Preoperative Patient Risk Factors Research Articles

Ophthalmology Residents' Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes.

This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30mm or < 21.5mm) or abnormal axial length (26-30mm), shallow anterior chamber (< 2.5mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience and surgical outcomes. As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience.

Surgical risk stratification in patients with cirrhosis.

Individuals with cirrhosis experience higher morbidity and mortality rates than the general population, irrespective of the type or scope of surgery. This increased risk is attributed to adverse effects of liver disease, encompassing coagulation dysfunction, altered metabolism of anesthesia and sedatives, immunologic dysfunction, hemorrhage related to varices, malnutrition and frailty, impaired wound healing, as well as diminished portal blood flow, overall hepatic circulation, and hepatic oxygen supply during surgical procedures. Therefore, a frequent clinical dilemma is whether surgical interventions should be pursued in patients with cirrhosis. Several risk scores are widely used to aid in the decision-making process, each with specific advantages and limitations. This review aims to discuss the preoperative risk factors in patients with cirrhosis, describe and compare surgical risk assessment models used in everyday practice, provide insights into the surgical risk according to the type of surgery and present recommendations for optimizing those with cirrhosis for surgical procedures. As the primary focus is on currently available risk models, the review describes the predictive value of each model, highlighting its specific advantages and limitations. Furthermore, for models that do not account for the type of surgical procedure to be performed, the review suggests incorporating both patient-related and surgery-related risks into the decision-making process. Finally, we provide an algorithm for the preoperative assessment of patients with cirrhosis before elective surgery as well as guidance perioperative management.

Assessing 3-month survival rate and preoperative risk factors in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma

Assessing 3-month survival rate and preoperative risk factors in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma

Risk factors for incident venous thromboembolism in patients with renal tumor and inferior vena cava tumor thrombus: a retrospective case-control study.

Venous thromboembolism (VTE) is a principal cause of mortality and adverse oncologic outcomes in patients with renal tumor and inferior vena cava tumor thrombus (RT-IVCTT). However, the preoperative thrombotic risk factors in these patients remain not fully characterized. To identify preoperative thrombotic risk factors in patients with RT-IVCTT. Two hundred fifty-seven consecutive postsurgical patients with RT-IVCTT aged 18-86 years were enrolled between January 2008 and September 2022. Clinicopathological variables were retrospectively reviewed. A multivariate logistic regression model was performed. Preoperative hemoglobin, neutrophils, and serum albumin levels were analyzed as both continuous and categorical variables. VTE was identified in 63 patients (24.5%). On both continuously and categorically coded variables, advanced IVC thrombus (OR 3.2, 95% CI: 1.4-7.0; OR 2.7, 95% CI: 1.2-6.1), renal sinus fat invasion (OR 3.4, 95% CI: 1.6-7.0; OR 3.7, 95% CI: 1.8-7.7), IVC wall invasion (OR 3.6, 95% CI: 1.6-7.9; OR 4.3, 95% CI: 1.9-10.0), IVC blockage status of greater than 75% (OR 5.2, 95% CI: 1.7-15.8; OR 6.1, 95% CI: 1.9-19.7), and higher neutrophils (OR 1.3, 95% CI: 1.0-1.7; OR 2.4, 95% CI: 1.1-5.4) were significantly associated with increased VTE risk in patients with RT-IVCTT. Except hemoglobin, categorically coded serum albumin (OR 0.36, 95% CI: 0.17-0.75) was validated as an independent risk factor for VTE. This study provided an insight of risk factors contributing to preoperative VTE in patients with RT-IVCTT, which may be beneficial for optimizing strategies to manage VTE in clinical practice.

Analysis of risk factors associated with distant metastasis detected at laparotomy in patients with radiologically resectable pancreatic ductal adenocarcinoma

AbstractPurposeThis study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively.MethodsData on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed.ResultsFifty‐three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no‐metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, P = .02), tumour size &gt;35 mm (OR 4.15, P = .017), tumours located at the body and tail of the pancreas (OR 6, P = .041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, P = .02), serum carbohydrate antigen 19‐9 &gt; 385 IU/mL (OR 3.58, P = .031) and serum carcinoembryonic antigen (CEA) levels &gt;9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, P = .011), SMV abutment from the tumour (adjusted OR 52.64, P = .01) and serum CEA levels &gt;9 IU/mL were associated with distant metastases found intraoperatively.ConclusionSignificant weight loss, SMV abutment and serum CEA levels of &gt;9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients.

