Risk Of Postoperative Infectious Complications Research Articles

Endoscopic stone surgery in patients having asymptomatic bacteriuria

Introduction. Endoscopic surgery for the treatment of urolithiasis is highly effective but is associated with the risk of infectious complications. Nevertheless, endoscopy is also associated with the risk of postoperative infectious complications, the primary risk factor being positive urine culture. Considering the possibility of detecting persistent asymptomatic bacteriuria (ASB) in this patients amid the shortfall of clear algorithms and schemes of ASB management before endoscopy, a comparative analysis of infectious complications in patients with sterile urine and persistent ASB undergoing endoscopic surgery for renal and ureteral stones is an urgent task.Оbjective. Analysis of the risk of infectious complications in patients undergoing endoscopic treatment of urinary stones, including those with preoperative evidence of asymptomatic bacteriuria.Materials & methods. We conducted a cohort, retrospective study of data from eligible patients who underwent endoscopic removal of renal and ureteral stones between January 2023 and July 2023. From the 449 patient records selected, 211 patients fulfilling the established inclusion and non-inclusion criteria were enrolled in further analyses. Antibacterial prophylaxis was administered a few hours before surgery for initial sterile urine culture, three days before surgery for clinically insignificant ASB, and seven days before surgery for clinically significant ASB, followed by repeat control urine culture and determination of antibacterial prophylaxis according to the proposed methodology.Results. A preoperative sterile urine culture was diagnosed in 152 patients (72.0%), while 59 patients 28% [22%; 34.5%] were found to have bacteriuria, of which 28 patients 13.3% [9%; 18.6%] had clinically significant bacteriuria at a titer of ≥ 105 CFU/mL. After antibiotic therapy, ASB persisted in six patients (22.0%). Accordingly, 37 patients 17.5% [12.79%; 23.4%] with clinically significant and insignificant ASB underwent endoscopic surgery. In the postoperative period, 54 patients (25.6%) had leukocytosis, 17 patients (8.1%) had hyperthermia, and 11 patients (5.2%) had fever accompanied by leukocytosis One patient (0.5%) had an elevated procalcitonin level, which may indicate a systemic inflammatory response. Logistic regression analysis revealed statistically significant associations between the probability of hyperthermia and bacteriuria. A positive urine culture increased the odds of hyperthermia 4.75-fold (OR = 4,75, 95% CI [1.222; 18.803], p = 0.023). Maximum stone size (p = 0.013), stone volume, and ureteral stent drainage (p = 0.006) were the factors influencing the development of leukocytosis. Moreover, the volume of the stone increases the odds of leukocytosis by 1.54 times (OR = 1.543, 95% CI [1.128; 2.158], p = 0.008) for a 1.0 cc enlargement.Conclusion. Our study shows that a positive urine culture is a significant risk factor for infectious complications after endoscopic surgery. Prolonged courses of antibiotic prophylaxis lasting seven and three days in patients having clinically significant and clinically insignificant ASB, respectively, seem adequate to minimize the risk of postoperative infectious complications. 

P818 Imaging-based preoperative body composition is associated with the risk of postoperative complications and postoperative endoscopic recurrence in patients with Crohn’s disease

