Presence Of Postoperative Complications Research Articles

Complications in Postoperative Evolution After Resection for Rectal Cancer and The Time of Postoperative Chemotherapy

Background: Same studies found that postoperative complications after rectal cancer resection influence the timing of chemotherapy. The relevance of severity of postoperative complications after rectal cancer resection with curative intent on survival / recurrence rates is a matter of controversy. The aim: To investigate the import of postoperative complications on survival after curative resection for rectal cancer. The second obiectiv was to shown the risk factors for delays in chemotherapy and the consecvence of delayed therapy on long –term survival. Material and methods:We investigate 177 patients with curative resection for rectal cancer between 2005-2015 , operated in I-st surgical clinic.This study was a retrospective review with univariate analysis to identify risk factors for delayed chemotherapy. In the present study were included the patients category who underwent resection with primary curative intent were excluded all other cases with proctectomy for rectal cancer. Results:Delays in chemotherapy > 8 weeks after resection were associated with postoperative complications worse local and distant reccurences rates and worse overall survival were observed in patients with chemotherapy > 8 weeks. In present study there was no significant difference between patients without complications, minor complications and major complications in terms of overall disease –free survival. Our study is retrospective and was performed at a single institution, and this is a possible limitation of this study. Conclusions: After rectal resection with curative intent , the severity of postoperative complications accordind to Clavien classification system does not have significant effect o overall and disease – free survival.Our results shown that the presence of postoperative complications are risk factors for delayed chemotherapy.

Clinical Usefulness of Perioperative C-reactive Protein/Albumin Ratio in Patients With Intrahepatic Cholangiocarcinoma: A Retrospective Single Institutional Study.

Prognoses of patients with cancer can be predicted on the basis of preoperative nutrition- or inflammation-based scores; however, predicting the prognostic impact of undergoing surgery remains challenging. In this study, we investigated the usefulness of the perioperative C-reactive protein/albumin (CRP/Alb) ratio in patients with intrahepatic cholangiocarcinoma (ICC). We retrospectively investigated 80 patients who had undergone curative resection of primary ICC between April 2002 and December 2017. We identified the time at which perioperative CRP/Alb ratio most influences the prognosis, and investigated the correlations among the perioperative CRP/Alb ratio, clinicopathological features and patient outcomes. The only perioperative CRP/Alb ratios significantly associated with shorter overall survival (OS) was a high CRP/Alb ratio on POD14. High CRP/Alb ratio on POD 14 was significantly associated with older age, male sex, and the presence of postoperative complications. Finally, a high CRP/Alb ratio at POD 14 was an independent prognostic factor for poor OS. CRP/Alb ratio on POD 14 may be a useful prognostic factor in patients with ICC who have undergone curative resections.

The Impact of a Surgical Unit’s Structure and Operative Technique on Quality in Two Swedish Rural Hospitals

Introduction: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure with a low complication rate. It is performed either as an acute or as an elective procedure. Most elective LCs are performed on nonlethal diseases and this is why good quality is important. Our study compared the quality of LC in two surgical units in northern Sweden (Sundsvall and Östersund) which use different clinical structures (subspecialised vs. general surgery) and surgical techniques (ultrasound fundus first vs. conventional diathermy). The study aimed to investigate whether these differences affected the quality of outcomes after LC. Materials and methods: This is a registry-based study which included 607 elective LCs from January 2014 to May 2016. There were 286 from Sundsvall and 321 from Östersund. Primary outcomes were operative time and the percentage of day surgeries. The secondary outcome was the presence of postoperative complications within the first 30 days in terms of bile duct injury, bleeding that necessitated reoperation, bile leakage and abscesses treated with drainage and mortality. Results: The time length of surgery was shorter in Sundsvall (mean 48.3 min) compared to Östersund (mean 108.6 min, p < 0.001. The percentage of day care surgeries was 94% in Sundsvall and 23% in Östersund, p < 0.001. Six patients (2.1%) had a complication in Sundsvall compared to seven patients (2.2%) in Östersund, p = 1.00. Conclusion: There is a significant difference between the two hospitals regarding operative time and the percentage of day surgeries. Complication rates in both units were equal and low.