Prevalence and risk factors of preoperative anemia in patients undergoing elective orthopedic procedures in Northwest Ethiopia: a multicenter prospective observational cohort study

BackgroundPreoperative anemia is a common hematologic problem in major orthopedic surgery in developing countries. It is a condition in which the number and size of red blood cells are insufficient to meet the body’s physiologic needs, consequently impairing the capacity of the blood to transport oxygen to the body. Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. This study aimed to assess preoperative anemia prevalence and risk factors in patients undergoing elective orthopedic procedures.MethodA multicenter prospective observational cohort study was conducted from June 01 to August 30, 2022. A systematic random sampling technique was used to select the study unit. Data were collected using a structured questionnaire. Descriptive statistics were expressed in percentages and presented with tables and figures. Binary logistic regression was used to see the association between independent and dependent variables. A P-value < 0.05 was considered statistically significant.ResultPreoperative anemia’s prevalence and risk factors in patients undergoing elective orthopedic procedures was 24.1[95%CI= (18.2–30.6)]. Multivariable logistic analyses showed that low monthly income level [AOR:5,95%CI:(1.36–7.98)], patient with cancer [AOR:3.4,95%CI:(3.7–8.84)], patient with malaria infectious [AOR: 3.2,95%CI:( 1.13–8.91)], patient with anti-retroviral therapy [AOR: 5.2,95%CI:( 1.8-11.04)], and previous history of surgery [AOR:1,95%CI(1.43–2.4)], were factors significantly associated with preoperative anemia.ConclusionThe prevalence of preoperative anemia among adult patients who underwent elective orthopedics procedures was high. Low Monthly income, patients with cancer, patient with malaria infection, and patients with anti-retroviral therapy, previous histories of surgery were found significantly associated with preoperative anemia. So, we recommend to health professional’s early identification, diagnosis and treatment of preoperative anemia should be done to reduce the risks of anemia and related adverse outcomes.

Diagnosis and Management of Intraoperative Periprosthetic Fractures in Primary Total Knee Arthroplasty.

Intraoperative periprosthetic fracture is an uncommon but notable complication that can occur during primary total knee arthroplasty. These fractures may occur at various stages during the procedure, including surgical exposure, implant preparation, implant trialing, and final implantation. Management of femoral and tibial fractures necessitates intraoperative recognition, including attentiveness of preoperative patient and surgical risk factors. This comprehensive review article focuses on the patient and surgical risk factors, diagnosis, management, and outcomes related to intraoperative fractures during primary total knee arthroplasty.

Preoperative risk factors in patients with xanthogranulomatous pyelonephritis undergoing nephrectomy

Preoperative risk factors in patients with xanthogranulomatous pyelonephritis undergoing nephrectomy

Preoperative and one-year postoperative frailty status changes and risk factors in elderly patients undergoing pancreatectomy

Preoperative and one-year postoperative frailty status changes and risk factors in elderly patients undergoing pancreatectomy

Preoperative Risk Factors in Patients With Pancreatic Cancer.

Pancreatic cancer is gastrointestinal cancer with a poor prognosis. Although surgical techniques and chemotherapy have improved treatment outcomes, the 5-year survival rate for pancreatic cancer is less than 10%. In addition, resection of pancreatic cancer is highly invasive and is associated with high rates of postoperative complications and hospital mortality. The Japanese Pancreatic Association states that preoperative body composition assessment may predict postoperative complications. However, although impaired physical function is also a risk factor, few studies have examined it in combination with body composition. We examined preoperative nutritional status and physical function as risk factors for postoperative complications in pancreatic cancer patients. Fifty-nine patients with pancreatic cancer who underwent surgical treatment and were discharged alive from January 1, 2018, to March 31, 2021, at the Japanese Red Cross Medical Center. This retrospective study was conducted using electronic medical records and a database of departments. Body composition and physical function were evaluated before and after surgery, and the risk factors between patients with and without complications were compared. Fifty-nine patients were analyzed: 14 and 45 patients in the uncomplicated and complicated groups, respectively. The major complications were pancreatic fistulas (33%) and infections (22%). There were significant differences in: age, 74.0 (44 - 88) (P = 0.02); walking speed, 0.93 m/s (0.3 - 2.2) (P = 0.01); and fat mass, 16.50 kg (4.7 - 46.2) (P = 0.02), in the patients with complications. On Multivariable logistic regression analysis, age (odds ratio: 2.28; confidence interval (CI): 1.3400 - 569.00; P = 0.03), preoperative fat mass (odds ratio: 2.28; CI: 1.4900 - 168.00; P = 0.02), and walking speed (odds ratio: 0.119; CI: 0.0134 - 1.07; P = 0.05) were identified as risk factors. Walking speed (odds ratio: 0.119; CI: 0.0134 - 1.07; P = 0.05) was the risk factor that was extracted. Older age, more preoperative fat mass, and decreased walking speed were possible risk factors for postoperative complications.

