Presence Of Postoperative Infection Research Articles

Meningosel ve miyelomeningosel nedeni ile opere edilen 0-1 yaş çocuklarda sentetik dura ile otolog dura kullanımının komplikasyon gelişimi açısından karşılaştırılması

Abstract: Aim: The aim of this study is to compare the usage of synthetic and autologous dura mater in terms of complication risk in 0-1-year-old children who were operated for meningocele and myelomeningocele. Material and Methods: This cross-sectional observational study was conducted with 44 children aged 0-1 years who were operated for meningocele and myelomeningocele in a university hospital neurosurgery clinic between November 2010 and December 2016. Patient data were extracted retrospectively from hospital records. The demographics and gestational and clinical features of the mothers and babies, and the need for secondary surgery and the presence of postoperative infection, necrosis, wound dehiscence, and/or neurological deficit were compared between the cases who synthetic dura mater was used in their surgery and those autologous dura was used in their surgery. Results: In total, 86.4% of the 44 infants were preterm, and the predominant neurological problem was plegia in the vast majority. While the defect was located in the lumbar region in more than half of them, myelomeningocele was detected in 77.3% of all cases. The median defect size detected in the patients was 20.0 cm2, primary closure was performed in 30 patients, Limberg flap procedure in 14 patients, however, autologous dura mater and synthetic dura mater were used equally in the patients. The defect size was larger in patients using synthetic dura, furthermore hydrocephalus was found more frequently in these patients. While primary closure was applied in all patients using autologous dura and in one third of the patients using synthetic dura, Limberg flap procedure was applied in two thirds of synthetic dura group. The need for secondary surgery developed more frequently in synthetic dura group, and all postoperative complications were observed more frequently in these patients. In addition, the need for secondary surgery and postoperative necrosis, wound dehiscence, and neurologic deficit are more frequent in patients who underwent Limber flap compared to primary closure. However, the need for secondary surgery and the risk of postoperative complications were similar between primary closure and Limberg flap procedures in synthetic dura group. Conclusion: Although the synthetic dura mater was used in more severe patients, it had a higher need for secondary surgery and a higher risk of complications compared to autologous dura. In patients using synthetic dura, on the other hand, primary closure and Limberg flap had similar efficacy and safety.

Advances in diagnosis and treatment of mechanical hemolysis following percutaneous interventional for valvular heart diseases.

Valvular heart disease is one of the common heart diseases in clinical practice, characterized by valve stenosis and/or incomplete closure. At present, drug therapy, surgery, and emerging percutaneous intervention therapy are the main treating methods for heart valve disease. Although the research and development of percutaneous intervention therapy devices is relatively mature, there are still problems such as postoperative mechanical hemolysis. The occurrence of mechanical hemolysis is associated with factors such as excessive shear stress experienced by red blood cells, direct interaction between red blood cells and the heart and valve surfaces, and thrombus formation. Furthermore, the presence of postoperative infection and other hemolytic diseases can also affect the occurrence of mechanical hemolysis. Although most patients are asymptomatic when hemolysis occurs, there are still critical cases. This type of hemolysis can accelerate the deterioration of the condition, and even endanger life in severe cases. Therefore, elucidating the background, pathogenesis, epidemiology, and related clinical research progress of mechanical hemolysis after percutaneous intervention therapy for valvular heart disease is of great significance for guiding the standardized diagnosis and treatment of the disease.

Correlation between cerebrospinal fluid abnormalities before ventriculoperitoneal shunt and postoperative intracranial infection in adult patients with hydrocephalus: A clinical study.

