Risk Of Postoperative Pneumonia Research Articles

Is quicker better? A NSQIP analysis of anesthesia time and complications following tracheostomy placement

BackgroundIncreased anesthesia time may lead to respiratory complications in patients receiving tracheostomy, which contributes to patient morbidity. MethodsThe American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for cases of planned tracheostomy (CPT 31600) from 2005 to 2012. Patients were stratified into quintiles based on anesthesia duration. Pearson's chi square, Fischer's exact test, one-way ANOVA, and multivariate regression were used to determine the association between patient characteristics with pneumonia and ventilator dependence. ResultsOut of 752 patients, 83 patients experienced post-operative pneumonia, and 166 experienced ventilator dependence. Following multivariate regression analysis, anesthesia quintiles were not significantly associated with pneumonia or ventilator dependence. Age (OR 1.03, 95% CI 1.00–1.05, P = .032), dyspnea (OR 2.21, 95% CI 1.18–4.13; P = .013), pre-operative ventilator dependence (OR 3.08, 95% CI 1.19–7.98; P = .020), and sepsis (OR 6.68, 95% CI 3.19–14.0; P < .001) remained as significant predictors of post-operative ventilator dependence. ConclusionsFaster may not be better-- prolonged anesthesia time does not increase the risk of post-operative pneumonia or ventilator dependence in patients receiving a planned tracheostomy in the operating room.

FA08.03: PREOPERATIVE SARCOPENIA INFLUENCES THE RISK OF POSTOPERATIVE PNEUMONIA IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Exact measurement of muscle mass is enabled by body composition analyzer, and it is reported that a body composition affects the perioperative outcomes. In this study, we investigated the relationship between depletion of preoperative muscle mass (sarcopenia) and postoperative outcomes in patients with esophageal cancer treated esophagectomy. Methods A total 58 esophageal cancer patients who underwent esophagectomy between January 2014 and January 2018 were enrolled. Preoperative muscle mass was evaluated by InBody-3.0 and S-10 which is body composition analyzer and expressed as muscle mass index; MMI (kg/m2) by dividing the muscle mass by the height in meters squared. The cut off values of MMI were the gender-specific lowest 20%, and we defined low MMI as sarcopenia. Postoperative complications were graded according to the Clavien-Dindo classification, univariate and multivariate analysis were performed for postoperative pneumonia. About the pneumonia, we defined that invasive shadow was observed by X-ray or CT and bacteria detected by sputum culture. Results By the definition of sarcopenia in this study, sarcopenia was determined in 11 patients (19%). Sarcopenia was significantly correlated with lower body weight (P &lt; 0.001), lower body mass index (P &lt; 0.001), the VC% (P = 0.0178). In other factors, there is no significant difference between sarcopenia and non-sarcopenia groups. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative pneumonia and chylothorax (P = 0.0144 and P = 0.0105). For other complications, the differences were not significant. In univariate analysis, sarcopenia (P = 0.0144), hypoalbuminemia (P = 0.0236), operative blood loss (P = 0.0436) were associated with postoperative pneumonia. Multivariate analysis revealed that sarcopenia (P &lt; 0.001) and longer operation time (P = 0.0354) were independent predictors of postoperative pneumonia. Conclusion Preoperative sarcopenia was identified as independent risk factor for postoperative pneumonia after esophagectomy. Preoperative nutrition and rehabilitation therapy may contribute to the prevention of pneumonia after surgery. Disclosure All authors have declared no conflicts of interest.

The Use of Regional or Local Anesthesia for Carotid Endarterectomies May Reduce Blood Loss and Pulmonary Complications