D84. Pre-operative Lymphedema Risk Factors in Patients with Inflammatory Breast Cancer: Optimizing Patient Selection for LYMPHA

PURPOSE: LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) is increasingly offered for prevention of upper extremity lymphedema after breast cancer treatment, which develops in up to 47% of breast cancer patients. Prior studies have focused on intraoperative and postoperative lymphedema risk factors. This study aimed to identify preoperative risk factors, when the decision to perform LYMPHA must be made. METHODS: Retrospective review of a dedicated inflammatory breast cancer (IBC) program database was conducted. The primary outcome was self-reported lymphedema development. Multivariable logistic regression analysis was performed to identify preoperative lymphedema risk factors, while controlling for number of lymph nodes removed during axillary lymph node dissection (ALND), number of positive lymph nodes, residual disease on final pathology, and need for adjuvant chemotherapy. RESULTS: Of 356 patients with IBC, 134 (mean age 51 years, range 22-89 years) had complete data. Forty-seven percent developed lymphedema. Obesity (BMI>30) (OR 2.7, CI 1.2-6.4, p=0.02) and non-white race (OR 4.5, CI 1.2-23, p=0.04) were preoperative risk factors for lymphedema development. CONCLUSION: Patients with IBC are at high risk for developing lymphedema, due to their need for ALND, radiation, and neoadjuvant chemotherapy. This study identified non-white race and obesity as additional risk factors. Due to the high prevalence of lymphedema, LYMPHA should be considered for all patients with inflammatory breast cancer. Larger prospective studies should evaluate potential racial disparities in lymphedema development.