To identify the relationship between preoperative cerebrospinal fluid (CSF) leukocyte, chloride, glucose, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase, lactic acid and protein levels and ventriculoperitoneal shunt infection. Records of 671 consecutive adult patients who underwent ventriculoperitoneal shunt surgery for the treatment of hydrocephalus at Zhujiang Hospital affiliated with Southern Medical University from January 2011 to March 2022 were reviewed. The patients were divided into infection and non-infection groups based on the presence of postoperative infection. For all patients, we analyzed age; sex; primary disease; preoperative CSF leukocyte, chloride, glucose, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase, lactic acid and protein levels; postoperative temperature; and postoperative infection. A total of 397 patients were included, 28 (7.05%) of whom had an infection within 6 months of the operation and the remaining had no infection. There was no significant difference in age, sex, primary disease, leukocyte, chloride ion, aspartate aminotransferase, lactate dehydrogenase, adenosine deaminase and protein levels in CSF between infection group and non-infection group (p > 0.05). The postoperative infection rate of patients with CSF glucose < 2.8 mmol/L (x 2 = 11.650, p = 0.001) and CSF lactic acid >2.8 mmol/L (x 2 = 12.455, p < 0.001) was higher than that of patients with CSF glucose level ≥2.8 mmol/L and CSF lactic acid level in the range of (1-2.8) mmol/L, respectively, with statistical difference. Compared with the non-infection group, the level of CSF glucose (t = 4.113, p < 0.001) was significantly lower, and the level of CSF lactic acid (t = 6.651, p < 0.001) was significantly higher in the infection group. Multivariate logistic regression analysis showed that preoperative cerebrospinal fluid glucose < 2.8 mmol/L (OR = 3.911, 95% CI: 1.653~9.253, p = 0.002) and cerebrospinal fluid lactate >2.8 mmol/L (OR = 4.712, 95% CI: 1.892~11.734, p = 0.001) are risk factors for infection after ventriculoperitoneal shunt. ROC analysis revealed that the area under the curve (AUC) for CSF glucose and lactic acid level were 0.602 (95% CI: 0.492-0.713) and 0.818 (95% CI: 0.738-0.898), respectively. The infection group had higher rates of fever and body temperature on postoperative day 3-7 (p < 0.05). For adult hydrocephalus patients without clinical manifestations of intracranial infection but only with simple abnormality of cerebrospinal fluid, when the content of glucose in cerebrospinal fluid is < 2.8 mmol/L, and the content of lactic acid is >2.8 mmol/L, it is recommended to perform ventriculoperitoneal shunt after further improvement of cerebrospinal fluid indicators, otherwise, hasty operation will increase the postoperative infection rate. The postoperative fever rate of ventriculoperitoneal shunt surgery is high and the body temperature drops rapidly. If there is still fever after day 3 after surgery, whether there is intracranial infection should be considered.

Safety and feasibility of posterior fossa neurosurgery in the supine position – A UK series from a large centre

BackgroundPosterior fossa surgery in the supine position remains a relatively underutilised approach, compared to the routinely performed prone, park-bench or sitting positions. This surgical approach may confer additional advantages over other modalities commonly restricted by patient co-morbidity and anaesthetic concerns. The purpose of this article is to highlight this approach as a potential viable, safe and alternative approach. MethodsWe retrospectively collected data of all supine infra-tentorial/posterior fossa surgery by one surgeon between 2015 and the present via our electronic patient record system. Demographic data alongside duration of surgery, ASA grading, location of lesions, length of stay, presence of post-operative infections, presence of post-operative CSF leak/pseudomeningocele and post-operative mortality were assessed. ResultsA total of 64 procedures on 58 patients were identified. Of the procedures, 60 were performed for neoplasms (93.8%). Mean overall surgical time was 176 min. Median ASA grade for tumour surgery was 3. Median length of stay was 3 days. Of the non-emergency tumour cases (n = 53), 43 (81.1%) lesions were located in the cerebellar hemisphere, the remainder were in the vermis and tentorium. There were 6 documented post-operative infections (9.4%). The rates of CSF-related complications were: CSF Leak 1.6% (1/64) and Pseudomeningocele 1.6% (1/64). 30-day mortality was 1.6% (1/64). ConclusionThis study suggests that supine positioning is a safe alternative to be considered when operating upon posterior fossa lesions. Further studies are warranted to assess efficacy of this approach, but it can be considered for wider use in the UK and further afield.