Results of treatment of patients with carotid artery stenosis in pathology of vision

The aim — to analyze the results of complex treatment of patients with carotid artery stenoses and abnormalities of the organ of vision. Materials and methods. The analysis was conducted of the results of the examination and treatment of 27 patients with changes in the visual fields and lesions of the carotid arteries in V. T. Zaitsev Institute of General and Emergency Surgery and Medical Center «Ophthalmika» during 2017—2018 years. The patients were divided into 2 groups: I group — 16 patients in whom the defeat of the carotid arteries required only conservative therapy and II group — 11 patients with hemodynamically significant stenosis or an unstable plaque that underwent carotid endarterectomy. Results and discussion. We evaluated the immediate results of the operation in a comprehensive manner based on the degree of change in clinical status, the presence of postoperative complications and data of instrumental studies. In I group on the background of disaggregant therapy and treatment with statins, the progression of the disease in the form of a narrowing of the visual fields on static perimetry was fixed in two cases, while stenosis of the internal carotid artery increased by 5 — 10 %. In II group, all operated patients had no complications in the postoperative period, enlargement of the fields of vision and expansion of the visual fields and improvement in visual acuity was noted in 10 patients. Complications in the form of a stroke, reduced vision and bleeding were not observed in any case. In two cases, on day 3, reperfusion syndrome manifested itself. Conclusions. Patients with a concentric narrowing of the visual fields and central scotomas should be screened for lesions of the carotid arteries. In case of hemodynamically significant stenosis or the presence of an unstable plaque, the patients must undergo carotid endarterectomy at the first stage, which reduces the risk of ischemic stroke and improves visual acuity and visual field.

Relationship Between Surgical Difficulty of Third Molar Extraction Under Local Anesthesia and the Postoperative Evolution of Clinical and Blood Parameters

To determine whether the Pederson scale is a good predictor of the surgical difficulty of third molar extraction and establish whether such surgical difficulty is directly related to the postoperative course as assessed from clinical (pain, inflammation, and trismus) and blood (C-reactive protein, interleukin-6 [IL-6], and fibrinogen) parameters. A prospective observational study was conducted of 2 groups of patients who underwent simple or surgical third molar extraction under local anesthesia. Clinical and blood parameters and possible complications were recorded for 1week after extraction. A total of 118 patients were studied. Surgical difficulty as predicted by the Pederson scale showed significant differences (P<.001) for osteotomy, sectioning of the crown, root sectioning, duration of intervention, type of closure, and number of sutures. Under conditions of equal surgical difficulty, the evolution of the groups was similar for pain and inflammation, although trismus was greater for patients subjected to surgical extraction. After the operation, marked increments were recorded in serum C-reactive protein, IL-6, and fibrinogen, although without differences among different levels of surgical difficulty. The probability of complications was similar in the routine and surgical extraction groups. The appearance of complications was the principal cause of alterations in clinical and blood parameters. The Pederson scale is a good predictor of the surgical difficulty of third molar removal as assessed from different clinical and blood parameters. C-reactive protein, IL-6, and fibrinogen concentrations varied considerably after the operation but were not influenced by the degree of surgical difficulty. The presence of postoperative complications was associated with a poorer evolution of clinical and blood parameters.

Outcome of Management of Neonatal Intestinal Obstruction at a Tertiary Center in Nigeria.

Background:Intestinal obstruction in a newborn remains a significant emergency in pediatric surgery. Clinical presentation is often subtle with sudden deterioration of their clinical states. Clinical outcome in the developing countries is poor owing to a variety of factors.Objective:The objective of this study is to identify the factors affecting the management outcome in our environment.Patients and Methods:Data on clinical presentation, management, and outcome of all neonates managed for intestinal obstruction over a 13-year period at a tertiary center in Nigeria were retrospectively reviewed. Analysis of factors affecting the management outcome was also performed.Results:One hundred and seventeen neonates comprising 85 (72.7%) boys and 32 (27.3%) girls were managed for intestinal obstruction. The age at presentation ranged from 0 to 29 days, with a mean of 6.86 ± 8.4 days. Seventy-five (64.1%) patients presented within a week of onset of symptoms and 42 (35.9%) patients later. Eighty-five patients (72.6%) presented with symptoms from birth. The most common causes of intestinal obstruction included anorectal malformation in 62 (53%) neonates and Hirschsprung's disease in 16 (13.7%) neonates. Other causes included obstructed inguinoscrotal hernias, duodenal atresia, jejunoileal atresia, malrotation, and annular pancreas. Eleven patients died with a mortality rate of 9.4%. The age at presentation (P = 0.001) and the presence of postoperative complications (P = 0.009) were significantly related to the duration of hospital stay. Furthermore, the presence of postoperative complications (P = 0.012) was significantly associated with postoperative mortality.Conclusion:Early presentation and postoperative complications significantly affected the morbidity and mortality associated with the management of neonates with intestinal obstruction.