MP52-17 DEMOGRAPHICS AND OUTCOMES OF BLADDER AUGMENTS IN ADULTS FOR NEUROGENIC BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP52-17 DEMOGRAPHICS AND OUTCOMES OF BLADDER AUGMENTS IN ADULTS FOR NEUROGENIC BLADDER Rishabh Simhal, Kerith Wang, Maria D'Amico, Courtney Capella, Radhika Ragam, Yash Shah, Joon Yau Leong, Alana Murphy, and Patrick Shenot Rishabh SimhalRishabh Simhal More articles by this author , Kerith WangKerith Wang More articles by this author , Maria D'AmicoMaria D'Amico More articles by this author , Courtney CapellaCourtney Capella More articles by this author , Radhika RagamRadhika Ragam More articles by this author , Yash ShahYash Shah More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Alana MurphyAlana Murphy More articles by this author , and Patrick ShenotPatrick Shenot More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Appendicovesicostomy (AV) or augmentation enterocystoplasty (AE) for neurogenic bladder (NB) are infrequently performed in adult patients. Outcomes and safety data have been limited to case series. Here, we aim to better elucidate the patient demographics and surgical outcomes for AV and AE using the National Surgical Quality Improvement Project (NSQIP). METHODS: AV and AE for NB were identified in NSQIP from 2006-2020 using CPT and ICD codes, and miscoded cases were filtered. Patients with concurrent radical cystectomy, pelvic exenteration, or continent urinary diversion/neobladder CPTs were excluded. Patients were then grouped by whether they had AV, AE, or both AV+AE. Patient baseline characteristics and 30-day outcomes were calculated and described. RESULTS: 131 cases (39 AV, 72 AE, and 20 AV+AE) of AV and/or AE for neurogenic bladder were identified. Patients undergoing these procedures were young (mean age of 38), mostly female (66%), and mostly white (73%). The most common medical comorbidities were hypertension (21.4%) and diabetes (8.4%). Of note, 9.2% of patients had preoperative wound infections and 5.6% were chronically on steroids. The cohort had significant surgical risk factors; 44% of patients were either partially or totally functionally dependent, and 73% had an ASA class of 3 (severe disturbance) or higher. 24% of patients had a minor 30-day complication, most commonly urinary tract infection (11.5% overall, 10.3% in AV, 13.9% in AE, and 5.0% in AV+AE), superficial surgical site infection (9.2% overall, 10.3% in AV, 8.3% in AE, and 10.0% in AV+AE), pneumonia (3.1% overall, 0.0% in AV, 4.2% in AE, and 5.0% in AV+AE), or bleeding requiring transfusion (3.1% overall, 2.6% in AV, 2.8% in AE, and 5.0% in AV+AE). 13% of patients had a major 30-day complication, most commonly sepsis (6.1% overall, 2.6% in AV, 9.7% in AE, and 0.0% in AV+AE) or pulmonary embolism (2.3% overall, 2.6% in AV, 1.4% in AE, and 5.0% in AV+AE). The 30-day reoperation rate was 2.8% in AEs resulting in a total of 1.5% of cases. 30-day readmission rate was 15.7% overall with 10.5% AVs, 23.1% AEs, and no AV+AEs returning to the hospital. There were no recorded 30-day mortalities. CONCLUSIONS: This is the largest study done on AV and AE. These procedures had high complication and readmission rates, which may in part be due to preoperative patient risk factors. Of note, our average patient age and complication rate were lower than previously published studies from NSQIP which may reflect our filtering of mislabeled cases. Further studies are needed to better characterize these patients. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e709 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Kerith Wang More articles by this author Maria D'Amico More articles by this author Courtney Capella More articles by this author Radhika Ragam More articles by this author Yash Shah More articles by this author Joon Yau Leong More articles by this author Alana Murphy More articles by this author Patrick Shenot More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies.

Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.

The Relationship Among Surgeon Experience, Complications, and Radiographic Outcomes in Spine Deformity Surgery: The Experience of a Junior Surgeon

To examine complication rates and radiographic outcomes in patients undergoing surgery for adult spinal deformity (ASD) by a junior surgeon. A study was conducted of a retrospective cohort of patients who underwent an open posterior interbody fusion of the thoracic and/or lumbar regions by a single surgeon for ASD between 2018 and 2022. Patient characteristics, complications, and common radiographic parameters of spinopelvic alignment were collated. A total of 112 patients with an average of 4.2 comorbidities underwent surgical correction of ASD. Thirty-seven patients (33.0%) experienced 52 major complications and 50 patients (44.6%) experienced 66 minor complications. Twenty-three patients (20.5%) required a revision operation. Both sagittal vertical axis (P < 10-14) and pelvic incidence-lumbar lordosis mismatch (P < 10-7) significantly improved postoperatively. Number of levels (P < 0.05), operative time >650 minutes (P < 0.01), estimated blood loss >1500 mL (P < 0.01), length of intensive care unit stay >1 day (P < 0.05), and hospitalization length >5 days (P < 0.05) all significantly increased the risk of a major complication. No patient factors significantly increased the risk of minor complications or revision surgery. Observed complication and revision rates in this cohort were consistent with rates reported in the literature. No preoperative patient risk factors significantly increased risk of complications or need for revision, suggesting that no patient population is at increased risk undergoing surgery by a junior surgeon. The relatively high rate of complications observed in this cohort may be a result of high baseline morbidity.

Management of Periprosthetic Acetabular Fractures: A Critical Analysis and Review of the Literature.

Periprosthetic acetabular fractures are uncommon and infrequently the focus of studies. Acetabular fractures are occasionally recognized postoperatively when patients report unremitting groin pain weeks after surgery. The widespread use of cementless acetabular cups might lead to a higher number of fractures than are clinically detectable. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular complications.

