demonstrated the risk factors for PRH to be (1) OPLL, (2) LET≥2 and (3) higher DBP before surgery and advocate paying increased attention to upper airway morphological features for identifying the risk of PRH after ACDF. With urgent recognition and timely intervention, severe clinical outcomes could be avoided.

Coronary heart disease increases the risk of perioperative ischemic stroke after noncardiac surgery: A retrospective cohort study.

To investigate the association between coronary heart disease (CHD) and the risk of perioperative ischemic stroke in patients undergoing noncardiac surgery. This retrospective study evaluated the incidence of ischemic stroke within 30 days after a noncardiac surgery. A cohort of 221,541 patients who underwent noncardiac surgery between January 2008 and August 2019 was segregated according to whether they were diagnosed with CHD. Primary, sensitivity, and subgroup logistic regression analyses were conducted to confirm that CHD is an independent risk factor for perioperative ischemic stroke. Propensity score matching analysis was used to account for the potential residual confounding effect of covariates. Among the 221,541 included patients undergoing noncardiac surgery, 484 patients (0.22%) experienced perioperative ischemic stroke. The risk of perioperative ischemic stroke was higher in patients with CHD (0.7%) compared to patients without CHD (0.2%), and multivariate logistic regression analysis showed that CHD was associated with a significantly increased risk of perioperative ischemic stroke (odds ratio (OR), 3.7943; 95% confidence interval (CI) 2.865-4.934; p < 0.001). In a subset of patients selected by propensity score matching (PSM) in which all covariates between the two groups were well balanced, the association between CHD and increased risk of perioperative ischemic stroke remained significantly significant (OR 1.8150; 95% CI, 1.254-2.619; p = 0.001). In the subgroup analysis stratified by age, preoperative β-blockers, and fibrinogen-to-albumin ratio (FAR), the association between CHD and perioperative ischemic stroke was stable (p for interaction >0.05). Subgroup analyses also showed that CHD was significantly increased the risk of perioperative ischemic stroke in the preoperative mean arterial pressure (MAP) ≥94.2 mmHg subgroups (p for interaction <0.001). CHD is significantly associated with an increased risk of perioperative ischemic stroke and is an independent risk factor for perioperative ischemic stroke after noncardiac surgery. Strict control of preoperative blood pressure may reduce the risk of perioperative ischemic stroke for patients with CHD undergoing noncardiac surgery.

Perioperative infection prevention during inflatable penile prosthesis surgery: a narrative review.

Penile prostheses are an option for the management of erectile dysfunction (ED). Over the years penile prosthesis surgery has become increasingly safe owing to improvements such as antibiotic usage, coated devices, and surgical techniques. However, infection remains a dreaded complication during prosthesis surgery. Efforts to minimize risk of infection in the perioperative period have been extensively studied. Herein, we performed a narrative review on preoperative, intraoperative, and postoperative strategies for infection prevention during placement of a penile prosthesis with a comparison of infection prevention strategies to other surgical fields. A literature review was performed using PubMed and Google Scholar. Studies evaluating perioperative management of penile prosthesis infection were included. The following search terms were used to for our literature search: penile prosthesis, inflatable penile prosthesis, infection, prevention, perioperative management. Articles were graded based on the 2011 Oxford Centre for Evidence Based Medicine (OCEBM) guidelines and a table was generated with each intervention discussed and its level of evidence based on current literature. Optimization of patient's comorbid conditions can help reduce risk during prosthesis operations. Monitoring and optimizing a patient's glycemic control has been investigated, but the current literature does not necessarily support a strict hemoglobin A1c (HbA1c) or pre-operative blood glucose level. Surgical field preparation using chlorhexidine-based solutions has been shown to be superior to iodine-based solutions. Appropriately selected peri-operative antibiotics have also been shown to reduce infection risk. Intraoperatively, the use of coated devices in addition to a 'no touch' technique have been shown to significantly reduce the risk of inflatable penile prosthesis (IPP) infection. Post operatively, available evidence of antibiotic use has not been demonstrated to be effective in reducing infection rates. Surgical infection following placement of an IPP is a devastating and morbid complication with infection rate up as high as 1-3% in virgin cases and 7-18% in revision cases. While perioperative techniques exist and have reduced risk of infection, more prospective data is needed to evaluate the clinical significance of these different approaches. More research in these areas, along with future options such as nanoparticles, antibiotic coated suture, and next generation sequencing (NGS) for bacterial pathogens, may shed light on further ways to optimize infection reduction strategies for prosthesis surgery.

