Predictor Of Postoperative Infectious Complications Research Articles

Influence of dental status on postoperative complications in major visceral surgical and organ transplantation procedures—the bellydent retrospective observational study

PurposeThe significance of dental status and oral hygiene on a range of medical conditions is well-recognised. However, the correlation between periodontitis, oral bacterial dysbiosis and visceral surgical outcomes is less well established. To this end, we study sought to determine the influence of dental health and oral hygiene on the rates of postoperative complications following major visceral and transplant surgery in an exploratory, single-center, retrospective, non-interventional study.MethodsOur retrospective non-interventional study was conducted at the Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Germany. Patients operated on between January 2018 and December 2019 were retrospectively enrolled in the study based on inclusion (minimum age of 18 years, surgery at our Department, intensive care / IMC treatment after major surgery, availability of patient-specific preoperative dental status assessment, documentation of postoperative complications) and exclusion criteria (minor patients or legally incapacitated patients, lack of intensive care or intermediate care (IMC) monitoring, incomplete documentation of preoperative dental status, intestinal surgery with potential intraoperative contamination of the site by intestinal microbes, pre-existing preoperative infection, absence of data regarding the primary endpoints of the study). The primary study endpoint was the incidence of postoperative complications. Secondary study endpoints were: 30-day mortality, length of hospital stay, duration of intensive care stay, Incidence of infectious complications, the microbial spectrum of infectious complication. A bacteriology examination was added whenever possible (if and only if the examination was safe for the patient)for infectious complications.ResultsThe final patient cohort consisted of 417 patients. While dental status did not show an influence (p = 0.73) on postoperative complications, BMI (p = 0.035), age (p = 0.049) and quick (p = 0.033) were shown to be significant prognostic factors. There was significant association between oral health and the rate of infectious complications for all surgical procedures (p = 0.034), excluding transplant surgery. However, this did not result in increased 30-day mortality rates, prolonged intensive care unit treatment or an increase in the length of hospital stay (LOS) for the cohort as a whole. In contrast there was a significant correlation between the presence of oral pathogens and postoperative complications for a group as a whole (p < 0.001) and the visceral surgery subgroup (p < 0.001). Whilst this was not the case in the cohort who underwent transplant surgery, there was a correlation between oral health and LOS in this subgroup (p = 0.040). Bacterial swabs supports the link between poor oral health and infectious morbidity.ConclusionsDental status was a significant predictor of postoperative infectious complications in this visceral surgery cohort. This study highlights the importance preoperative dental assessment and treatment prior to major surgery, particularly in the case of elective surgical procedures. Further research is required to determine the effect of oral health on surgical outcomes in order to inform future practice.Trial registrationTrial registered under the ethics-number S-082/2022 (Ethic Committee of the University Heidelberg).

Predictors of postoperative infectious complications after partial nephrectomy: Analysis at a referral institution

ObjectiveInfectious complications after partial nephrectomy (PN) remain a significant concern. We aimed to analyze predictive factors of postoperative infectious complications (PICs) occurring after PN. MethodsData on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed. Patients were stratified into two groups based on the occurrence of PICs during admission for PN. A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination. Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of PIC. ResultsSix-hundred and twenty-eight patients underwent PN; rough incidence of PICs was 11.6%, with median time to PIC onset of 1 (interquartile range 0–3) day. Compared to patients without PIC events, the PIC group showed a significantly higher proportion of open surgeries (53.6% vs. 20.4%, p<0.001), hemoglobin drop vs. baseline (−2.6 g/dL vs. −1.7 g/dL, p=0.001), bleeding events (23.2% vs. 10.1%, p<0.01), postoperative transfusion (5% vs. 18.8%, p<0.001), and urinary leakage (4.1% vs. 0.2%, p=0.01). At multivariable logistic regression, the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery (odds ratio 0.32, 95% confidence interval 0.17–0.59), and higher for patients who received transfusion (odds ratio 2.64, 95% confidence interval 1.38–5.05). ConclusionsWe underlined factors that impact the occurrence of PICs and, consequently, duration of hospitalization following PN. By addressing these predictors, clinicians can promote enhanced patient recovery.

Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study.

The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear. We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery. Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146min vs. laparoscopic surgery 203min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications. Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications.

Preoperative predictors of postoperative infectious complications in acute cholecystitis: a blinded case-control study

Preoperative predictors of postoperative infectious complications in acute cholecystitis: a blinded case-control study

The role of geriatric nutritional risk index as a predictor for postoperative outcomes in gastrointestinal emergencies.

The geriatric nutritional risk index (GNRI) is a simple nutritional and inflammatory marker for older adults. The aim of the present study was to investigate the usefulness of the GNRI in older adults who underwent emergency gastrointestinal surgery. This study included 206 older adults who had undergone emergency gastrointestinal surgery. We retrospectively investigated the relationship between the GNRI and postoperative complications. Univariate and multivariate analyses were performed to evaluate risk factors for postoperative complications. We then evaluated the association between GNRI and clinical variables among older adults undergoing emergency gastrointestinal surgery. Postoperatively, all complications occurred in 89 (43%) older adults, infectious in 53 (26%), and non-infectious in 36 (17%). In the multivariate analysis, age (p=0.016), GNRI (p=0.012), operative severity (p=0.003), and operation time (p=0.003) were independent risk factors for all postoperative complications. While the GNRI (p=0.049) was an independent risk factor for infectious complications, age (p=0.035) and bleeding volume (p=0.035) were independent risk factors for postoperative non-infectious complications. In the low GNRI group, age (p=0.029), serum C-reactive protein levels (p<0.001), and proportion of sarcopenia (p<0.001) were significantly higher, and the length of hospital stay (p<0.001) was significantly longer than that in the high GNRI group. In Spearman's rank correlation coefficient, the skeletal mass index and the GNRI had a positive correlation (r=0.415 and p<0.001). The GNRI may be a predictor of postoperative infectious complications in older adults after emergency gastrointestinal surgery, suggesting the usefulness of the GNRI as a nutritional marker and sarcopenia-related parameter. No. 22-16.

Early postoperative hyperglycemia as a predictor of postoperative infectious complications and overall survival in non-diabetic patients with esophageal cancer

BackgroundDiabetes mellitus (DM) is known to be a risk factor for postoperative infectious complications (PICs). However, the significance of postoperative hyperglycemia in non-DM cases has not been well investigated. We sought to establish whether postoperative hyperglycemia is associated with PICs and survival among patients with esophageal cancer, with a focus on non-DM cases. MethodsA total of 430 patients who underwent subtotal esophagectomy for esophageal cancer between 2014 and 2018 were enrolled. Postoperative blood glucose was measured by arterial blood gas test every 8 h from postoperative day (POD) 1 to POD4. The association between hyperglycemia (mean ≥ 200 mg/dl) and PICs or long-term outcomes on each POD was investigated. ResultsThere were 53 DM and 377 non-DM cases. PICs occurred in 127 patients. In the multivariate analysis of all cases, PICs were associated with hyperglycemia on POD1 or -2 (odds ratio [OR] = 1.69, 95% CI, 1.05–2.73, P = 0.031 for POD1; OR = 2.55, 95% CI, 1.10–5.93, P = 0.029 for POD 2). Among non-DM cases, the association was more evident, and persisted until POD4 (OR = 1.94, 95% CI, 1.16–3.24, P = 0.012 for POD1; OR = 3.68, 95% CI, 1.28–10.6, P = 0.016 for POD2; OR = 3.07, 95% CI, 1.11–8.51, P = 0.031 for POD4). Survival analyses limited to R0 cases revealed hyperglycemia on POD2 as an independent prognostic factor in all cases (N = 412) [hazard ratio (HR) = 2.61, 95%CI, 1.21–5.63, P = 0.014], with the prognostic impact more evident among non-DM cases (N = 360) (HR = 4.38, 95% CI, 1.82–10.57, P = 0.0010). ConclusionPostoperative hyperglycemia is associated with PICs and worse survival after esophagectomy, particularly in patients without DM.