Effect of structured exercise sessions on post-operative problems related to immobility in post-caesarean patients

As the well-being of maternal and child health occupies a paramount place in the healthcare delivery system, caesarean section (CS) has become the most common intervention in obstetrics care, in many countries. Although the indicated and timely CS has tremendous advantages for the mother and the baby, there are several consequences of caesarean delivery in comparison to normal delivery. Being one of the major abdominal surgeries, it also carries the risk associated with general surgeries. Non-probability sampling design was used to recruit 500 participants, who were allotted to experimental and control groups. With the routine post-caesarean care as per hospital routine, the planned structured exercise session was initiated for the experimental group on the day of lower segment caesarean section and was followed twice a day for the first 5 post-caesarean days. The study participants of the control group were given the routine care only. At the end of each day, the selected data for the presence of post-operative complications were collected by structured observation and self-report techniques. It was evident that the selected post-operative problems related to immobility were less in the experimental group as compared to that of the control group. The study concluded that structured post-operative exercise sessions are effective in reducing the potential post-operative problems associated with immobility in post-caesarean period. It can be implemented effectively to enhance the recovery of women after CS.

Evaluating the Outcome of Direct Repair of Bile Duct Injury

AbstractBackground: Bile duct injury (BDI) during laparoscopic cholecystectomy is a surgical catastrophe with an incidence ranging. Between 0.3 to 1,4%. Many surgeons think that direct repair of BDI carries a high risk of stricture that is why the bilioenteric reconstruction is more popular.Aim of Study: Evaluating the results of direct repair in selected cases and compare it to the classic bilioenteric reconstruction.Methods: We had 2 groups, group A had direct bile duct repair and group B had bilioenteric reconstruction. The choice of doing the direct repair was based on the absence of risk factors for biliary complications. Both are compared as regards the presence of postoperative complications either leakage or stricture and hospital stay. All cases were done in Ain Shams university hospitals during the period between January 2013 until December 2017.Results: Bile leakage had happened in one case of group A (11%) and 2 cases of group B (16.7%) with no statistically significant difference, (p-value is 0.72). One case of group A (11.1%) had biliary stricture which was presented at 6 months follow up, managed first by ERCP and stent twice and required reconstruction by Roux en Y after 15 months. For group B, 2 cases had anastomotic strictures presented at 9 and 12 months. They were managed by PTC, dilatation, and stenting and followed by redo reconstruction of the anastomosis at 15 and 17 months after the surgery.Conclusions: Direct repair of the Bile duct can be safely done in properly selected patients with comparable results to bilioenteric reconstruction and no increase in the incidence of postoperative complications.

Хирургическое лечение атеротромботической и гемодинамической форм ишемического инсульта