Influence of Corticosteroid Injections on Postoperative Infections in Carpal Tunnel Release

Corticosteroid injections (CSIs) are commonly used in carpal tunnel syndrome; however, recent literature has demonstrated risk of postoperative infection associated with preoperative CSIs in other orthopedic fields. The aim of this study was to assess the relationship of CSIs and postoperative infection following carpal tunnel release (CTR). A single-center retrospective review was conducted from 2010 to 2019 to identify patients who underwent CTR with subsequent antibiotic prescription for chart-documented wound infection. A demographically-matched cohort of 100 patients was identified for comparison. Information on patient demographics, comorbidities, injection history, and presence of postoperative infection was collected. Thirty-nine patients (0.67% of all CTR patients) were identified with postoperative infections, 3 of which (0.05% of all CTR patients) were deep infections. In the infection cohort, 16 of 39 (41%) patients received an injection prior to surgery, whereas 16 of 100 (16%) patients in the control cohort received an injection. History of CSI was significantly more common in patients with postoperative infection, and patients in the infection cohort had a significantly shorter average time from injection to surgery by approximately 55 days. Corticosteroid injections in the preoperative period are associated with postoperative infection after CTR. Proximity of injection to time of surgery plays a role, although comorbidities, the corticosteroid dose, and frequency of injection require further study to determine risk contribution. Prognostic III.

The Effect of Corticosteroid Injections on Postoperative Infections in Trigger Finger Release.

Corticosteroid injections have proven benefit in the treatment of symptomatic trigger finger; however, the immune system and tissue repair modulating properties of corticosteroids justify further consideration in surgical candidates. The aim of this study was to assess the relationship between corticosteroid injections and postoperative infection in trigger finger release. A single-center retrospective review was conducted of patients seen from 2010 to 2019 to identify those who underwent trigger finger release with subsequent antibiotic prescription for chart-documented wound infection. A demographic matched cohort of 100 patients was identified for comparison. Preoperative corticosteroid injection history including timing, frequency, and dose was collected for all patients. Patient demographics, comorbidities, and presence of postoperative infection were collected from patient medical records. Superficial infection was defined as those requiring antibiotics for resolution without return to the operating room; deep infection was defined as infections that required irrigation and debridement. Of 3234 patients who underwent trigger finger release, 58 (1.8%) were identified with postoperative infections, 6 (0.2%) of which were deep infections. History of corticosteroid injection was significantly more common in patients with postoperative infection. Compared with an age-matched, gender-matched, and body mass index-matched cohort, patients with postoperative infection had significantly increased rate of diabetes mellitus at 34.5% to 19% (P = .04). While corticosteroid injection in the preoperative period is associated with a higher rate of postoperative infection, the time before surgery and the corticosteroid dose do not appear to have an effect.

The predictive value of plasminogen activator inhibitor-1, fibrinogen, and D-dimer for deep venous thrombosis following surgery for traumatic lower limb fracture.

Deep venous thrombosis (DVT) is a common postoperative complication in patients with lower limb fractures. This study aims to investigate the predictive value of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) for DVT following lower limb traumatic fracture surgery and to investigate risk factors for DVT. Clinical data of 63 patients who underwent lower limb traumatic fracture surgery in our hospital from September 2018 to March 2019 were retrospectively analyzed. Patients were divided into a DVT group and a non-DVT group. The differences in the levels of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) were compared, and a receiver operating characteristic (ROC) curve was used to analyze their predictive value for DVT following surgery for lower limb traumatic fracture. Multiple logistic regression analysis was used to analyze the risk factors of DVT. The levels of PAI-1, FIB, and D-D in the DVT group were higher on the third day after surgery compared to the pre-surgical levels, and were also higher than those in the non-DVT group (P<0.05). The area under the ROC curve indicated that the predictive values of PAI-1, FIB, D-D, and the combination of these three indicators for DVT were 0.792, 0.429, 0.966, and 0.992, respectively. Patients with preexisting factors including a BMI ≥24 kg/m2 , a history of diabetes, postoperative infection, an abnormal white blood cell count, an abnormal average thrombocytocrit, and abnormal levels of PAI-1, FIB, and D-D had a higher incidence of DVT following surgery compared to patients without these factors (P<0.05). The results of the multivariate logistic regression model analysis showed that the presence of postoperative infection, abnormal white blood cell count, abnormal mean platelet volume, and abnormal levels of PAI-1, FIB, and D-D were independent risk factors affecting postoperative DVT in patients with lower limb fractures (P<0.05). The levels of PAI-1, FIB, and D-D were significantly increased in patients with DVT following surgery for lower limb fractures. Therefore, early monitoring of PAI-1, FIB, and D-D levels, and coagulation function is a good predictive indicator of postoperative thrombosis.