Commentary: The status quo and influencing factors of clinical research nurses' participation in preoperative blood sampling in patients with pulmonary nodules.

Commentary: The status quo and influencing factors of clinical research nurses' participation in preoperative blood sampling in patients with pulmonary nodules.

The status quo and influencing factors of clinical research nurses' participation in preoperative blood sampling in patients with pulmonary nodules.

Under-recruitment in clinical trials has become a worldwide problem, and has many causes that need to be understood. Clinical Research Nurses (CRNs) provide a new research perspective. To understand the current situation about the informed consent rate after the participation of CRNs and analyse the possible influencing factors. This cross-sectional study was conducted at a hospital. A convenience sample was used to study patients with pulmonary nodules who underwent day surgery from March to May 2023. Patients first received information from doctors and a second session by CRNs was provided for those who initially were hesitant about the research. A questionnaire survey was conducted using an online survey platform to collect information. After education by doctors, 208 patients were hesitant and CRNs conducted a second education session, the CICARE model was used for communication. Following this session a further 161 patients were willing to participate. Finally, 374 patients were willing to participate. Related factors include age, education level and the attitude of self-assessed family members towards their participation in clinical projects. CRNs' participation can improve patients' willingness to participate. It is crucial to pay attention to the role of CRNs and propose a new model of CRNs involvement in clinical research based on identifying factors.

Risk factors for acute complicated appendicitis in children aged three years and younger

ObjectiveThe aim of this study is to identify risk factors associated with acute complicated appendicitis (CA) in children aged three years or younger, providing a theoretical foundation for the management and treatment of acute appendicitis (AA).MethodsA retrospective analysis was conducted on 135 pediatric patients with AA, admitted to the Department of General Surgery at Anhui Children’s Hospital between December 2020 and December 2023, who underwent successful surgical treatment. Based on the intraoperative and postoperative pathological findings, patients were categorized into two groups: complicated appendicitis (CA) (n = 97 cases) and uncomplicated appendicitis (UA) (n = 38 cases). Clinical data including gender, age, weight, disease duration, preoperative white blood cell count (WCC), neutrophil granulocyte (NEUT) count, C-reactive protein (CRP) levels, total bilirubin (TBil) levels, procalcitonin (PCT) levels, calprotectin (Cal) levels, preoperative ultrasound results indicating the presence or absence of fecaliths, maximum appendix diameter, and pediatric appendicitis sore (PAS) were collected and analyzed. Comparative analysis was performed to investigate the differences between the groups and identify risk factors of CA.ResultsThe CA group exhibited significantly higher values in disease duration, CRP levels, PCT, Cal, presence of appendiceal fecaliths, maximum appendix diameter, and PAS compared to the UA group (P < 0.05). Multivariate analysis identified CRP levels, maximum appendix diameter, and PAS as independent risk factors for CA. Specifically, differences in CRP level (OR = 1.045, 95% CI:1.024 ~ 1.067, P < 0.001), PAS (OR = 1.768, 95% CI:1.086 ~ 2.879, P = 0.022), and maximum appendix diameter (OR = 1.860, 95% CI:1.085 ~ 3.191, P = 0.024) were significant. The area under the receiver operating characteristic curve values were 0.6776 for the PAS, 0.7663 for CRP, and 0.5604 for the maximum appendix diameter.ConclusionCRP levels, PAS, and maximum appendix diameter are independent risk factors for CA in children under three years of age. These parameters are valuable for the early diagnosis of CA.