Skeletal Muscle Loss During Neoadjuvant Chemotherapy Predicts the Incidence of Postoperative Infectious Complications in Esophageal Cancer Patients Undergoing Esophagectomy.

Malnutrition, immune deficiency, and skeletal muscle loss are associated with a risk of postoperative complications in patients with various types of cancer. This study evaluated whether malnutrition, immunological deficiencies, and skeletal muscle loss during neoadjuvant chemotherapy (NAC) predict postoperative complications in patients with esophageal cancer. We retrospectively reviewed 123 patients with esophageal squamous cell carcinoma treated with NAC and esophagectomy at our hospital between 2014 and 2019. Patients were divided into two groups based on the presence or absence of postoperative infectious complications, such as pneumonia, anastomotic leakage, surgical site infections, pyothorax, acalculous cholecystitis, and peripheral phlebitis. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Onodera prognostic nutritional index were used as indicators of systemic inflammation and nutritional status. Skeletal muscle mass was evaluated using the skeletal muscle index (SMI), calculated by evaluating the total cross-sectional area of muscle tissue at the third lumbar level in computed tomography imaging. Univariable and multivariable logistic regression analyses were used to identify predictors of postoperative infectious complications. Postoperative infectious complications occurred in 41 patients (33.3%). A reduction in SMI was observed in 105 patients (87.8%) during NAC. Univariable and multivariable analyses indicated that the reduction in SMI during NAC was an independent predictor of postoperative complications (odds ratio=0.89; 95% confidence interval=0.79-0.99; p=0.048). Skeletal muscle loss during NAC is a useful predictor of postoperative complications in patients with esophageal cancer undergoing esophagectomy.

Prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in obstructive colorectal cancer patients with a stent inserted as a bridge to curative surgery.

The prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in patients with malignancy have not been intensely investigated and are largely overlooked. We, therefore, investigated the clinical significance of MCV and RDW in non-metastatic obstructive colorectal cancer (OCRC) patients with a self-expandable metallic stent inserted as a bridge to curative surgery. Eighty-five pathological stage II and III OCRC patients were retrospectively evaluated. The associations of the preoperative MCV and RDW values with short- and long-term outcomes were examined. There were 50 males and 35 females, and the median age was 71years old. The median interval between stenting and surgery was 17days, and the median postoperative hospital stay was 16days. Fifty-six patients were in the MCV ≥ 87 group, and 47 were in the RDW ≥ 13.8 group. Multivariate analyses revealed the MCV ≥ 87 status to be independently associated with a poor relapse-free survival (hazard ratio [HR] = 4.70, 95% confidence interval [CI] 1.52-14.58, P = 0.007). The RDW ≥ 13.8% was an independent predictor of postoperative infectious complications (HR = 7.28, 95% CI 1.24-42.70, P = 0.028). The MCV and RDW are simple but strong predictors of postoperative outcomes in OCRC patients.

Role of cultural analysis in patients with indwelling ureteral stent submitted to ureteroscopy for stones.