Цель. Проанализировать результаты хирургического лечения пациентов с поражением сонных артерий в остром и раннем восстановительном периоде ишемического инсульта.&#x0D; Материалы и методы. Проанализированы результаты хирургического лечения 47 пациентов с гемодинамически значимым стенозом сонных артерий (СА) и/или наличием эмбологенной бляшки в остром и раннем восстановительном периоде ишемического инсульта в ИОНХ имени В. Т. Зайцева НАМН Украины с 2014 по 2017 г. Среди пациентов 41 (87,2%) мужчина и 6 (12,8%) женщин. Средний возраст оперированных больных - (60 ± 15) лет. Всем пациентам, обследуемым по поводу предполагаемого ишемического инсульта, сначала выполняют компьютерную томографию (КТ) как более быстрое исследование, позволяющее исключить кровоизлияние в мозг. Показаниями к каротидной эндартерэктомии были стеноз СА более 60%, окклюзия СА или наличие эмбологенной бляшки. Всем пациентам выполняли оперативное вмешательство под проводниковой анестезией, что позволяло контролировать сознание в период пережатия СА. Наличие неврологического дефицита было показанием к выполнению эндартерэктомии из внутренней сонной артерии (ВСА) с использованием временного шунта и вшиванием синтетической заплаты в 17% наблюдений. Эверсионная эндартерэктомия была выполнена 39 больным.&#x0D; Результаты. Непосредственные результаты операции оценивали комплексно на основании степени изменения клинического статуса и наличия послеоперационных осложнений. У 32 больных в послеоперационном периоде осложнений не было. Регресс неврологического дефицита отмечали с 7-х сут после операции, в зависимости от степени проявления - до 3 - 4 мес. Больным проведен контроль проходимости СА и состояния зоны ишемии на 14-е сутки. Констатировали отсутствие стеноза СА и уменьшение очага ишемии в 2 раза. Особое опасение в послеоперационном периоде вызывал реперфузионный синдром, который проявлялся у 35% больных головной болью и головокружением. Данный синдром начинался с 3-х сут, требовал контроля и коррекции артериального давления (АД) и исчезал самостоятельно на 7 – 10-е сут.&#x0D; Выводы. Пациентам с поражением СА в остром и раннем восстановительном периоде ишемического инсульта необходимо выполнять магнитно-резонансную томографию (МРТ) или КТ с контрастированием в первые 6 ч для определения тактики лечения.&#x0D; При гемодинамически значимом стенозе и нестабильности бляшки больным с ишемическим инсультом необходимо выполнять каротидную эндартерэктомию в первые 14 сут.&#x0D; Каротидная эндартерэктомия уменьшает риск повторного ишемического инсульта и зону ишемии головного мозга в 98% наблюдений.

Early postoperative complications after elective degenerative lumbar spine surgery in elderly patients

Object: Degenerative lumbar spine disease is an increasing problem nowadays, affecting unceasingly more people, especially, the elderly population. The older age of patients is generally associated with a higher rate of postoperative complications. Methods: A retrospective analysis of patients aged 60 years or older who underwent the elective spine surgery at the Clinic of Neurosurgery at the University hospital Martin from January 2015 to December 2016. Authors assessed the incidence of early postoperative complications after lumbar spine surgery in older patients and conducted to determine a correlation between comorbidities, selected risk factors and the occurrence of postoperative complications. Results: Overall, 107 patients were assessed (46 men and 59 women). The incidence of postoperative complications was 24.3%. The incidence of major complications was 9.35 %, the incidence of minor complications was 17.76%. 7.5% of patients needed a revision surgery. 83.2% of patients underwent decompressive surgery alone while, 16.8% of patients underwent spinal surgery with fusion. The rate of complications was higher in those patients who underwent surgery with instrumentation in comparison to the decompressive surgery alone (23.6% vs. 27.8%; p = 0.7561). There was a statistically significant association between the presence of type II diabetes mellitus and the incidence of complications (p = 0.0082). The length of a surgical procedure strongly affected the occurrence of postoperative complications (p = 0,000013). Conclusion: Almost one quarter of patients developed postoperative complications with the predominance of minor complications. This study showed an increasing rate of complications in patients who underwent a surgical procedure with instrumentation than in patients with a decompressive surgery only, but without statistical significance. We proved an association between the operation time, the length of the hospital stay, the presence of type II diabetes mellitus and the presence of postoperative complications.