Pre-operative spinal cord perfusion quantified by DSC MRI as a predictor of post-operative prognosis in patients with cervical spondylotic myelopathy.

This study aims to investigate the potential of preoperative blood supply condition measured by dynamic susceptibility contract (DSC) MRI in prediction of postoperative outcomes for patients with cervical spondylotic myelopathy (CSM). Thirty-nine patients (Age: 61 ± 7, male: 23, female: 16) with CSM who underwent laminoplasty were enrolled. All patients received DSC MRI before the operation. Five parameters include Enhance, rEnhance, full width at half maxima (FWHM), Slope1 and Slope2 in DSC MRI, were calculated at all the compressed spinal cord segments. Clinical outcomes were evaluated by modified Japanese Orthopaedic Association (mJOA) scores. Patients were divided into two groups based on mJOA recovery rate of 5years: good recovery (> 50%) or poor recovery (≤ 50%). The difference between two groups were compared. The value of DSC MRI to CSM was evaluated by logistic and receiver operating characteristic (ROC) curve analysis. There were 26 patients in good recovery group and 13 patients in poor recovery group. The baseline characteristics, including age, gender, preoperative mJOA score, and smoking status showed no significant difference between the two groups (all p > 0.05). The FWHM was significantly higher in the poor recovery group (9.77 ± 2.78) compared to the good recovery group (6.64 ± 1.65) (p = 0.002). Logistic regression analysis indicated that an increased FWHM was a significant risk factor for poor prognosis recovery (p = 0.013, OR = 0.392, 95%CI: 0.187-0.822). The AUC of FWHM for ROC was 0.843 (95% CI: 0.710-0.975) with a p value of 0.001. In addition, an FWHM greater than 5.87, with a sensitivity of 92.3% and specificity of 69.2%, was found to be an independent risk factor for poor postoperative recovery in patients with CSM. In this study, we successfully quantified the spinal cord blood supply condition by DSC MRI technique. We found that an increase in FWHM was an independent risk factor for poor postoperative recovery in CSM patients. Specifically, patients with FWHM > 5.87 have a poor postoperative recovery.

Intraoperative Polymerase Chain Reaction from Cardiac Valve Tissue Is Beneficial for Guiding Further Therapy in Patients with Infective Endocarditis.

Background: Infectious endocarditis (IE) remains a critical condition despite all the medical advances in recent decades. Reliable pathogen identification is indispensable for precise therapy. The aim of this study was to evaluate the diagnostic and therapeutic benefit of additional polymerase chain reaction (PCR) in comparison with microbiological culture alone based on intraoperative tissue sampling for patients operated on due to IE. Methods: A total of 224 patients diagnosed with acute or subacute IE were analyzed. Intraoperatively resected infectious tissue was analyzed using both PCR and microbiological culture. Subsequently, the results of the detection of bacteria obtained based on intraoperative measurements from tissue via culture and PCR were compared with preoperative blood culture results. Furthermore, we evaluated the therapeutic impact of the culture and/or PCR results obtained from cardiac tissue. Results: The 224 patients were 63 ± 17 years old, and 64 (29%) were female. In total, 149 (67%) suffered from aortic valve endocarditis, 45 (45%) had mitral valve endocarditis, and 39 (18%) were afflicted with double-valve endocarditis. Prosthetic valve endocarditis was present in 70 (31%) patients. Pathogens were detected in 70% of the cases analyzed via PCR using cardiac valve tissue and in 25% of those analyzed via a culture of cardiac valve tissue; this figure was only 64% for preoperative blood culture. Overall, a pathogen was identified in 197 patients (88%), leading to antibiotic therapy. Targeted antibiotic therapy, based on the PCR results, was carried out in 37 cases and was conducted based on a culture from cardiac valve tissue in three cases. Finally, in 12% of patients, the causative pathogen remained unclear. Conclusions: For patients suffering endocarditis, PCR analysis is indispensable and superior to preoperative blood culture and intraoperative culture in detecting bacteria. Based on PCR testing, antibiotic therapy can be individually adjusted. The high precision of pathogen identification may lead to a significant reduction in IE-associated morbidity and mortality.