Aim of our study is to analyze the incidence of postoperative infectious complications and to assess its predictors in patients with indwelling ureteral stent treated with ureteroscopy (URS). We retrospectively evaluated data of patients treated with URS from January 2017 to July 2018 at our center. We included 88 consecutive patients with available stent culture (SC) and urine culture (UC). Cefoxitin 2 g IV was given as prophylaxis in all patients with negative preoperative UC; otherwise, the choice of antibiotic was based on antibiogram. Ureteral stent was removed before URS procedure and analyzed. No postoperative antibiotic was given. Multivariable logistic regression analysis was built to assess preoperative predictors of postoperative infectious complications. Nineteen patients (22%) developed postoperative infectious complications and fever was the most common one. E. faecalis, which is not responsive to common prophylaxis schemes in force in our institution, was the most frequent pathogen isolated. Overall, 26% of patients were found to have a discordance between SC and UC. At multivariable logistic regression analysis preoperative SC positivity (Odds Ratio [OR]: 11.00, 95% Confidence Interval [CI]:1.08-111.41, P=0.04) was the only significant predictor of postoperative infectious complications. About one to five patients treated with URS developed an infectious complication and E. faecalis and E. coli were the most frequent pathogen isolated. A positive SC is the only independent risk factor for postoperative infection: consequently, an early SC analysis could allow a prompt antibiotic therapy in all patients with positive SC even if mildly symptomatic.

The prognostic nutritional index for postoperative infectious complication in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis following subtotal colectomy.

Objectives: Restorative proctocolectomy and ileal pouch-anal anastomosis is frequently performed in patients with ulcerative colitis and factors suspected of increasing the risk of postoperative infectious complications. Using a three-stage approach may result in improvement in overall outcomes, because this leads to improvement in nutritional status and reduction of immunosuppressive doses. However, the influence of preoperative nutritional status on postoperative infectious complications after this procedure has not been examined. The aim of this study was to clarify the potential associations between nutritional status and postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis. Methods: The records of 110 patients who had undergone proctectomy with ileal pouch-anal anastomosis from January 2000 to March 2018 in Mie University and met the eligibility criteria were reviewed and possible associations between postoperative infectious complications and clinical factors were assessed. Results: Of the remaining 110 patients, 18 (16.4%) had developed postoperative infectious complications. Multivariate analysis revealed that operative bleeding ≥270 g and prognostic nutritional index <47 were significant predictors of postoperative infectious complications (P = 0.033, 0.0076, respectively). Various variables associated with immunosuppressives before ileal pouch-anal anastomosis were not associated with postoperative infectious complications. Conclusions: Our findings suggest that immunosuppressives have no association with postoperative infectious complications, whereas a poor prognostic nutritional index may be a significant predictor of postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis.

Serum procalcitonin as a predictor of infectious complications after pancreaticoduodenectomy: review of the literature and our experience.

Procalcitonin (PCT) is an early predictor of bacterial infection. We reviewed the literature and analyzed data on our own patients to assess the value of PCT as a predictor of infectious complications after pancreaticoduodenectomy (PD). The relevant literature published up until November 30, 2018, was reviewed, with no publication date restrictions. Letters to the editor and studies lacking necessary data were excluded. We also reviewed, retrospectively, the medical records of 77 patients who underwent PD between January, 2011 and April, 2016 at our hospital, to evaluate infectious complications and laboratory results on postoperative days (PODs) 1 and 3. Six studies were screened, and four cohort studies on patients undergoing PD were analyzed. One report examined preoperative PCT and C-reactive protein (CRP) levels, whereas the others examined only postoperative PCT and/or CRP levels. All reports demonstrated the usefulness of PCT as a predictor of postoperative infectious complications; however, no report concluded that PCT was a better predictor than CRP, except for the one report that examined preoperative PCT levels. Conversely, our experience demonstrated that the most significant factor predicting infectious complications was PCT on POD 3 (sensitivity, 0.87; specificity, 0.88). Thus, serum PCT could be a predictor of all complications, including infectious complications, after PD, but no advantage over CRP was identified.