Factors influencing extended hospital stay in patients undergoing metastatic spine tumour surgery and its impact on survival

Metastatic spine tumour surgeries (MSTS) are indicated for preservation or restoration of neurological function, to provide mechanical stability and pain alleviation. The goal of MSTS is to improve the quality of life of the patients with spinal metastases and rarely for oncological control which is usually achieved by adjuvant therapies. Hence outcome measures such as length of stay (LOS) and rate of complications after MSTS are important indicators of quality but there is limited literature evidence for the same. We carried out a retrospective study to determine the incidence and the factors influencing normal (nLOS) and extended length of stay (eLOS) after MSTS. Data of 220 consecutive patients who underwent MSTS between 2005 and 2015 were retrieved from hospital electronic records. The preoperative, intraoperative and postoperative variables, discharge destinations as well as socioeconomic factors were analyzed. eLOS defined as positive when the LOS exceeded the 75th percentile for this cohort, was the key outcome indicator. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors of eLOS. The overall median LOS was 7 days (1–30 days) and 55 patients had eLOS (LOS ≥ 11 days). Multivariate analysis revealed that significant variables independently associated with eLOS were instrumentation >9 spinal segmental levels (OR 2.89, 95% CI 1.1–7.5, p = 0.032) and presence of postoperative complications (OR 3.68, 95% CI 1.85–7.30, p < 0.001). Metastatic tumours other than breast, prostate and lung have lesser risk of eLOS (OR 0.31, 95% CI 0.14–0.70, p = 0.004). Survival estimates show that patients with eLOS have shorter survival than patients with nLOS (Crude HR 1.81, 95% CI 1.13–2.89, p = 0.003).

Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery.

Study Design:Retrospective study. Level of evidence III.Objective:Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous.Methods:Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated.Results:A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%.Conclusions:Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period 2010–2017 was sought in Russian and foreign databases. This review included 58 only full-text publications. The search results have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the problem of this disease has not yet been fully resolved today. This is evidenced by fairly high global prevalence rates in patients with postoperative epilepsy resistant to antiepileptic therapy. The literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according to the type of an epileptogenic structural lesion and its location in the brain. However, despite the rapid development of epilepsy surgery, currently there is still a low surgical activity in the treatment of patients with drugresistant epilepsy. Of importance is also the presence of postoperative complications, including various infectious complications and neurological deficit. Taking into account the high rate of postoperative epilepsy, it is concluded that it is appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

Recurrent pyogenic cholangitis – an independent poor prognostic indicator for resectable intrahepatic cholangiocarcinoma: A propensity score matched analysis

BackgroundRecurrent pyogenic cholangitis (RPC) is a known risk factor for intrahepatic cholangiocarcinoma (ICC), whether it represents a poor prognostic factor remains controversial. The aim of this study was to investigate the post-hepatectomy oncological outcomes of patients with ICC and coexisting RPC. MethodA retrospective analysis with propensity score matching (PSM) was performed for comparison between ICC patient with and without RPC. ResultsThere were 143 patients with ICC with a median follow-up of 21 months. RPC was diagnosed in 18% of patients. The time from RPC diagnosis to ICC diagnosis was 137(47–481) months. The 3-year disease-free (DFS) and overall survival for the whole population was 34% and 43% respectively. Preoperative child score, elevated carcinoembryonic antigen, presence of microvascular invasion, multiple tumours, presence of postoperative complications and RPC were independent factors for DFS and OS. After PSM, 60 ICC patients who did not have RPC were compared with 20 ICC patients with RPC. Patients with RPC had significantly worse median DFS (10 vs 23 months, P = 0.020) and OS (15 vs 45 months, P = 0.004) when compared to the patients without RPC. ConclusionRPC represents a poor prognostic factor affecting outcomes after hepatectomy for patients with ICC.

A comparison of the operative outcomes of D1 and D2 gastrectomy performed at a single Western center with multiple surgeons: a retrospective analysis with propensity score matching