Endovascular Aortic Balloon control versus open Aortic cross Clamp in open ruptured abdominal Aortic aneurysm repair

To determine 30-day mortality of endovascular aortic balloon control compared with open aortic cross clamp in open surgical repair (OSR) of ruptured abdominal aortic aneurysms (rAAAs). A retrospective cohort review was performed of all adult patients who underwent OSR of an infrarenal rAAA between 2001 and 2018 at a single tertiary care center. A total of 174 patients were identified, of which 21 patients received endovascular aortic balloon control and 137 patients received an open aortic cross clamp. Primary outcome was 30-day mortality. Two-variable multivariate logistic regression was adjusted for preoperative blood pressure and age. Endovascular aortic balloon control was nonsignificantly associated with lower mortality (adjusted odds ratio [OR]=0.75 (95% confidence interval [CI] 0.24 to 2.38), P=0.63), and when placed under local anesthesia showed a trend toward improved mortality (adjusted OR=0.34 (95%CI 0.06 to 1.77), P=0.19). Balloon placement under general anesthesia was nonsignificantly associated with worse mortality (adjusted OR=2.50 (95%CI 0.35 to 9.13), P=0.46). There is no significant difference in mortality with the use of endovascular aortic balloon control in rAAA patients undergoing OSR, and it may be considered as an alternative approach to open aortic cross clamp in properly selected patients.

Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia

PurposeThe trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes.MethodsWe selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery.ResultsThe mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006).ConclusionsIntraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.

Association of Preoperative Copeptin Levels with Risk of All-Cause Mortality in a Prospective Cohort of Adult Cardiac Surgery Patients.

We aimed to investigate the association of preoperative copeptin, a new cardiovascular biomarker, with short- and long-term mortality in a cohort of adult patients undergoing cardiac surgery, including its potential as a prognostic marker for clinical outcome. Preoperative blood samples of the Bern Perioperative Biobank, a prospective cohort of adults undergoing cardiac surgery during 2019, were analyzed. The primary and secondary outcome measures were 30-day and 1-year all-cause mortality. Optimal copeptin thresholds were calculated with the Youden Index. Associations of copeptin levels with the two outcomes were examined with multivariable logistic regression models; their discriminatory capacity was assessed with the area under the receiver operating characteristic (AUROC). A total of 519 patients (78.4% male, median age 67 y (IQR: 60-73 y)) were included, with a median preoperative copeptin level of 7.6 pmol/L (IQR: 4.7-13.2 pmol/L). We identified an optimal threshold of 15.9 pmol/l (95%-CI: 7.7 to 46.5 pmol/L) for 30-day mortality and 15.9 pmol/L (95%-CI: 9.0 to 21.3 pmol/L) for 1-year all-cause mortality. Regression models featured an AUROC of 0.79 (95%-CI: 0.56 to 0.95) for adjusted log-transformed preoperative copeptin for 30-day mortality and an AUROC of 0.76 (95%-CI: 0.64 to 0.88) for 1-year mortality. In patients undergoing cardiac surgery, the baseline levels of copeptin emerged as a strong marker for 1-year all-cause death. Preoperative copeptin levels might possibly identify patients at risk for a complicated, long-term postoperative course, and therefore requiring a more rigorous postoperative observation and follow-up.

The Relation of Preoperative HbA1c Level With Intraoperative and Postoperative Complications in Type-2 Diabetic Patients: An Observational Study.