Over 150,000 carotid endarterectomy (CEA) procedures are performed each year. Perioperative anesthetic management may be complex due to multiple patient and procedure-related risk factors. The authorsaimed to determine whether the use of general anesthesia (GA), when compared with regional anesthesia (RA), would be associated with reduced perioperative morbidity and mortality in patients undergoing a CEA. Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The authors evaluated patients undergoing a CEA at multiple university- and community-based settings. A total of 43,463 patients were identified; 22,845 patients were propensity matched after excluding for missing data. The study population was divided into 2 groups: patients undergoing RA or GA. The RA group included regional anesthesia performed by the anesthesiologist or surgeon, monitored anesthesia care, and local infiltration. The primary endpoint was 30-day mortality. Secondary endpoints included surgical site infection, pulmonary complications, return to the operating room, acute kidney injury, cardiac arrest, urinary tract infection, myocardial infarction, thromboembolism, perioperative transfusion, sepsis, and days to discharge. Younger age, Hispanic ethnicity, body mass index <18.5, dyspnea, chronic obstructive pulmonary disease, and smoking history were associated with receiving GA. Patients with low hematocrit and low platelets were more likely to get RA. There was no mortality difference. GA was associated with a significantly higher rate of perioperative transfusions (p = 0.037) and perioperative pneumonia (p = 0.027). The use of RA over GA in CEA is associated with decreased risk of postoperative pneumonia and a reduced need for perioperative blood transfusions.

PV-0099: Neoadjuvant radiation dose to the lungs and the risk of postoperative pneumonia in esophageal cancer

PV-0099: Neoadjuvant radiation dose to the lungs and the risk of postoperative pneumonia in esophageal cancer

The Relationship Between Postoperative Pneumonia and Endotracheal Suctioning Under General Anesthesia in Ophthalmic Surgery: A Retrospective Study.

Postoperative pneumonia is the third most common postoperative complication. It may result from aspiration of secretions accumulating in the subglottic space during general anesthesia (GA). However, the relationship between endotracheal suctioning (ETS) during extubation from GA emergence and postoperative pneumonia has not been well investigated. Therefore, the aim of this study was to investigate the effectiveness of ETS during extubation in prevention of postoperative pneumonia in ophthalmic surgery under GA in our medical center from 2011 through 2015. Three thousand, seven hundred and ninety-four patients receiving ophthalmic surgery under GA were included and divided into two groups by the anesthesiologists. The first group underwent the conventional ETS during extubation, while the other group was extubated without ETS. The incidences of postoperative pneumonia were compared between the two groups to find the correlation between ETS during extubation and postoperative pneumonia. In addition, other complication such as postoperative hemorrhage was also recorded. Of the 3,794 patients undergoing ophthalmic surgery under GA, 2,187 (58%) patients underwent extubation with ETS, whilst 1,607 (42%) patients were extubated without ETS. The incidence rates of postoperative pneumonia with or without ETS during extubation were both 0%. Besides, the incidence rates of postoperative hemorrhage were also both 0% in two groups. Extubation from GA without ETS seemed not to increase the risk of postoperative pneumonia. Thus, no routine ETS during extubation seemed not to be a risk factor for postoperative pneumonia under GA in ophthalmic surgery.

Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy.

Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy. All patients in our institutional database (2008-2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study. The relationship between mediastinoscopy and POP was examined using univariate (Chi square) and multivariate analyses (binary logistic regression). In order to validate our institutional findings, lobectomy data in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2014 were analyzed for these associations. Of 810 patients who underwent a lobectomy at our institution, 741 (91.5%) surgeries were performed by video-assisted thoracic surgery (VATS) and 487 (60.1%) patients underwent concomitant mediastinoscopy. Univariate analysis demonstrated an association between mediastinoscopy and POP in patients undergoing VATS [odds ratio (OR) 1.80; p=0.003], but not open lobectomy. Multivariate analysis retained mediastinoscopy as a variable, although the relationship showed only a trend (OR 1.64; p=0.1). In the NSQIP cohort (N=12,562), concomitant mediastinoscopy was performed in 9.0% of patients, with 44.5% of all the lobectomies performed by VATS. Mediastinoscopy was associated with POP in patients having both open (OR1.69; p<0.001) and VATS lobectomy (OR 1.72; p=0.002). This effect remained in multivariate analysis in both the open and VATS lobectomy groups (OR 1.46, p=0.003; and 1.53, p=0.02, respectively). Mediastinoscopy may be associated with an increased risk of POP after pulmonary lobectomy. This observation should be examined in other datasets as it potentially impacts preresectional staging algorithms for patients with lung cancer.

The Effect of Improving Oral Hygiene through Professional Oral Care to Reduce the Incidence of Pneumonia Post-esophagectomy in Esophageal Cancer.