BackgroundThere has been worldwide debate on lymphadenectomy for gastric cancer, with increasing consensus on performing an extended (D2) resection. There is a paucity of data in Australia. Our aim is to compare overall outcomes between a D1 and D2 lymphadenectomy for gastric cancer in a single specialist unit.MethodsWe performed a retrospective analysis on patients who underwent a curative primary gastric resection for gastric adenocarcinoma between January 1996 and April 2016, primary outcomes included overall survival (OS) and disease-free survival (DFS). Propensity score matching (PSM) analysis was used to balance covariates between D1/D1+ and D2 groups. Kaplan-Meier survival curves of D1/D1+ versus D2 were constructed and evaluated using the log-rank test with subgroup analyses for pathological node (pN) status. Multiple Cox proportional hazards model was used to determine predictors of overall survival.ResultsTwo hundred four patients underwent a gastrectomy, 54 had D1/D1+, and 150 had a D2 lymphadenectomy. After PSM, there were 39 patients in each group, the 10-year OS for D1/D1+ was 52.1 and 76.2% for D2 (p = 0.008), and 10-year DFS was 35% for D1 and 58.1% for D2 (p = 0.058). Subgroup analysis showed that node-negative (N0) patients had improved 5-year OS for D2 (90.9%), compared to D1/D1+ (76.4%) (p = 0.028). There was no difference in operative mortality between the groups (D1 vs D2: 2 vs 0%, p = 0.314), nor in post-operative complications (p = 0.227). Multiple Cox analysis showed advanced tumor stage (stages III and IV), and lymphadenectomy type (D1) and the presence of postoperative complications were independent predictors of poor overall survival.ConclusionsD2 lymphadenectomy with spleen and pancreas preservation can be performed safely on patients with gastric adenocarcinoma. Significant improvement in overall survival is observed in patients with N0 disease who underwent D2 lymphadenectomy without increasing operative morbidity or mortality. This paper supports the notion of a global consensus for a D2 lymphadenectomy, particularly in the Western context.

Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma

BackgroundPostoperative complications may adversely affect oncological outcomes. The aim of this study was to evaluate the impact of postoperative complications on early-phase recurrence after curative resection for hepatocellular carcinoma (HCC). MethodsWe included 145 HCC patients who underwent initial and curative resection between January 2004 and December 2013. Postoperative complications of grade III or higher based on Clavien–Dindo classification were defined as clinically relevant postoperative complications. Recurrence within two years after hepatectomy was defined as early-phase recurrence. ResultsThirty-eight patients (26%) developed postoperative complications. The only predictive factor for postoperative complication was longer operative duration (P = 0.037). The disease-specific survival rate of patients with complication was lower than that of patients without complications (P = 0.015). Early-phase recurrence was observed in 20/38 (53%) patients who suffered postoperative complications and 36/107 (34%) patients with no complications, which was statistically significant (P = 0.039). Multivariate analysis identified four factors contributing to early-phase recurrence: high serum AFP level (P = 0.042), multiple tumors (P < 0.001), poor differentiation (P = 0.036) and presence of postoperative complication (P = 0.039). ConclusionsPostoperative complication is an independent prognostic factor for early-phase recurrence after curative resection of HCC. Close observation of patients with postoperative complications may be a necessary treatment strategy for HCC.

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal

Background:There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis.Purpose:To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention.Study Design:Case series; Level of evidence, 4.Methods:The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes.Results:Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty (P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group.Conclusion:Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee stability (100%), although the rate of return to active duty was low in the graft resection group (33%). The risk of knee laxity did not differ based on early graft retention. Time to presentation with graft retention was not associated with a decreased rate of graft laxity.

Increased Variance in Oral and Gastric Microbiome Correlates With Esophagectomy Anastomotic Leak

Anastomotic leak after esophagectomy remains a significant source of morbidity and mortality. The gastrointestinal (GI) microbiome has been found to play a significant role in tumor oncogenesis and postoperative bowel anastomotic leak. We hypothesized that the GI microbiome could differentiate between esophageal cancer histologies and predict postoperative anastomotic leak. A prospective study of esophagectomy patients was performed from May 2013 to August 2014, with the collection of oral saliva, intraoperative esophageal and gastric mucosa, and samples of postoperative infections (neck swab or sputum). The presence and level for each bacterial probe as end points were used to analyze correlations with tumor histology, tumor stage, and presence of postoperative complications by unequal variances t tests for multiple comparisons and principal coordinate analysis. Esophagectomy was successful in 55 of 66 patients who were enrolled. Among those, the diagnosis was adenocarcinoma in 44 (80%) squamous cell carcinoma in (13%), and benign disease in 4 (7%). The 30-day mortality was 1.8% (1 of 55). Complications included anastomotic leak requiring local drainage in 18% (10 of 55) and postoperative pneumonia in 2% (1 of 55). No correlation was noted between GI microbiome flora and tumor histology or tumor stage. A significant difference (p= 0.015) was found when the variance in bacterial composition between the preoperative oral flora was compared with intraoperative gastric flora in patients who had a leak but not in patients with pneumonia. Patients with anastomotic leaks had increased variance in their preoperative oral and gastric flora. Microbiome analysis could help identify patients at higher risk for leak after esophagectomy.