Nodal Assessment in Endometrial Atypical Hyperplasia

Objective: Atypical endometrial hyperplasia (AH) is the neoplastic precursor more often associated with endometrial cancer (EC). Nowadays, 25–50% of patients subjected to hysterectomy for preoperative AH are diagnosed with EC at the final pathological analysis. Furthermore, there is no consensus on which preoperative AH patients would benefit from sentinel lymph node mapping. This study aimed to evaluate nodal assessment and preoperative cancer risk factors in preoperative AH patients undergoing nodal surgical staging. Methods: Patients undergoing surgical treatment for AH were retrospectively included in the analysis. Patients were divided into two groups (AH and EC groups) based on the final surgical pathology. The ESGO/ESTRO/ESP risk classification was used for EC cases. Design: This was a retrospective study. Results: Of the 207 AH patients treated, 152 cases met the inclusion criteria. Among preoperative AH patients with final EC diagnosis, 39 patients were in the low-risk group (25.7%), 8 in the intermediate-risk group (5.3%), 4 in high-intermediate (2.6%), and 3 patients were allocated in the high-risk group (2.0%). Fifty-four total patients underwent nodal surgical staging. Only one nodal micrometastasis (0.7%) was found at ultrastaging. Multivariate analysis showed abnormal uterine bleeding (AUB) (p = 0.01), hypertension (p < 0.01), and endometrial thickness ≥20 mm (p = 0.02) statistically more represented in patients with EC at final surgical analysis. EC risk was 2.9 (95% CI: 1.29–6.48) in AUB, 2.7 (95% CI: 1.06–6.92) in hypertension, and 3.1 (95% CI: 1.19–7.97) in endometrial thickness ≥20 mm cases. Limitations: The present study has limitations inherent in its retrospective nature. Conclusion: The overall risk of nodal metastases in preoperative AH patients was low. Conversely, 9.9% of the preoperative AH patients belonged to the intermediate or high-risk group for EC at the final histological examination. Preoperative cancer risk factors would identify AH patients for whom nodal staging could be suggested.

Augmentation of the Esophageal Sphincter Using LINX.

Gastroesophageal reflux disease (GERD) is the retrograde flow of gastric contents into the distal esophagus and may be treated medically or surgically. Magnetic sphincter augmentation surgery using LINX has recently demonstrated comparable results to Nissen fundoplication. We aimed to evaluate preoperative patient risk factors that were associated with LINX removal rates or postoperative EGD with dilation rates (POEGDD). This is a single institution retrospective review of patients undergoing LINX between 2015 and 2021. One hundred and twelve patients were reviewed, 106 included within the study; those excluded had prior foregut surgery or device fracture. Variables including age, sex, BMI, size of device, DeMeester score, manometry, GERD Health-Related Quality of Life (GERD HRQL) questionnaires, POEGDD, and removal rates were recorded. Comparing removal and dilation status, the chi-square or Fisher's exact test and the Mann-Whitney U test were used to analyze categorical and continuous variables, respectively. A P < .05 was considered to be statistically significant. Eleven LINX devices were removed (10%); of these, 9 (81%) underwent POEGDD (P = .0023). There was no difference in DeMeester scores, size of device, or BMI in patients requiring LINX removal compared to those not removed or POEGDD rates. Patients who required LINX removal had higher GERD HRQL scores both preoperatively (median 34 vs 28) and postoperatively at all visits compared to those patients who did not undergo removal (P = .032). Manometry and DeMeester scores were not associated with LINX removal suggesting a less invasive GERD HRQL questionnaire may be a better predictor of patients who will succeed with LINX surgery.