Surgical wound dehiscence in dermatologic surgery.

e22101 Background: Surgical wound dehiscence (SWD) describes separation of wound edges due to mechanical failure of a healing wound. The rate of SWD following dermatology office-based surgery and factors associated with its occurrence are poorly characterized in the current literature. This study aims to elucidate factors contributing to SWD following cutaneous excisions of malignant and non-malignant through a novel data mining methodology. The utility of this methodology in quality assurance and risk management applications will be concomitantly explored. Methods: An electronic query directed at the electronic medical record (EMR) database of a large national dermatology practice employing over 400 providers yielded 22,548 instances of cutaneous excision meeting inclusion criteria between 1 January 2018 and 9 September 2019. To control for confounding, procedures positive for SWD were randomly matched in 1:4 ratio with procedures negative for SWD on the basis of sex, age, and precise anatomic location. Procedures were then statistically analyzed to elucidate factors associated with SWD. Results: Of 22,548 procedures analyzed, 123 were positive for wound dehiscence, yielding an incidence of 0.54%. Age ( Χ2 ( df = 1, N = 615) = 2.49, p = 0.039), smoking history ( Χ2 ( df = 2, N = 534) = 9.97, p = 0.007), wound location on the distal extremities ( Χ2 ( df = 1, N = 615) = 9.54, p = 0.002), presence of postoperative infection ( Χ2 ( df = 1, N = 600) = 34.87, p &lt; 0.001), and presence of postoperative bleeding ( Χ2 ( df = 1, N = 600) = 62.73, p &lt; 0.001) are all significantly associated with SWD. A wound positive for postoperative infection or bleeding has 14.48 times the odds of being positive for SWD (95% CI: 4.62 - 45.21). A wound positive for postoperative bleeding has 20.15 times the odds of being positive for SWD (95% CI: 7.42 – 54.73). No significant relationship between SWD and sex, diabetes, or provider type is evident. Conclusions: Age, smoking history, wound location on the distal extremities, and especially other postoperative complications such as bleeding and infection are associated with SWD. There is no association between SWD and sex, diabetes, or provider type. Forthcoming multifactorial, nonlinear, non-time-dependent analysis of variables may allow for the development of a statistical model to provide greater insight into SWD following dermatologic surgery.

Bone Anchor Suture Tape Fixation Technique for the Treatment of Calcaneal Avulsion Fractures

Category:Hindfoot, TraumaIntroduction/Purpose:Surgical treatment of avulsion fractures of the calcaneus has a reported fixation failure rate as high as 23%, and there is much controversy surrounding the best method of treatment for these fractures. We present a technique for fixation of calcaneal avulsion fractures utilizing a bone anchor suture tape fixation technique that can be utilized with or without additional standard internal fixation.Methods:Five patients (2 male, 3 female), with an average age of 73 years old, presenting with a closed extraarticular avulsion fracture of the calcaneus, are included in this case series. Patients underwent bone anchor and suture tape fixation of fracture by a single foot and ankle-fellowship trained orthopaedic surgeon. Patients were additionally assessed pre-operatively, using the contralateral uninjured limb, for gastrocnemius equinus; and if present, patients underwent a gastrocnemius recession. If appropriate, a single compression lag screw and washer inserted perpendicular to fracture line was utilized for additional fixation. Outcomes observed were time to radiographic consolidation, failure of fixation, reoperation rate, presence of post-operative infection, and return to previous function.Results:Of the included patient cohort, all fractures went on to union, and there were no failures of fixation. There was one removal of a compression screw and washer due to hardware pain, and one superficial infection, which resolved with local wound care. All patients went on to weight-bearing as tolerated within 8 weeks post-operatively. Radiographic consolidation was observed at approximately 12 weeks. 4 out of 5 patients returned to previous function, with 1 patient expiring due to unrelated causes prior to determination of final function.Conclusion:Use of a bone anchor suture tape fixation technique appears to hold promise and warrants further investigation for its potential utilization as a reliable technique for fixation for avulsion fractures of the calcaneus. Our technique increases the distribution of surface area forces over the cortical bone while incorporating multiple points of fixation, including through the Achilles tendon insertion, neutralizing the distraction forces of the tendon directly.