Mortality Predictors in the Surgical Treatment of Active Infective Endocarditis.

IntroductionActive infective endocarditis is associated with high morbidity and mortality. Surgery is indicated in high-risk conditions, and the main determinants of mortality in surgical treatment should be evaluated.ObjectiveTo identify mortality predictors in the surgical treatment of active infective endocarditis in a long-term follow-up.MethodsThis prospective observational study involved 88 consecutive patients diagnosed with active infective endocarditis, who underwent surgery between January 2005 and December 2015. Fifty-eight (65.9%) patients were male, the mean age was 50.87±16.15 years. A total of 31 (35.2%) patients had a history of rheumatic fever; 48 (54.5%) had had heart surgery with prosthetic valve implantation; 45 (93.8%) had biological prosthetic valve endocarditis and 3 (6.3%) mechanical prosthetic valve; 40 (45.5%) patients had the disease in their native valve. The mean EuroSCORE II was 8.9±6.5%, and the main surgical indication was refractory heart failure in 38 (43.2%) patients. A total of 68 bioprosthesis (36 aortic, 32 mitral) and 29 mechanical prostheses (12 aortic, 17 mitral) were implanted and three mitral valve plasties performed. A total of 25 (28.4%) patients underwent double or triple valve procedures. Aortic annulus reconstruction by abscess was performed in 18 (20.5%) and six (6.81%) patients had combined procedure. The mean surgery time was 359±97.6 minutes.ResultsThe overall survival in up to a 10-year follow-up period was 79.5%. In the univariate analysis, the main mortality predictors were positive blood cultures (P=0.003), presence of typical microorganisms (P=0.008), most frequently Streptococcus viridans (12 cases; 25%); C-reactive protein (hazard ratio [HR] 1.034, 95% confidence interval [CI] 1.000 to 1.070, P=0.04); creatinine clearance (HR 0.977, 95% CI 0.962 to 0.993, P=0.005); length of surgery: every five minutes multiplies the chance of death 1.005-fold (HR 1.005, 95% CI 1.001 to 1.009, P=0.0307); age (HR 1.060, 95% CI 1.026 to 1.096, P=0.001); and EuroSCORE II (HR 1.089, 95% CI 1.030 to 1.151, P=0.003).ConclusionA positive blood culture with typical microorganism, C-reactive protein, age, EuroSCORE II, total surgical time and the presence of postoperative complications were the major predictors of mortality and significantly impacted survival in up to a 10-year follow-up period.

Evaluating Resident Training in Oculoplastic Surgery: A Case Series of 104 Eviscerations

Purpose The aim of this study is to evaluate resident surgical performance based on complications after ocular evisceration. Methods A retrospective chart review of eviscerations performed between October 2011 and May 2017 by ophthalmology residents as the primary or assistant surgeon under the guidance of a single oculofacial plastic surgeon (M.O.G.) was completed. Data collected included reason for evisceration, resident participation in the case and resident's month of oculoplastic training, surgical technique, subsequent complications, and duration of follow-up. Results There were no significant differences in complication rates or surgical sequelae in resident-led versus attending-led surgeries. The complication rate for all cases in total was 5.77%. A slight negative correlation existed between the resident's month of training and the presence of postoperative complications. The number of adverse events was found to be significantly correlated with the duration of patient follow-up. Discussion Ocular eviscerations performed by ophthalmology residents as primary surgeons achieve outcomes equivalent to published reports, suggesting ocular eviscerations are a safe, effective procedure wherein residents can refine surgical skills. Some surgical sequelae may be linked to particular surgeons, implying evisceration outcomes can be used to assess resident surgical performance. Fewer adverse events arose as the resident's length of oculoplastic training increased, but this finding did not reach significance. Larger studies are needed to explore these trends.