A CLINICAL STUDY OF THE FACTORS AFFECTING POST LAPAROTOMY WOUND HEALING

BACKGROUND: Wound Healing is the summation of a number of processes that follow injury. Despite immense advances in the technique of wound creation and closure, there continues to be an important percentage of patients undergoing abdominal operations, suffering from delayed wound healing and partial wound failure. Apart from increasing patient morbidity and hospital stay, it also is a psychological blow to both the surgeon and patient alike. The incidence of post-operative wound dehiscence was investigated in patients in several studies (e.g., 1.25 per 1,000 discharges at 0 to 17 years, 1.74 at 18 to 44 years, 2.65 at 45 to 65 years, and 3.77 at 65 or more years. Additionally, it was found that this complication resulted in an increased mean length of stay (by 21.1 days) and a tremendous increase in charges for affected patients, with 5.7 times higher odds of in-hospital mortality.Wound Infection rate varies from 6.8 percent to 21.4 percent depending on the procedure and other patient factors. The aim of this study is to assess the various factors inuencing post laparotomy wound healing. To identify the pre-operative, operative and post operative risk factors in patients having poor wound healing. RESULTS This prospective study was conducted in Government General Hospital, kurnool. A total of 100 patients undergoing laparotomies were studied .40 patients were found to have delayed wound healing. The strongest association for delayed healing was found to be wound infection, followed by chronic cough,steroids and poorly controlled diabetes. CONCLUSIONS The incidence of delayed healing was found to be higher in our study with increased incidence of wound infection. It was found that emergency laparotomies were associated with an increased incidence of wound infection and thereby delayed healing. Poor wound healing is also associated strongly with poor nutrition and uncontrolled diabetes. These factors should be taken into account and efforts have to be made to correct the risk factors pre or post-operatively.

The association of polypharmacy with functional decline in elderly patients undergoing cardiac surgery.

Identifying preoperative risk factors in older patients becomes more important to reduce adverse functional outcome. This study investigated the association between preoperative medication use and functional decline in elderly cardiac surgery patients and compared polypharmacy as a preoperative screening tool to a clinical frailty assessment. This sub-study of the Anaesthesia Geriatric Evaluation study included 518 patients aged ≥70 years undergoing elective cardiac surgery. The primary outcome was functional decline, defined as a worse health-related quality of life or disability 1 year after surgery. The association between polypharmacy (i.e. ≥5 prescriptions and <10 prescriptions) or excessive polypharmacy (i.e. ≥10 prescriptions) and functional decline was investigated using multivariable Poisson regression. Discrimination, calibration and reclassification indices were used to compare preoperative screening tools for patient selection. Functional decline was reported in 284 patients (55%) and preoperative polypharmacy and excessive polypharmacy showed higher risks (adjusted relative risk 1.57, 95% confidence interval [CI] 1.23-1.98 and 1.93, 95% CI 1.48-2.50, respectively). Besides cardiovascular medication, proton-pump inhibitors and central nervous system medication were significantly associated with functional decline. Discrimination between models with polypharmacy or frailty was similar (area under the curve 0.67, 95% CI 0.61-0.72). The net reclassification index improved when including polypharmacy to the basic model (17%, 95% CI 0.06-0.27). Polypharmacy is associated with functional decline in elderly cardiac surgery patients. A preoperative medication review is easily performed and could be used as screening tool to identify patients at risk for adverse outcome after cardiac surgery.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Pulmonary Evaluation and Optimization.

There are no current recommendations for preoperative pulmonary evaluation and management of patients undergoing elective spine surgery. The aim of this guideline is to determine preoperative risk factors for perioperative and postoperative pulmonary adverse events and to determine the optimal preoperative evaluation and management of at-risk patients. A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to postoperative pulmonary adverse events in patients undergoing spine surgery. Clinical studies evaluating preoperative patient risk factors and preoperative diagnostic and treatment interventions were selected for review. The literature search yielded 152 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 65 articles for full-text review, and 24 were selected for inclusion in this systematic review. Twenty-three articles addressed preoperative patient risk factors. One article addressed preoperative diagnostic studies of pulmonary function. There were no studies meeting the inclusion criteria for preoperative pulmonary treatment. There is substantial evidence for multiple preoperative patient factors that predict an increased risk of a postoperative pulmonary adverse event. Individuals with these risk factors (functional dependence, advanced age [≥65 yr], chronic obstructive pulmonary disease, congestive heart failure, weight loss, and obstructive sleep apnea) who are undergoing spine surgery should be counseled regarding the potential increased risk of a perioperative and postoperative pulmonary adverse events. There is insufficient evidence to support any specific preoperative diagnostic test for predicting the risk of postoperative pulmonary adverse events or any treatment intervention that reduces risk. It is suggested, however, to consider appropriate preoperative pulmonary diagnostic testing and treatment to address active pulmonary symptoms of existing or suspected disease.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/5-preoperative-pulmonary-evaluation-optimization.