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms.

To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Retrospective study (January 2003-October 2017). Two hundred seventy-five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow-up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm-adjusted P > .05). No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.

Clostridium difficile Colitis Following Revision Total Knee Arthroplasty: Incidence and Risk Factors

BackgroundClostridium difficile–associated diarrhea (CDAD) is associated with adverse events and financial liability. As institutions continue to adopt CDAD rates as a quality control metric, it is important to identify patients at risk before surgery, including revision total knee arthroplasty (rTKA). This study was conducted to (1) determine the incidence of CDAD within 30 days of rTKA and (2) identify perioperative risk factors for CDAD following rTKA. MethodsThe American College of Surgeons National Surgical Quality Improvement Program was queried to identify 6023 rTKA procedures from 2015-2016. Preoperative and perioperative variables, including patient demographics, lab values, comorbidities, operative time, procedure type, presence of postoperative infections, and rates of CDAD were collected. Chi-square and Fisher’s exact tests were used to detect differences between categorical variables, and t-tests were used to compare continuous variables. A stepwise logistic regression model was used to identify the risk factors for CDAD. ResultsThe rate of CDAD within 30 days of rTKA was found to be 0.4% (24/6024). The CDAD rate following aseptic revision was 0.2% (12/4893), while the incidence of CDAD after septic revision was 1.1% (12/1130). Preoperative functional dependence (odds ratio [OR] = 5.14; P = .002), septic revision (OR = 2.77; P = .026), and cancer (OR = 14.26; P = .016) were statistically significant independent risk factors for CDAD after rTKA. ConclusionThe incidence of CDAD after rTKA is approximately 0.4% in the United States. Independent risk factors for CDAD include septic revision, preoperative functional dependence, and cancer. Prevention of CDAD in these higher risk patients must be considered before surgery and antibiotic selection for other infections should be managed judiciously.

LEUCOCYTOSIS AFTER POST TRAUMATIC SPLENECTOMY- A PHYSIOLOGICAL EVENT OR INDICATOR OF SEPSIS.

Background: Blunt injury abdomen causes a variety of injuries, the commonest being solid organ injury. Among the solid organs, the spleen is most commonly injured. Operative management plays a major role in treatment of blunt injury abdomen. Various postoperative complications can occur following emergency laparotomy including surgical site infection, abdominal abscess, urinary tract infection and lower respiratory tract infection. Diagnosing these infections becomes particularly challenging following splenectomy because of the unusual physiological response to leucocyte count and platelet count. The aim of this study is to assess the three risk factors i.e Total Leucocyte Count, Platelet count/Total Leucocyte Count Ratio and Injury Severity Score in patients undergoing splenectomy and to compare them with other patients undergoing laparotomies other than splenectomy for blunt injury abdomen in order to achieve a cut off value beyond which persistence of leucocytosis may denote infection. Aim and objectives: To study the WBC Count and Platelet Count(PC)/WBC Count ratio in infected and non infected individuals who have undergone post traumatic splenectomy compared to other blunt abdomen trauma patients who have undergone laparotomy. To study the relationship of three prognostic factors : WBC count, PC/WBC count ratio and Injury Severity Score in individuals who have undergone emergency laparotomy after trauma and their role in post operative infection. Materials and Methods: This Observational study (Prospective) was conducted in Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai from June 2017 to October 2018. All patients undergoing splenectomy after trauma and other blunt trauma patients who underwent laparotomy were included in the study. Sample size is 30 cases of splenectomy. Parameters assessed were WBC count, platelet count, injury severity score, presence of post operative infections like pneumonia, abdominal abscess, septicaemia, urinary tract and wound infections. Results: The following are the results of the study.Injury severity score &gt;21 is a signicant risk factor. Post operative day 5 WBC count more than 15000 indicates infection. PC/TC ratio &lt; 20 on the 5th post operative day indicates infection. Patients who underwent laparotomies other than splenectomy showed elevated Total count and Decreased platelet/total count ratio only if infected . Presence of more than 1 risk factor is associated with 72% chance of infection. Conclusion: Post operative day 5 is the earliest time that infected and non infected patients can be distinguished on the basis of total count and PC/TC ratio.Risk factors for infection includes Total count &gt;15,000 on 5th post operative day,PC/TC ratio&lt; 20 on 5th post operative day, ISS &gt; 21. Presence of more than one risk factor carries 72% increased chance of infection and these patients should be monitored with high degree of suspicion.