Background Perioperative dysglycemia increases morbidity and mortality, particularlyamong those with diabetes mellitus (DM), and elevated HbA1clevels,reflecting long-term blood glucose, are linked to poor healing and higher infection rates. This study investigates the link between preoperative HbA1c levels and perioperative outcomes in type-2 DM patients. Methodology This prospective observational study was conducted in India between January 2021 and April 2022. Sixty patients aged 18-60 with type-2 DM who underwent electivesurgery under general anesthesia (GA) were included; the American Society of Anesthesiologists class >III and patients with severe organ failures were excluded. Participants were divided into two groups: A (HbA1c ≤7.5%) and B (HbA1c >7.5%). Data on preoperative vitals, intraoperative hemodynamics, and postoperative complications were collected. SPSS v23 was used for data analysis; p-value <0.05 was considered significant. Results The mean age of the participants was 48.22 years; males comprised 58.3%. Group A had a higher proportion of oral hypoglycemic agents. Group B showed higher maximum mean blood pressure and intraoperative blood sugar levels at one hour. Postoperatively, Group B had higher glucose levels, more prevalent hyperglycemia, and higher preoperative and postoperative blood urea levels. No significant differences were found in postoperative outcomes like acute kidney injury (AKI), leukocytopenia, leucocytosis, fever, and intensive care admission. Surgical site infection (SSI) incidence was higher in group B, though not statistically significant. Group B had more extended hospital stays. Conclusion Preoperative HbA1c above 7.5% was associated with impaired perioperative glycemic control and higher dysglycemic episodes. Higher preoperative HbA1c was found to be linked to increased postoperative hyperglycemia, AKI, intensive care admissions, and more extended hospital stays, though not statistically significant. SSI incidence was higher, highlighting its importance over preoperative HbA1c.

Using fosfomycin to prevent infection following ureterorenoscopy in response to shortage of cephalosporins: a retrospective preliminary study

BackgroundIn 2019, the shortage of cefazolin led to the demand for cefotiam and cefmetazole exceeding the supply. The Department of Nephro-urology at Nagoya City University Hospital used fosfomycin as a substitute for perioperative prophylaxis. This retrospective preliminary study evaluated the efficacy of fosfomycin and cefotiam for preventing infections following ureterorenoscopy.MethodsThe study included 182 patients who underwent ureterorenoscopy between January 2018 and March 2021). Perioperative antibacterial treatment with fosfomycin (n = 108) or cefotiam (n = 74) was administered. We performed propensity score matching in both groups for age, sex, preoperative urinary catheter use, and preoperative antibiotic treatment.ResultsThe fosfomycin and cefotiam groups (n = 69 per group) exhibited no significant differences in terms of patients’ median age, operative duration, preoperative urine white blood cell count, preoperative urine bacterial count, and the rate of preoperative antibiotic treatment. In the fosfomycin and cefotiam groups, the median duration of postoperative hospital stay was 3 and 4 days, respectively; the median maximum postoperative temperature was 37.3 °C and 37.2 °C, respectively. The fosfomycin group had lower postoperative C-reactive protein levels and white blood cell count than the cefotiam group. However, the frequency of fever > 38 °C requiring additional antibiotic administration was similar.ConclusionsDuring cefotiam shortage, fosfomycin administration enabled surgeons to continue performing ureterorenoscopies without increasing the complication rate.

Influence of implantable Collamer lens implantation on choroidal thickness and blood flow density