Abstract Background Alterations in body composition are common in Crohn’s disease (CD) patients and influence disease outcomes. However, the impact of preoperative body composition on postoperative outcomes is not completely understood. Therefore, this study aimed to investigate the association of preoperative body composition with postoperative complications and endoscopic recurrence in CD patients undergoing ileocolic (re-)resection (ICR). Methods CD patients (≥16 years) scheduled for an ICR with a computed tomography (CT) scan available (<12 months prior to ICR) were identified from an ongoing prospective, multicenter cohort study. Skeletal muscle mass (SM), visceral (VAT) and subcutaneous adipose tissue (SAT), and their radiation attenuation (RA) were assessed on a single CT image at L3 using a validated deep-learning automatic segmentation tool (Mosamatic). Low RA is associated with increased tissue triglyceride content (e.g. myosteatosis in case of SM). Cut-offs, based on sex-specific tertiles, were set at the lower and upper tertile for low and high values. The primary outcome was the development of overall postoperative complications within 90 days. Secondary outcomes were postoperative endoscopic recurrence (Rutgeerts’ score ≥ i2b) at 6 months, infectious complications, and moderate to severe complications (Clavien-Dindo ≥ II). Multivariable logistic regression was performed to assess the association of body composition variables with postoperative outcomes, including adjustment for confounders. Results 121 patients were included (median age 37.1 years (IQR 27.1–53.2), 59.5% female). Median disease duration at surgery was 3.6 years (IQR 0.4–12.7), and 57.0% had prior exposure to ≥ 1 biological. Overall postoperative complications were reported in 51.2%, endoscopic recurrence in 33.3%, infectious complications in 26.4%, and moderate to severe complications in 41.3%. High SM-RA (aOR 0.67; 95%CI 0.16–0.85) and low VAT (aOR 0.38; 95%CI 0.17–0.87) were associated with decreased overall postoperative complications. Low VAT-RA was associated with decreased endoscopic recurrence (aOR 0.21; 95%CI 0.07–0.67), and high SAT with increased infectious complications (aOR 3.05; 95%CI 1.28–7.28). Conclusion Low visceral adipose tissue and high radiation attenuation of skeletal muscle (i.e. no myosteatosis) were protective of overall postoperative complications in CD patients undergoing ICR. Low radiation attenuation of visceral adipose tissue (i.e. high triglyceride content) was protective of endoscopic recurrence. High subcutaneous adipose tissue increased the risk of postoperative infectious complications. Further research in larger populations is warranted to validate these findings to improve preoperative stratification and strategies for CD.

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis.

This was a retrospective study. The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections. Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications. The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications. A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P <0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P <0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications. CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

Dorsal Subcutaneous Fat Thickness as a Risk Factor for Pancreatic Fistula After Gastric Cancer Surgery.

Recently, there have been many reports on the use of preoperative body composition analysis to predict postoperative complications in gastric cancer surgery, most of which used 3D image analysis software for the measurements. This study aimed to evaluate the risk of postoperative infectious complications (PICs), especially pancreatic fistulas, using a simple measurement method incorporating only preoperative computed tomography images. A total of 265 patients with gastric cancer underwent laparoscopic or robot-assisted gastrectomy with lymph node dissection at Osaka Metropolitan University Hospital between 2016 and 2020. To simplify the measurement method, we measured the length of each region of the subcutaneous fat area (SFA). Each area included a) umbilical depth, b) thickness of the longest ventral subcutaneous fat, c) thickness of the longest dorsal subcutaneous fat, and d) thickness of the median dorsal subcutaneous fat (MDSF) measurements. PICs occurred in 27 of 265 cases, of which pancreatic fistula was present in 9. SFA for pancreatic fistulas showed high diagnostic accuracy (area under the curve=0.922). Among the subcutaneous fat lengths, the MDSF was the most useful, and the optimal cut-off value was 16 mm. MDSF and non-expert surgeons were found to be independent risk factors for pancreatic fistula. Since the possibility of developing pancreatic fistula is high in cases with MDSF ≥16 mm, careful surgical strategies, such as having a skilled physician, are necessary.

The usefulness of preoperative bile cultures for hepatectomy with biliary reconstruction

BackgroundInfectious complications can cause lethal liver failure after hepatectomy with biliary reconstruction. This study assessed the increased risk for postoperative infectious complications in patients who underwent hepatectomy with biliary reconstruction and explored the possibility of predicting pathogenic microorganisms causing postoperative infectious complications based on preoperative monitoring of bile cultures. MethodsThis study involved 310 patients who received major hepatectomy with or without biliary reconstruction at our institution between January 2010 and December 2019. The relationship between the microorganisms detected through perioperative monitoring of bile culture and those in the postoperative infectious foci was examined. ResultsForty-nine patients underwent major hepatectomy with biliary reconstruction, and 261 received hepatectomy without biliary reconstruction. The multivariate analysis revealed hepatectomy with biliary reconstruction to be associated with an increased risk of postoperative infectious complications (odds ratio: 22.9, 95% confidence interval: 5.2–164.3) compared to hepatectomy without biliary reconstruction. In the patients with biliary reconstruction, the concordance rates between the microorganisms detected in the postoperative infectious foci and those in preoperative bile cultures were as follows: incisional surgical site infection (44.4%), organ/space surgical site infection (52.9%), bacteremia (47.1%), and pneumonia (16.7%); the concordance rates were high, and the risk of infection increased over time. ConclusionsBiliary reconstruction is a significant risk factor for postoperative infectious complications, and preoperative bile cultures may aid in prophylactic and therapeutic antimicrobial agent selection.

Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery

Whether preoperative treatment of inflammatory bowel disease (IBD) with tumor necrosis factor inhibitors (TNFis) increases the risk of postoperative infectious complications remains controversial. The primary aim of this study was to determine whether preoperative exposure to TNFis is an independent risk factor for postoperative infectious complications within 30 days of surgery. We conducted a multicenter prospective observational study of patients with IBD undergoing intra-abdominal surgery across 17 sites from the Crohn's & Colitis Foundation Clinical Research Alliance. Infectious complications were categorized as surgical site infections (SSIs) or non-SSIs. Current TNFi exposure was defined as use within 12 weeks of surgery, and serum was collected for drug-level analyses. Multivariable models for occurrence of the primary outcome, any infection, or SSI were adjusted by predefined covariates (age, sex, preoperative steroid use, and disease type), baseline variables significantly associated (P < .05) with any infection or SSI separately, and TNFi exposure status. Exploratory models used TNFi exposure based on serum drug concentration. A total of 947 patients were enrolled from September 2014 through June 2017. Current TNFi exposure was reported by 382 patients. Any infection (18.1% vs 20.2%, P= .469) and SSI (12.0% vs 12.6%, P= .889) rates were similar in patients currently exposed to TNFis and those unexposed. In multivariable analysis, current TNFi exposure was not associated with any infection (odds ratio, 1.050; 95% confidence interval, 0.716-1.535) or SSI (odds ratio, 1.249; 95% confidence interval, 0.793-1.960). Detectable TNFi drug concentration was not associated with any infection or SSI. Preoperative TNFi exposure was not associated with postoperative infectious complications in a large prospective multicenter cohort.

Infectious complications of intercostal nerve cryoablation mediated by perioperative hypothermia during pediatric Nuss procedure

BackgroundIntercostal nerve cryoablation (cryoanalgesia) is increasingly used for pain control in minimally invasive repair of pectus excavatum (MIRPE) by Nuss procedure. Cryoanalgesia may lower core body temperature and increase the risk of postoperative infectious complications. We investigated cryoanalgesia effects on infectious complications following MIRPE. MethodWe performed a retrospective review of patients undergoing MIRPE at our institution. Patients treated via multimodal analgesia with cryoanalgesia (Cryo) were compared to patients treated via multimodal analgesia +/- elastomeric pain pumps (Non-cryo). Core body and intraoperative minimum/maximum temperatures were recorded. Primary outcomes were wound infection and pneumonia; secondary outcome was length of stay (LOS). Fisher's Exact and Mann-Whitney U tests compared proportions and medians respectively, p-value ≤ 0.05 being significant. Results80 patients were included, 35(43.7%) Cryo and 45(56.3%) Non-cryo. There were no significant differences in median [IQR] for age(15[13.3,16.0];p =0.86), number of bars inserted (2[1,2];p = 0.57), or operative time(123.5[98.3, 148.8]; p = 0.11) between the two groups. We found no significant differences in median [IQR] minimum temperature (35.4°C [35.0,35.8];p = 0.76), median change in intraoperative temperature (-0.13°C [-0.44,0.00];p = 0.94) or median recovery temperature (-1.10°C [-1.56,-0.65]; p = 0.59) between Cryo and Non-cryo. PACU temperature was significantly lower in the Cryo group, 36.4°C [36.2,36.6] p = 0.04. There were no postoperative wound infections in either group and no significant difference in incidence of postoperative pneumonia (8.57% versus 2.22%,p = 0.31) or median[IQR] for LOS (4[3,4];p = 0.57), between Cryo and Non-cryo patients. ConclusionAlthough cryoanalgesia for MIRPE resulted in lower core body temperature, there appears to be no significant difference between Cryo and Non-Cryo patients for LOS or infectious complications.

Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat

BackgroundMajor liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier. MethodsWistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour–1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4+ and CD8+ T-lymphocytes) of the intestinal mucosa. ResultsNo changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4+, and CD8+ T-lymphocytes was less pronounced in group LH compared to group H. ConclusionThe employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.