Surgical stress biomarkers as early predictors of postoperative infectious complications in patients with colorectal cancer

Background: The aim of this study was to determine if the serum surgical stress biomarkers tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) could predict infectious complications in patients who underwent colorectal cancer (CRC) surgery. Methods: A total of 200 consecutive patients who underwent resection for primary CRC were enrolled. The clinicopathological characteristics, serum TNF-α and IL-10 levels, and infectious complications were analyzed. The TNF-α and IL-10 levels were classified using cut-off values based on a ROC analysis. Results: Infectious complications developed in 27 (13.5%) patients. Patients with complications had higher serum IL-10 levels than those without complications during the first 5 postoperative days (PODs) (P 72.4 ng/L on POD 1, >35.3 ng/L on POD 3 or >20.3 ng/L on POD 5 was associated with the occurrence of infectious complications (all P 6.9 ng/L and a TNF-α level >8.1 ng/L on POD 1 and >7.5 ng/L on POD 3 were confirmed as sensitive and specific predictors of complications (P Conclusions: Serum TNF-α and IL-10 levels were associated with the development of infectious complications. These cytokines can serve as useful biomarkers for identifying perioperative morbidity and for helping to guide the postoperative management of patients undergoing CRC surgery.

Surgical stress biomarkers as early predictors of postoperative infectious complications in patients with colorectal cancer

Background: The aim of this study was to determine if the serum surgical stress biomarkers tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) could predict infectious complications in patients who underwent colorectal cancer (CRC) surgery.

Predictors of postoperative infectious complications in liver transplant recipients: experience of 185 consecutive cases.

Background/AimsInfections following liver transplant (LT) remain a major cause of mortality. This study was conducted to evaluate risk factors for infection and to review clinical characteristics.MethodsMedical records of patients who underwent LT from 2010 to 2014 were retrospectively analyzed. Binary logistic regression analysis was used to investigate risk factors of infection. Kaplan-Meier analysis was used to predict prognosis of infected and non-infected groups.ResultsOf 185 recipients, 89 patients experienced infectious complications. The median follow-up period was 911 days (range, 9 to 2,031). The infected group had higher 1-year mortality (n = 22 [24.7%] vs. n = 8, [8.3%], p = 0.002), and longer postoperative admission days (mean: 53.7 ± 35.8 days vs. 28.3 ± 13.0 days, p < 0.001), compared to the non-infected group. High preoperative Model for End-Stage Liver Disease (MELD) score (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010 to 1.105; p = 0.016), deceased-donor type (OR, 5.475; 95% CI, 2.442 to 12.279; p < 0.001), and acute rejection (OR, 3.042; 95% CI, 1.241 to 7.454; p = 0.015) were independent risk factors associated with infection. Intra-abdominal infection (n = 35, 20.8%) was the major infectious complication. Among identified bacteria, Enterococcus species (28.4%) were major pathogens, followed by Escherichia coli and Klebsiella species.ConclusionsHigh preoperative MELD score, deceased-donor type, and acute rejection were risk factors associated with infection. To prevent infections following surgery, it is important to determine the appropriate time of operation before the recipient has a high MELD score.

The role of preoperative C-reactive protein and procalcitonin as predictors of post-pancreaticoduodenectomy infective complications: A prospective observational study.

The common causes of morbidity after pancreaticoduodenectomy (PD) are infective complications. Till date, no specific preoperative markers have been identified to determine the probability of developing infective complications. We have studied the factors predicting the occurrence of the infective complication/s in the present study. The present prospective observational study included 133 consecutive patients who underwent PD from January 2011 to June 2016 at a specialized hepatopancreaticobiliary surgical oncology unit. The surgeries were done using a standardized technique. Postoperative complications were segregated into two categories-(a) infective (e.g. cholangitis) and (b) non-infective (e.g. delayed gastric emptying). Increased age, preoperative serum albumin levels, preoperative biliary stenting, pre-stenting serum bilirubin levels, duration of common bile duct stenting, preoperative C-reactive protein [CRP], and procalcitonin [PCT] were evaluated. Overall morbidity rate was 48.8%. Morbidity associated with infective complications was 21.8%. Increased age, preoperative serum albumin levels, and pre-stenting serum bilirubin levels did not increase the rate of the infective complications. The association between preoperative PCT and preoperative CRP with the infective complications was significant with a p-value of <0.01 (6.75E-07) and <0.01 (4.80E-10), respectively. In the multivariate analysis, only the elevated preoperative procalcitonin was a statistically significant predictor of postoperative infective complications. Preoperative PCT and CRP levels done 48h before surgery are sensitive, specific, easily available, and cost-effective predictors of infective complications after PD.