Mandibular angle augmentation using solid silicone implants.

The demand for facial esthetics has increased dramatically to overcome the ongoing aging process and/or improve facial appearance. The aim of this study was to evaluate the outcomes of using bilateral silicone implants for mandibular angle augmentation. The study involved a prospective analysis of the outcomes of the mandibular angle region augmentation with bilateral silicone implants in 58 patients (2 males and 56 females) within 1 year. All the data was collected either from patients' interviews or their records, after receiving the ethical approval from the relevant hospital. The collected patients' data was analyzed based on 3 main outcomes: occurrence of implant displacement, presence of postoperative infection and patient satisfaction. Only the patients who completed a follow-up of 6 months postoperatively were included in this study. A total of 58 patients received bilateral silicone implants at the mandibular angle with a total of 116 implants, out of which 96 were found intact, with no evidence of complications. The total number of implants that were infected was 5 (4.3%), 16 implants were found displaced (13.8%) and only 3 patients of those without complications were dissatisfied with the final facial appearance (6%). Using solid silicone implants in the augmentation of the mandibular angle resulted in low postoperative infection and displacement rates, as well as in high patient satisfaction.

Comparação do índice de infecção pós-operatória em fraturas mandibulares lineares com o uso de profilaxia antibiótica

Resumo Introdução Infecções pós-operatórias representam a maior complicação no tratamento de fraturas mandibulares. A utilização de profilaxia antibiótica diminui os índices de infecção, entretanto sua manutenção após o procedimento cirúrgico é controversa na literatura. Objetivo Comparar o índice de infecção pós-operatória no tratamento de fraturas mandibulares lineares com ou sem profilaxia antibiótica pós-operatória. Metodologia Foi realizada uma análise retrospectiva transversal para verificar a presença de infecção pós-operatória. Trinta prontuários de pacientes portadores de fraturas mandibulares lineares, tratados por meio de acesso intrabucal e fixação interna estável, foram selecionados e divididos em dois grupos com 15 prontuários cada: pacientes que realizaram apenas profilaxia antibiótica pré-operatória e pacientes que realizaram profilaxia antibiótica pré e pós-operatória por seis dias. Resultado Foram observadas cinco infecções, sendo três no grupo que realizou apenas profilaxia pré-operatória e duas no grupo que fez uso de antibiótico após o procedimento. Conclusão Em fraturas mandibulares lineares, a utilização de antibiótico pós-operatório não reduziu o índice de infecções significantemente.

Surgical Outcomes of a Combined Surgical Approach for Apical Prolapse Repair.

Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n = 135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity = 2.49) and overweight (mean BMI = 27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intra-operative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.