About the possibility of using physiotherapy in the practice of a surgeon. Literature review

Physiotherapy is a field of medicine based on the study and application of natural and artificially created natural factors on the human body. Physical factors can have both local and systemic effects on the patient’s body. In the postoperative period, physiotherapy helps to solve the most important problems, such as accelerating the processes of tissue regeneration and reducing the risk of infection in the area of surgery. Physical factors, activating fibroblasts, accelerate the synthesis of collagen fibers and increase the regenerative capacity of damaged tissues. In addition, due to bacteriostatic and bactericidal action, microorganisms are destroyed and the risk of postoperative infectious complications is reduced. Understanding the key features of all stages of the wound process allows you to rationally affect the wound. The use of an integrated approach based on drug therapy and the use of physiotherapy procedures significantly increases the effectiveness of treatment and helps the patient to return to their usual level of life as soon as possible. This article is a review of the literature on the most commonly used methods of physiotherapy in the postoperative period. Based on the analysis of publications, the article presents the features and principle of operation of such techniques as electrophoresis, phonophoresis, magnetotherapy, ozone therapy, electrical stimulation, cryotherapy, shock wave therapy, galvanization, darsonvalization, as well as therapy based on the effects of ultraviolet radiation, laser, ultrasound, microcurrents. Examples of physiotherapeutic procedures that should be used at various stages of the wound process, depending on the impact, are given. It is the use of various methods of influence in combination with each other that helps to achieve the maximum effect of treatment in the postoperative period.

Intra-Operative Abdominal Drain Placement for Gallbladder Cancer Surgery and Risk of Infectious Complications.

Background: Routine intra-operative abdominal drain placement (IADP) is not beneficial for uncomplicated cholecystectomies though outcomes in gallbladder cancer surgery is unclear. This retrospective study hypothesized that patients with IADP (+IADP) for gallbladder cancer surgery have a higher risk of post-operative infectious complications (PIC) compared with patients without IADP (-IADP). Patients and Methods: The 2014-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for +IADP and -IADP patients who had gallbladder cancer surgery. Post-operative infectious complications were defined as septic shock, organ/space infection (OSI), or percutaneous drainage. Multivariable analyses were performed to analyze the associated risk of PIC. Results: Of 385 patients, 237 (61.6%) were +IADP. The +IADP patients had higher rates of post-operative bile leak, OSI, re-admission, and increased length of stay (p < 0.05). The +IADP patients were not associated with increased risk of PIC (p > 0.05). Bile leak (odds ratio [OR], 10.61; p < 0.001), peri-operative blood transfusion (OR, 3.77; p = 0.003), biliary reconstruction (OR, 2.88; p = 0.018), and pre-operative biliary stent placement (OR, 3.02; p = 0.018) were the strongest associated risk factors of PIC. Patients with drains in place at or longer than 30 days post-operatively had an increased associated risk compared with patients who did not (OR, 6.88; 95% confidence interval [CI], 2.16-21.86; p < 0.001). Conclusions: More than 60% of gallbladder cancer surgeries included IADP and was not associated with an increased risk of PIC. Intra-operative abdominal drain placement was not associated with an increased risk of PIC, unless drains were left in place for 30 days or longer. Increased risk of PIC was associated with bile leak, peri-operative blood transfusion, pre-operative biliary stent placement, and biliary reconstruction.

P61. Allogenic transfusion increases the risk for postoperative infectious complications in children undergoing spinal fusion