C-Reactive Protein Was an Early Predictor of Postoperative Infectious Complications After Pancreaticoduodenectomy for Pancreatic Cancer

Objective The study objective was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications (PICs) after pancreaticoduodenectomy. Summary of Background Data The incidence of PICs after pancreaticoduodenectomy still remains high and a clinically relevant problem, despite improvements in the surgical procedure. Methods We examined 110 consecutive patients who underwent pancreaticoduodenectomy for primary pancreatic cancer between 2006 and 2014. The predictive value was assessed by estimating the area under the receiver operating characteristic curve (AUC). Clinical and laboratory data, including CRP, were analyzed with univariate and multivariate logistic regression analyses to identify predictors of PICs of grade III or higher according to the Clavien-Dindo classification. Results PICs of grade III or higher occurred in 13 patients [11.8%; 95% confidence interval (CI), 6.45%–19.36%]. CRP level on postoperative day 3 (POD 3) was a good predictor of PICs (AUC, 0.815; 95% CI, 0.651–0.980), showing the highest accuracy among clinical and laboratory data. A cutoff value of 13.2 mg/dL yielded a sensitivity of 0.846 and a specificity of 0.794. On multivariate analysis, a POD 3 CRP level of 13.2 mg/dL or higher (odds ratio, 20.0; 95% CI, 4.07–97.9; P = 0.002) was a significant predictor of PICs after pancreaticoduodenectomy. Conclusions CRP elevation above 13.2 mg/dL on POD 3 is a significant predictive factor for PICs and should prompt an intense clinical search and therapeutic approach for PICs.

The Granulocyte-to-Lymphocyte Ratio as a Marker of Surgical Stress and a Predictor of Postoperative Infectious Complications After Gastric Cancer Surgery: An Analysis of Patients Enrolled in a Prospective Randomized Trial.

The granulocyte-to-lymphocyte ratio (GLR) in the blood may be a useful marker of surgical stress (SS) following surgery for cancer. The aim of the present study was to compare the SS by measuring the GLR, and further study the value of the GLR in predicting postoperative infectious complications (ICs). Data from 201 gastric cancer patients at Fujian Medical University Union Hospital who were enrolled in our prospective randomized controlled trial were extracted for this study. Blood samples to perioperatively measure the GLR were routinely taken. Additional external validation was performed using the dataset (n=135) from Nanfang Hospital who were enrolled in the same trial. Patients undergoing either laparoscopic or open resection showed a similar preoperative GLR, as well as similar GLRs, on postoperative days (PODs) 1 and 3. The GLR on POD 5 was lower in the laparoscopic group compared with the open group (p=0.014), and the optimal predictive GLR thresholds of postoperative ICs in both the laparoscopic and open groups were the same on POD 5, i.e. 6.5 and 7.4, respectively. The GLR on POD 5 was identified as an independent factor for postoperative ICs in both the laparoscopic and open groups. Similar results were found in the validation dataset. The GLR status not only correlates with SS but may also be a reliable predictor of ICs for gastric cancer patients after gastrectomy. The ideal GLR thresholds on POD 5 for ICs following laparoscopic and open gastrectomy are 6.5 and 7.4, respectively.