Objective: To observe the impact of implantable Collamer lens (ICL) implantation surgery on choroidal thickness and blood flow density in myopic patients. Methods: This was a prospective cohort study. Patients undergoing ICL surgery at Qingdao University Affiliated Hospital between June 2021 and May 2023 were consecutively enrolled. Patients were categorized into high myopia (HM) and super high myopia (SHM) groups based on whether their spherical equivalence power exceeded 10.00 D. Comprehensive ophthalmic examinations, including optical coherence tomography, optical coherence tomography angiography, visual acuity assessment, intraocular pressure measurement, and optometry, were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results: A total of 42 patients (84 eyes), with an average age of (25.27±3.18) years, comprising 11 males and 31 females, were enrolled in the study. Among them, 20 patients belonged to the HM group, while 22 patients were in the SHM group. Both choroidal thickness and blood flow density exhibited significant increases at postoperative 1 week and 1 month compared to preoperative levels (P<0.05), but returned to baseline levels by postoperative 3 months. Specifically, the subfoveal choroidal thickness increased from (169.49±61.57) μm preoperatively to (180.16±66.61) μm at 1 week, (186.69±63.32) μm at 1 month, and then reverted to (169.58±60.82) μm at 3 months. The central choroidal blood flow density showed changes from 60.03%±1.60% preoperatively to 61.04%±1.17% at 1 week, 60.42%±1.81% at 1 month, and 60.22%±1.57% at 3 months. Furthermore, the HM group exhibited more pronounced changes in both choroidal thickness and blood flow density across all time points compared to the SHM group. Significant differences were observed in choroidal thickness changes at various areas at 1 month, while changes in blood flow density in specific areas were significant. However, no significant differences were noted at 3 months postoperatively. Correlation analysis revealed a negative correlation of changes in subfoveal choroidal thickness and central choroidal blood flow density postoperatively at 1 week and 3 months with preoperative choroidal blood flow density. Notably, no correlation was found between preoperative choroidal thickness and postoperative changes. Conclusions: In the early period following ICL implantation, the increase in choroidal thickness and blood flow density may be more pronounced in HM compared to SHM, but the two parameters can return to baseline levels by 3 months. ICL implantation transiently affects the fundus microenvironment in myopic patients, with implications of preoperative choroidal blood flow.

Construction and validation of a nomogram for blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures in the elderly: a cross-sectional study

PurposeFew studies have focused on the risk factors leading to postoperative blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures (PHFs) in the elderly. Therefore, we designed this study to explore potential risk factors of blood transfusion after ORIF for PHFs. We have also established a nomogram model to integrate and quantify our research results and give feedback.MethodsIn this study, we retrospectively analyzed the clinical data of elderly PHF patients undergoing ORIF from January 2020 to December 2021. We have established a multivariate regression model and nomograph. The prediction performance and consistency of the model were evaluated by the consistency coefficient and calibration curve, respectively.Results162 patients met our inclusion criteria and were included in the final study. The following factors are related to the increased risk of transfusion after ORIF: time to surgery, fibrinogen levels, intraoperative blood loss, and surgical duration.ConclusionsOur patient-specific transfusion risk calculator uses a robust multivariable model to predict transfusion risk.The resulting nomogram can be used as a screening tool to identify patients with high transfusion risk and provide necessary interventions for these patients (such as preoperative red blood cell mobilization, intraoperative autologous blood transfusion, etc.).

Evaluation of the adherence to surgical antibiotic prophylaxis recommendations and associated factors in a University Hospital: A cross-sectional study

Surgical antibiotic prophylaxis (SAP) is an important preventive measure, aiming to minimize surgical site infections. However, despite evidence-based guidelines, adherence to SAP protocols remains suboptimal in clinical practice. The aim of this study was to assess the adequacy of SAP in a high-complexity hospital and investigate associated factors. A cross-sectional design was conducted, involving surgeries performed by expert teams in cardiology, urology, neurology, and gastrointestinal. SAP prescriptions were evaluated based on indication, antibiotic choice, dosage, and duration, according to the hospital protocol. Data analysis included descriptive statistics and association tests between protocol adherence and patient demographics, clinical variables, surgical teams, and types of surgeries. Out of 1,864 surgeries, only 20.7% adhered to SAP protocols. Lower adherence rates were observed for antibiotic choice and duration of prophylaxis. Neurological surgeries exhibited significantly lower adherence, particularly concerning antibiotic choice and duration. Factors associated with nonadherence included elevated preoperative blood glucose levels, prolonged hospitalization, and extended surgical duration. Logistic regression analysis identified surgical teams as significant factors influencing protocol adherence. Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment. Poor glycemic control, prolonged surgery, and surgical teams were variables associated with inappropriate practice.

Excessive use of preoperative blood type and antibody screening: A retrospective observational study conducted in a hospital in Norway.