<h3>BACKGROUND CONTEXT</h3> Perioperative transfusion is thought to contribute to infectious complications in adolescent spinal fusion procedures, though low power, inconsistent findings, and uncontrolled potential confounders limit interpretation of the literature to date. <h3>PURPOSE</h3> Perioperative allogenic RBC transfusion is associated with 30-day postoperative infectious complications in pediatric spinal fusion patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP) database. <h3>PATIENT SAMPLE</h3> A total of 19,132 pediatric patients from the ACS-NSQIP database. <h3>OUTCOME MEASURES</h3> Postoperative infections. <h3>METHODS</h3> The multicenter NSQIP pediatric surgical database was queried for spinal fusion procedures in patients <18 years, from 2016-2019. Perioperative allogenic blood transfusion was defined as any transfusion of red blood cells (RBCs) from surgery start until 72h postoperative. Postoperative complications included surgical site infection (SSI), pneumonia (PNA), urinary tract infection (UTI), systemic sepsis, or septic shock up to 30 days postoperative. Logistic regression was performed comparing those who did and did not experience infectious complications. <h3>RESULTS</h3> Of 19,132 children undergoing spinal fusion, 693 (3.6%) patients. experienced ≥1 infectious complication postop: 393 (2.0%) with SSI, 192 (1.0%) with PNA, 155 (0.6%) with UTI, 120 (0.6%) with systemic sepsis, and 29 (0.2%) with septic shock. 4075 (21.3%) were transfused allogenic RBCs. In multiple logistic regression, after adjusting for comorbid conditions, periop RBC transfusion was independently associated with experiencing ≥1 infectious complication (OR 1.54, 95%CI 1.26-1.87), SSI (OR 1.35, 95%CI 1.04-1.75) and PNA (OR 1.91, 95%CI 1.34-2.72). In addition, age (OR 0.92, p<0.0001), weight (OR 1.01, p=0.0009), ASA status (OR 2.73 p<0.0001), neuromuscular disease (OR 1.83 p<0.0001), operative time >300 minutes (OR 1.35 p=0.0017), 13 or more levels fused (OR 1.67 p<0.0001), and antibiotic treatment of the surgical site (OR 0.75, p=0.0102), were also independently associated with infectious complications. <h3>CONCLUSIONS</h3> This is the largest cohort to date examining infectious outcomes following pediatric spinal fusion surgery, providing evidence for the association between transfusion and postoperative infections. After adjusting for patient and procedure-specific characteristics, transfusion increased the odds of any postoperative infection by 54%, SSI by 35%, and pneumonia by 91%. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effect of Preoperative Biliary Stenting on Outcomes of Pancreaticoduodenectomy.

Biliary drainage before pancreaticoduodenectomy was introduced to decrease morbidity from obstructive jaundice. Recent retrospective and randomised data show that preoperative biliary drainage (PBD) increases perioperative infectious complications. Most patients presenting to our tertiary care centre have undergone drainage procedures prior to surgical consultation. We analysed the impact of PBD, specifically endoscopic stent placement, on the postoperative outcome of pancreaticoduodenectomy at our centre. A cohort of 87 patients undergoing pancreaticoduodenectomy from 2012 to 2016 was identified. Data was collected retrospectively and a comparative analysis of stented and nonstented patients was done. Comparison of the 23 stented patients was done with 23 nonstented patients after matching them for age, sex and bilirubin levels. Median total bilirubin level in stented patients was 10.2mg/dl versus 7.7mg/dl in nonstented patients. The infectious complication rate in the stented group was 39.1% versus 12.7% in the nonstented group (P value < 0.05). There was no difference in the anastomotic leak rate between the two groups. Time to curative surgery in the stented group was significantly more than in the nonstented group. Stented patients are at a higher risk for postoperative infectious complications. Patients with obstructive jaundice awaiting surgery should undergo selective biliary drainage after careful planning and discussion between the operating surgeon and the endoscopist.

P474 Postoperative infectious complications in patients with Inflammatory Bowel Disease: experience of a tertiary center