Infectious complications after cardiac transplantation in patients bridged with mechanical circulatory support devices versus medical therapy

Mechanical circulatory support (MCS) is increasingly used as a bridge to heart transplantation. It is not known whether patients who receive MCS as bridge to transplantation (BTT) have more frequent and severe infectious complications in the first transplant year. Using a retrospective cohort in a single large transplant center from 2009 to 2014, we compared rates of post-transplant infections among patients bridged to transplantation with medical therapy (n = 134) or MCS (n = 178) over the first post-transplant year. Serious infections necessitated >14 days of continuous intravenous antibiotic therapy. Pre-transplant device infections were common in the MCS group (32.6%). The proportion of patients with any infection (74.2% vs 60.5%; p = 0.01, relative risk 1.23 [1.04 to 1.44]) or serious infections (45.5% vs 31.3%; p = 0.01, relative risk 1.45 [1.08 to 1.96]) in the first post-transplant year was significantly higher in the MCS group than in the medical therapy group, respectively. MCS patients but not medical therapy patients had significantly higher 1-year all-cause mortality in the presence of post-operative infections (16.7% vs 4.3%, p = 0.04). Device-related infections occurred in 67 (37.6%) MCS patients up to 337 days post-transplant, including 26 (14.6%) patients without a known or active pre-operative device infection. In multivariable analyses, age, intensive care unit length of stay, presence of pre-transplant device infection and use of an anti-thymocyte agent were associated with increased rates of infection. More infectious complications are experienced by patients who receive MCS as BTT, with a significant occurrence of device-related infections. MCS patients with post-transplant infections have higher mortality at 1 year compared with uninfected MCS patients.

Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients

Sepsis remains a significant source of mortality among hospitalized patients. This study examines the usage of a vital sign-based screening protocol in identifying postoperative patients at risk for sepsis at an academic-affiliated medical center. We identified all general surgery inpatients undergoing abdominopelvic surgery from January to June 2014, and compared those with positive screening tests to a sample of screen-negative controls. Multivariate logistic regression was used to identify predictors of positive screening tests and progression to severe sepsis. In total, 478 patients underwent abdominopelvic operations, 59 had positive screening tests, 33 qualified for sepsis, and six progressed to severe sepsis. Predictors of a positive screening test were presence of cancer [odds ratio (OR) 30.7, 95% confidence interval (CI) 2.2-420], emergency operation (OR 6.5, 95% CI 1.7-24), longer operative time (OR 2.2/h, 95% CI 1.2-4.1), and presence of postoperative infection (OR 6.4, 95% CI 1.5-27). The screening protocol had sensitivity 100 per cent and specificity 88 per cent for severe sepsis. We identified no predictors of severe sepsis. In conclusion, vital sign-based screening provides value by drawing early attention to patients with potential to develop sepsis, but escalation of care for these patients should be based on clinical judgment.

Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg.

To assess the influence of locking plate and screw implants on postoperative infection rate in dogs >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Retrospective case series. Dogs >50 kg (n = 208) that had TPLO. Medical records (January 2003-September 2011) were reviewed for dogs that had TPLO. Type of implant used (locking plate and screw fixation [LP] and dynamic compression plate and screw fixation [NLP]), use of postoperative antibiotics and presence of postoperative infection were recorded. Multivariate analysis was performed. Forty dogs (21.3%) had clinical signs compatible with postoperative infection. A positive microbiology swab was available in 16/40 cases (40%). Administration of postoperative antibiotics was associated with a lower incidence of infection (P = .006) and the use of NLP was associated with a higher incidence of infection (P = .01). Use of LP construct and postoperative antibiotic therapy significantly decreased infection rate in dogs >50 kg that have TPLO.