Basal insulin therapy is associated with beneficial effects on postoperative infective complications, independently from circulating glucose levels in patients admitted for cardiac surgery

BackgroundAlthough hyperglycemia is a strong predictor of postoperative infective complications (PIC), little is known about the effect of basal insulin therapy (BIT) per se on PIC. AimTo evaluate if there is an association between BIT, independent of glucose levels, and a possible improvement of PIC during the perioperative cardiosurgery period (PCP). MethodsIn 812 patients admitted for cardiac intervention and treated with a continuous intravenous insulin infusion (CIII) for hyperglycemic levels (>130mg/dl), a retrospective analysis was performed during the PCP (January 2009–December 2011). Upon transfer to the cardiac surgery division, if fasting glucose was ≥130mg/dl, a basal+premeal insulin therapy was initiated (121 patients, group 1); for <130mg/dl, a premeal insulin alone was initiated (691 patients, group 2). FindingsCompared with group 2, group 1 showed reductions in PIC (2.48% vs 7.96%, p<0.049; odds ratio: 0.294; 95% CI: 0.110–0.780), C-Reactive Protein (p<0.05) and white blood cell (p<0.05) levels despite glucose levels and CIII that were higher during the first two days after surgery (179.8±25.3 vs 169.5±10.6mg/dl, p<0.01; 0.046±0.008 vs 0.037±0.015U/kg/h, p<0.05, respectively). Normal glucose levels were achieved in both groups from day 3 before the discharge. The mean length of hospital duration was 18% lower in group 1 than in group 2 (7.21±05.08 vs 8.76±9.08days, p<0.007), providing a significant impact on public health costs. ConclusionsBasal+preprandial insulin therapy was associated with a lower frequency of PIC than preprandial insulin therapy alone, suggesting a beneficial effect of basal insulin therapy on post-surgery outcome.

Prognostic Nutritional Index Predicts Short-Term Postoperative Outcomes After Bowel Resection for Crohn's Disease.

Bowel resection is required in the majority of patients with Crohn's disease (CD) during their lifetime. The Prognostic Nutritional Index (PNI) is a useful tool for predicting postoperative outcomes in patients undergoing cancer surgery. We examined the ability of the PNI to predict short-term outcomes in patients with CD-related bowel resection. Seventy-three patients who underwent bowel resection for CD were retrospectively enrolled in the study. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mL). Patients were divided into 2 groups: PNI <40 (n = 30) and PNI ≥40 (n = 43). A significant difference was found in body mass index (17.9 ± 2.4 vs 19.2 ± 2.2, P = .018) between the 2 groups. Postoperative overall and infectious complications occurred more frequently in patients with PNI <40 than in those with PNI ≥40 (50.0% and 46.7% vs 23.3% and 16.3%, P = .018 and P = .005, respectively). In the univariate analysis, body mass index <18.5, penetrating behavior, open surgery, and PNI <40 were associated with an increased risk of overall complications and infectious complications. In the multivariate analysis, only PNI <40 was an independent prognostic factor for infectious complications (odds ratio: 3.846, 95% confidence interval: 1.145-12.821). Preoperative PNI is a useful predictor of postoperative infectious complications in patients with CD-related bowel resection.

Nutritional risk is still a clinical predictor of postoperative outcomes in laparoscopic abdominal surgery

The relationship between nutritional risk and postoperative recovery of patients with major laparoscopic abdominal surgery is still unclear. The present study was designed to assess the value of the nutritional risk screening in predicting the postoperative outcomes in this cohort of patients. Data from a consecutive series of 75 patients undergoing various elective major laparoscopic abdominal operations was prospectively collected. Nutritional risk was defined by the Nutritional Risk Screening 2002 (NRS 2002) score and correlated to the incidence of postoperative complications and hospital stay. Multivariate regression identified factors associated with 30-day complications [odds ratio (95 % confidence interval)]. The overall incidence of nutritional risk was 34.7 %. There was a significantly higher infectious complication rate of 38.5 % in patients at nutritional risk, compared to 12.2 % in patients at no risk (p = 0.008). No significant difference of postoperative hospital stay and overall complications was found in patients at nutritional risk or not. Nutritional risk was identified as an independent predictor of postoperative infectious complications (odds ratio 4.87 [1.33-17.84]; p = 0.017). The present study reinforces the value of the NRS 2002 to identify patients at higher risk of infectious complications after major laparoscopic abdominal surgery. In the era of minimally invasive surgery, the problem of nutritional risk still deserves our attention and concern.