Abstract Background Patients with Inflammatory Bowel Disease (IBD) are at increased risk of postoperative infectious complications (PIC). There are few studies and conflicting data regarding the risk factors involved in these patients. The aim of this study was to investigate the incidence of infectious complications and postoperative mortality in patients with IBD who underwent intestinal surgery, as well as describe the characteristics of our population and identify possible risk factors. Methods Retrospective study on patients with Inflammatory Bowel Disease (Crohn’s disease (CD) and Ulcerative Colitis (UC)) treated in “Virgen de las Nieves” University Hospital between January 2019 and December 2020. Patients who underwent small bowel or colorectal surgery were included. Information regarding demographic and clinical data, procedures, treatments and surgical outcomes were collected. Clinical outcomes documented were postoperative infectious complications and in-hospital mortality. Descriptive inferential were carried out. Results 36 patients were included (47.2% male, median age 44.9 years). All the characteristics of our sample are detailed in Figures 1 and 2. Regarding surgical outcomes, 7 patients developed PIC (6 surgical site infection (SSI) and 1 multiple infections including pneumonia, candidemia and SSI). The features of these patients are detailed in Figures 3 and 4. Conclusion Postoperative infectious complications after intestinal surgery are an important cause of morbi-mortality in CD and UC patients. Identifying risk factors early, could help reduce the incidence of these complications. Seven patients (19,4%) in our sample developed PIC, mostly SSI. All of them diagnosed of CD, which explains the greater need of surgery in them compared to patients with UC. These patients had more severe disease: penetrating pattern (B3 according to Montreal Classification) and ileocolonic location (L3). Most patients were receiving immunosuppressive treatments by the time of surgery, especially biological treatments. The median time of evolution of the disease was high, describing a profile of disease more advanced. Our efforts should be determined to early prevention and treatment of modifiable risk factors during the perioperative period. In order to achieve this aim, further research is needed, with prospective, multicenter and wider population studies, trying to control any confusion factors. Finally, we would like to highlight the need of studies analyzing UC population, as most of them focus on patients with CD.

Nasal Microbiota and Infectious Complications After Elective Surgical Procedures

The association of the nasal microbiome with outcomes in surgical patients is poorly understood. To characterize the composition of nasal microbiota in patients undergoing clean elective surgical procedures and to examine the association between characteristics of preoperative nasal microbiota and occurrence of postoperative infection. Using a nested matched case-control design, 53 individuals who developed postoperative infection were matched (approximately 3:1 by age, sex, and surgical procedure) with 144 individuals who were not infected (ie, the control group). The 2 groups were selected from a prospective cohort of patients undergoing surgical procedures at 2 tertiary care university hospitals in Baltimore, Maryland, who were at high risk for postoperative infectious complications. Included individuals were aged 40 years or older; had no history of autoimmune disease, immunocompromised state, immune-modulating medication, or active infection; and were scheduled to undergo elective cardiac, vascular, spinal, or intracranial surgical procedure. Data were analyzed from October 2015 through September 2020. Nasal microbiome cluster class served as the main exposure. An unsupervised clustering method (ie, grades of membership modeling) was used to classify nasal microbial samples into 2 groups based on features derived from 16S ribosomal RNA gene sequencing. The microbiome cluster groups were derived independently and agnostic of baseline clinical characteristics and infection status. Composite of surgical site infection, bacteremia, and pneumonia occurring within 6 months after surgical procedure. Among 197 participants (mean [SD] age, 64.1 [10.6] years; 63 [37.7%] women), 553 bacterial taxa were identified from preoperative nasal swab samples. A 2-cluster model (with 167 patients in cluster 1 and 30 patients in cluster 2) accounted for the largest proportion of variance in microbial profiles using grades of membership modeling and was most parsimonious. After adjusting for potential confounders, the probability of assignment to cluster 2 was associated with 6-fold higher odds of infection after surgical procedure (odds ratio [OR], 6.18; 95% CI, 3.33-11.7; P < .001) independent of baseline clinical characteristics, including nasal carriage of Staphylococcus aureus. Intrasample (ie, α) diversity was inversely associated with infectious outcome in both clusters (OR, 0.57; 95% CI, 0.42-0.75; P < .001); however, probability of assignment to cluster 2 was associated with higher odds of infection independent of α diversity (OR, 4.61; 95% CI, 2.78-7.86; P < .001). These findings suggest that the nasal microbiome was an independent risk factor associated with infectious outcomes among individuals who underwent elective surgical procedures and may serve as a biomarker associated with infection susceptibility in this population.

Medical Management Following Surgical Therapy in Inflammatory Bowel Disease: Evidence from Cochrane Reviews.

Although medical therapy for inflammatory bowel disease (IBD) has greatly improved over the past 2 decades, surgery continues to be an integral part of the management of ulcerative colitis (UC) and Crohn’s disease (CD). This article reviews data from Cochrane reviews relevant to the medical management of IBD in surgical patients including treatment and prevention of pouchitis in UC patients with an ileal pouch-anal anastomosis, the risk of postoperative infectious complications from medical therapies, infertility after IBD surgery, and prevention of recurrence after bowel resection for CD. A summary of the overall certainty of evidence was assessed using Grading of Recommendations Assessment (GRADE; Table 1), and a summary of the results of these reviews is provided in Table 2. Pouchitis is an chronic inflammatory disease that may occur in the ileal pouch after proctocolectomy in patients undergoing...