Management approach to hemodynamic instability in early postoperative phase

Background: This study aims to investigate the management approach to hemodynamic instability due to several surgical reasons in the early postoperative period. Methods: A total of 222 patients who underwent open heart surgery in our clinic and re-exploration in the intensive care unit (ICU) and operating room between January 2006 and January 2012 were included in the study. The patients were divided into three groups. Group 1 (n=47), which constituted the basis of our study, consisted of the patients re-explored in the ICU with the support of cardiopulmonary bypass (CPB); group 2 (n=65) consisted of patients re-explored without CPB support in the ICU, and group 3 (n=110) consisted of patients re-explored in the operating room in the early postoperative period. The CPB time during the primary surgery, re-exploration time (in hours postoperatively), duration and reason for re-exploration, the primary surgery, the procedure performed in the ICU, the presence of postoperative infection, the length of ICU and hospital stay, the need for blood product replacement, and mortality and morbidity outcomes were compared among the groups. Results: Sixty-four percent of the patients required revision due to massive drainage, 20% due to cardiac arrest, and 16% underwent re-exploration due to malign arrhythmia. Of the patients, 74% had postoperative re-exploration, 12% had support by CPB, 8% had revascularization, and 6% had postoperative complication repair. The mortality rate of the patients who were re-explored in the operating room was significantly lower than the other groups (group 1, 72%; group 2, 45%; group 3, 9%). Conclusion: In the patients in whom open heart resuscitation is obligatory ensuring the operating room conditions quickly and effectively in the ICU is life-saving. Effective and timely support of the CPB is essential for a good postoperative intensive care. This process does not bring an extra burden to the patient, protecting the patient from the time loss and adverse events possibly to be encountered during transport.

Colorectal Cancer Surgery in Portal Hypertensive Patients

Oxaliplatin is used in adjuvant treatment of colorectal cancer and is associated with sinusoidal obstruction syndrome. Few data are available on its effects in patients in whom portal hypertension was diagnosed before cancer treatment. Our aim was to investigate short- and long-term outcomes of surgery for colorectal cancer in patients with portal hypertension with or without cirrhosis, particularly regarding effects of adjuvant chemotherapy with oxaliplatin. This was a prospective cohort study performed at an academic medical center. Patients with stage II or III colorectal cancer and portal hypertension who underwent curative resection were included. All patients received adjuvant chemotherapy with oxaliplatin (FOLFOX 4) or 5-fluorouracil and leucovorin. Potential predictive laboratory and clinical variables and postoperative (30-day) and long-term morbidity and mortality were recorded. Of 63 patients enrolled, 23 (37%) had a total of 82 postoperative complications; 5 patients (8%) died within 30 days postoperatively. Univariate analysis showed that severe portal hypertension, preoperative Child class B, low albumin, the presence of ascites, preoperative upper GI tract bleeding, and high intraoperative blood loss were linked to postoperative morbidity. Presence of postoperative infection (p = 0.004), presence of preoperative ascites (p = 0.01), high intraoperative blood loss (p = 0.02), and preoperative upper GI tract bleeding (p = 0.03) were significantly related to mortality. Of 58 patients receiving adjuvant chemotherapy, 20 received the oxaliplatin regimen and 38 received 5-fluorouracil/leucovorin without oxaliplatin. The median length of follow-up was 26 (range, 6-36) months. Kaplan-Meier analyses showed that patients who received oxaliplatin had higher cumulative incidences of newly developed esophageal varices (p = 0.002), GI tract bleeding (p = 0.02), and newly formed ascites (p = 0.03). Death occurred in 8 of 20 patients (40%) in the oxaliplatin group and in 5 of 38 patients (13%) in the 5-fluorouracil group. Kaplan-Meier estimates of mean survival time were 34.4 months (95% CI, 32.4-36.5) in the 5-fluorouracil/leucovorin group vs 29.9 months (95% CI, 26-33.7) in the oxaliplatin group, and patients receiving oxaliplatin had a significantly higher relative risk of death (HR = 2.98; 95% CI, 1.03-8.65). Cancer-specific mortality was not related to treatment type. The study was limited by the relatively small sample size and lack of randomization, which may have led to selection bias in treatment regimens. Colorectal cancer surgery can be done safely in portal hypertensive patients with good hepatic function; however, higher mortality is expected in patients with compromised hepatic function reserve. Compared with adjuvant chemotherapy without oxaliplatin, oxaliplatin-based chemotherapy does not significantly reduce cancer-specific mortality and may increase overall morbidity and mortality. Therefore, oxaliplatin-based chemotherapy should be used with caution in patients who have portal hypertension, even in those with good liver function.