This study aimed to identify the blood transfusion rates for several surgical procedures in a single district general hospital and assess the value of preoperative blood type and antibody screen across all relevant surgical procedures. We hypothesized that there was an overuse of blood type and antibody screen in our general surgical population. A database containing transfusions of patients who underwent elective- or emergency surgery from January 2015 to September 2020 was matched to a database of preoperative type-and-screen performed in the same period. Registered procedures where the incidence of transfusion is deemed low were excluded. The included procedures were assessed for the intraoperative usefulness of type- and-screen testing. In the included 68.892 surgeries, 36.134 (52.0%) blood samples were preoperatively tested for the blood type and screened for antibodies according to the hospital's routine. Overall 3.517 (5.1%) of surgeries had patients that received a transfusion in the perioperative period and 1.2% (n = 850) during the surgery. Most surgeries had a very low incidence of transfusion. Despite this, type-and-screen tests were widely used. This suggests the need for a more focused pre-surgery type-and-screen approach, and a more data driven approach to local guidelines in collaboration with surgical specialties.

Machine learning models to predict systemic inflammatory response syndrome after percutaneous nephrolithotomy

ObjectiveThe objective of this study was to develop and evaluate the performance of machine learning models for predicting the possibility of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL).MethodsWe retrospectively reviewed the clinical data of 337 patients who received PCNL between May 2020 and June 2022. In our study, 80% of the data were used as the training set, and the remaining data were used as the testing set. Separate prediction models based on the six machine learning algorithms were created using the training set. The predictive performance of each machine learning model was determined by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity using the testing set. We used coefficients to interpret the contribution of each variable to the predictive performance.ResultsAmong the six machine learning algorithms, the support vector machine (SVM) delivered the best performance with accuracy of 0.868, AUC of 0.942 (95% CI 0.890–0.994) in the testing set. Further analysis using the SVM model showed that prealbumin contributed the most to the prediction of the outcome, followed by preoperative urine culture, systemic immune-inflammation (SII), neutrophil to lymphocyte ratio (NLR), staghorn stones, fibrinogen, operation time, preoperative urine white blood cell (WBC), preoperative urea nitrogen, hydronephrosis, stone burden, sex and preoperative lymphocyte count.ConclusionMachine learning-based prediction models can accurately predict the possibility of SIRS after PCNL in advance by learning patient clinical data, and should be used to guide surgeons in clinical decision-making.

Association between preoperative persistent hyperglycemia and postoperative delirium in geriatric hip fracture patients

BackgroundThe management of preoperative blood glucose levels in reducing the incidence of postoperative delirium (POD) remains controversial. This study aims to investigate the impact of preoperative persistent hyperglycemia on POD in geriatric patients with hip fractures.MethodsThis retrospective cohort study analyzed medical records of patients who underwent hip fracture surgery at a tertiary medical institution between January 2013 and November 2023. Patients were categorized based on preoperative hyperglycemia (hyperglycemia defined as ≥ 6.1mmol/L), clinical classification of hyperglycemia, and percentile thresholds. Multivariate logistic regression and propensity score matching analysis (PSM) were employed to assess the association between different levels of preoperative glucose and POD. Subgroup analysis was conducted to explore potential interactions.ResultsA total of 1440 patients were included in this study, with an incidence rate of POD at 19.1% (275/1440). Utilizing multiple logistic analysis, we found that patients with hyperglycemia had a 1.65-fold increased risk of experiencing POD compared to those with normal preoperative glucose levels (95% CI: 1.17–2.32). Moreover, a significant upward trend was discerned in both the strength of association and the predicted probability of POD with higher preoperative glucose levels. PSM did not alter this trend, even after meticulous adjustments for potential confounding factors. Additionally, when treating preoperative glucose levels as a continuous variable, we observed a 6% increase in the risk of POD (95% CI: 1-12%) with each 1mmol/L elevation in preoperative glucose levels.ConclusionsThere exists a clear linear dose-response relationship between preoperative blood glucose levels and the risk of POD. Higher preoperative hyperglycemia was associated with a greater risk of POD.Clinical trial numberNCT06473324.