Short-term Outcomes of Liver Resection in Patients With Hemodialysis.

The number of patients with hemodialysis is increasing increased yearly. Few reports are available on hepatobiliary and gastrointestinal surgery in these patients. A total of 222 patients who underwent partial liver resection or segmentectomy in our hospital between January 2015 and September 2019 were included in this study. Patients were divided into the hemodialysis group (n=9) and non-hemodialysis group (n=213). No significant difference was observed in postoperative complications between the hemodialysis and non-hemodialysis group. The hemodialysis group had a significantly higher infectious complication rates than the non-hemodialysis group (33.3% vs. 8.0%, p=0.009). In logistic regression analysis, hemodialysis was only a significant risk factor for postoperative infectious complications (OR=5.61, 95% CI=1.12-28.20, p=0.036). Liver resections, at least segmentectomy or smaller, is acceptable in patients on hemodialysis. However, these patients may have a higher risk of postoperative infectious complications than other patients.

Impact of obesity on short-term outcomes of laparoscopic colorectal surgery for Japanese patients with colorectal cancer: A multicenter study.

The impact of obesity on short-term outcomes after laparoscopic colorectal surgery (LAC) in Asian patients is unclear. The purpose of the present multicenter study was to evaluate the safety and feasibility of LAC in obese Japanese patients. We retrospectively reviewed 1705 patients who underwent LAC between April 2016 and February 2019. Patients were classified according to body mass index (BMI): non-obese (BMI < 25 kg/m2 , n=1335), obese I (BMI 25-29.9kg/m2 , n=313), and obese II (BMI ≥30 kg/m2 , n=57). Clinical characteristics and surgical outcomes were compared among the three groups. The proportion of patients with comorbidities (non-obese, 58.1%; obese I, 69.6%; obese II, 75.4%; P < .001) and median operation time (non-obese, 224 minutes; obese I, 235 minutes; obese II, 258 minutes; P=.004) increased significantly as BMI increased. The conversion rate was similar among the groups (P=.715). Infectious complications were significantly high in obese II patients (non-obese, 10.4%; obese I, 8.3%; obese II, 28.1%; P < .001). Multivariate analysis revealed that in obese II patients, BMI was an independent predictive factor of infectious postoperative complications (odds ratio 2.648; 95% confidence interval, 1.421-4.934; P=.002). LAC has an increased risk of postoperative infectious complications in obese II patients, despite improvements in surgical technique. Management of obese II colorectal cancer patients requires meticulous perioperative management.

Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease.

Medications used to treat inflammatory bowel disease (IBD) have significantly improved patient outcomes and delayed time to surgery. However, some of these therapies are recognized to increase the general risk of infection and have an unclear impact on postoperative infection risk. To assess the impact of perioperative IBD medications on the risk of postoperative infections within 30 days of surgery. We searched the Cochrane IBD Group's Specialized Register (29 October 2019), MEDLINE (January 1966 to October 2019), Embase (January 1985 to October 2019), the Cochrane Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception up to October 2019, and reference lists of articles. Randomized controlled trials, quasi-randomized controlled trials, non-randomized controlled trials, prospective cohort studies, retrospective cohort studies, case-control studies and cross-sectional studies comparing participants treated with an IBD medication preoperatively or within 30 days postoperatively to those who were not taking that medication (either another active medication, placebo, or no treatment). We included published study reports and abstracts. Two review authors independently screened titles and abstracts and extracted data. The primary outcome was postoperative infection within 30 days of surgery. Secondary outcomes included incisional infections and wound dehiscence, intra-abdominal infectious complications and extra-abdominal infections. Three review authors assessed risks of bias using the Newcastle-Ottawa Scale. We contacted authors for additional information when data were missing. For the primary and secondary outcomes, we calculated odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) using the generic inverse variance method. When applicable, we analyzed adjusted and unadjusted data separately. We evaluated the certainty of the evidence using GRADE. We included 68 observational cohort studies (total number of participants unknown because some studies did not report the number of participants). Of these, 48 studies reported including participants with Crohn's disease, 36 reported including participants with ulcerative colitis and five reported including participants with indeterminate colitis. All 42 studies that reported urgency of surgery included elective surgeries, with 31 (74%) of those also including emergency surgeries. Twenty-four studies had low risk of bias while the rest had very high risk. Based on pooling of adjusted data, we calculated ORs for postoperative total infection rates in participants who received corticosteroids (OR 1.70, 95% CI 1.38 to 2.09; low-certainty evidence), immunomodulators (OR 1.29, 95% CI 0.95 to 1.76; low-certainty evidence), anti-TNF agents (OR 1.60, 95% CI 1.20 to 2.13; very low-certainty evidence) and anti-integrin agents (OR 1.04, 95% CI 0.79 to 1.36; low-certainty evidence). We pooled unadjusted data to assess postoperative total infection rates for the use of aminosalicylates (5-ASA) (OR 0.76, 95% CI 0.51 to 1.14; very low-certainty evidence). One secondary outcome examined was wound-related complications in participants using: corticosteroids (OR 1.41, 95% CI 0.72 to 2.74; very low-certainty evidence), immunomodulators (OR 1.35, 95% CI 0.96 to 1.89; very low-certainty evidence), anti-TNF agents (OR 1.18, 95% CI 0.83 to 1.68; very low-certainty evidence) and anti-integrin agents (OR 1.64, 95% CI 0.77 to 3.50; very low-certainty evidence) compared to controls. Another secondary outcome examined the odds of postoperative intra-abdominal infections in participants using: corticosteroids (OR 1.53, 95% CI 1.28 to 1.84; very low-certainty evidence), 5-ASA (OR 0.77, 95% CI 0.45 to 1.33; very low-certainty evidence), immunomodulators (OR 0.86, 95% CI 0.66 to 1.12; very low-certainty evidence), anti-TNF agents (OR 1.38, 95% CI 1.04 to 1.82; very low-certainty evidence) and anti-integrin agents (OR 0.40, 95% CI 0.14 to 1.20; very low-certainty evidence) compared to controls. Lastly we checked the odds for extra-abdominal infections in participants using: corticosteroids (OR 1.23, 95% CI 0.97 to 1.55; very low-certainty evidence), immunomodulators (OR 1.17, 95% CI 0.80 to 1.71; very low-certainty evidence), anti-TNF agents (OR 1.34, 95% CI 0.96 to 1.87; very low-certainty evidence) and anti-integrin agents (OR 1.15, 95% CI 0.43 to 3.08; very low-certainty evidence) compared to controls. The evidence for corticosteroids, 5-ASA, immunomodulators, anti-TNF medications and anti-integrin medications was of low or very low certainty. The impact of these medications on postoperative infectious complications is uncertain and we can draw no firm conclusions about their safety in the perioperative period. Decisions on preoperative IBD medications should be tailored to each person's unique circumstances. Future studies should focus on controlling for potential confounding factors to generate higher-quality evidence.

The Risk of Postoperative Infectious Complications Following Massive Intraoperative Blood Loss During Gynaecologic Laparotomy: Retrospective Cohort Study

PurposeTo determine whether massive intraoperative blood loss (MIBL) was independently associated with postoperative infectious complications after gynaecologic laparotomy. MethodsWe conducted a retrospective cohort study of patients undergoing gynaecologic laparotomy who were exposed or not exposed to MIBL. The outcome of interest was composite postoperative febrile morbidity. Multiple logistic regression was used to determine the association between exposure and outcome while controlling for measured covariates. ResultsThe primary outcome was identified to have occurred in 48% (144 of 298) of surgeries with MIBL compared with 12% (51 of 413) of surgeries without MIBL (P < 0.0001). MIBL was found to be strongly and independently associated with primary outcome (adjusted odds ratio 7.04; 95% confidence interval 4.62–10.74; P < 0.0001) after adjusting for age, body mass index, diabetes, immunosuppression, type of procedure, incision type, drains left in situ, and bowel complications. ConclusionMIBL is strongly and independently associated with postoperative febrile morbidity after gynaecologic laparotomy.

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy.

Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.