Radical esophagectomy for thoracic esophageal cancer is invasive and frequently results in postoperative pulmonary complications. Postoperative pneumonia is the most common such complication and affects hospital mortality and survival rates. Oral care has been very effective in reducing pneumonia. In Japan, preoperative professional oral care is highly recommended. However, there are few studies on the effect of preoperative improvements in oral hygiene as a result of intervention on the incidence of postoperative pneumonia. The primary end-point of this retrospective study was the incidence of postoperative pneumonia after radical esophagectomy. The oral health levels of 46 patients were individually categorized, and then patients were grouped according to whether they maintained or improved their oral hygiene. At the first dental examination, oral health levels were classified as good in 22 patients and bad in 24. Of the 46 patients studied, 39 patients maintained or improved their oral hygiene (good control group), whereas 7 showed no improvement (bad control group). Postoperative pneumonia occurred in eight patients: four in the good control group and four in the bad control group. Statistical analysis with postoperative pneumonia as a dependent variable showed a significant effect of oral hygiene improvement on the incidence of pneumonia. Logistic regression analysis with this factor as an independent variable demonstrated that the risk of postoperative pneumonia was reduced in the good control group (OR 0.086, 95% CI 0.014-0.529). Therefore, preoperative professional oral care may improve oral hygiene and oral health, which may in turn reduce the incidence of postoperative pneumonia.

Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study.

Limited information is available on the association between influenza vaccination and postoperative outcomes. Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination. Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls. Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes.

Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

Identifying patients at higher risk of pneumonia after lung resection.

Pneumonia is considered as one of the most common and serious complications after lung resection. The purpose of this study was to identify the risk factors associated with postoperative pneumonia (POP) after lung resection and to develop a scoring system to stratify patients with increased risk of POP. A retrospective review of a prospective database of patients between September 2014 and June 2016 was carried out. Logistic regression analysis was used to examine the risk factors for POP. Bootstrap resampling analysis was used for internal validation. Regression coefficients were used to develop weighted risk scores for POP. Results revealed that age ≥64 years, smoking (current or previous), high pathological stage, and extent of excision of more than one lobe as risk factors. Logistic regression analysis showed that the predictors of POP were as follows: age ≥64 years, smoking, extent of excision of more than one lobe. A weighted score based on these factors was developed which was follows: smoking (three points), age ≥64 years (four points), and extent of excision of more than one lobe (five points). POP score >5 points offered the best combination of sensitivity (64.7%) and specificity (83.3%), and an area under receiver operating characteristic (ROC) curve (AUC) of 0.830 [95% confidence interval (CI): 0.746-0.914]. Patients with older age, smoking and extent of excision of more than one lobe have a higher risk for pneumonia after lung cancer surgery. Also, the scoring system helps to guide decision making of POP risk reduction.

Factors for postoperative complications following pressure ulcer operation: stepwise multiple logistic regression analysis.

Patients with pressure ulcers are generally older, have a long hospital stay and often have a variety of comorbidities. The decision to perform surgery for pressure ulcer management can be difficult because of concerns about the risk of postoperative complications. The aim of this study was to analyse the relationship between comorbid conditions and surgical outcomes in order to guide patient selection for pressure ulcer surgery. In 57 patients, data on age, defect size, operating time, hospital stay, body mass index, surgical site, mobility state, cardiac ischaemic history, diabetes, renal failure, ventilator dependency, tracheostomy state, use of haemodilution therapy and cancer were evaluated using stepwise multiple logistic regression analysis to determine the relationships between variables. There were no postoperative cardiac ischaemic events. Wound complications occurred in 8 patients (14%), pneumonia in 12 patients (21·1%) and mortality in 1 patient (1·7%). The risk of postoperative pneumonia increased 1·069-fold in elderly patients (odds ratio = 1·069, P < 0·05) and increased 44·17-fold in preoperative ventilator users (odds ratio = 44·17, P < 0·05). The risk of wound complication increased 1·012-fold with the presence of a larger defect site (odds ratio = 1·012, P < 0·05) and increased 7·474-fold in patients who received haemodilution therapy (odds ratio = 7·474, P < 0·05). Our results indicate that most comorbid conditions did not significantly affect postoperative cardiopulmonary or wound complications. However, the risk of postoperative pneumonia increased in patients with ventilator use or old age, and the risk of wound complication increased in patients with a large defect size and in those who used haemodilution therapy.

Nondepolarizing Neuromuscular Blocking Agents, Reversal, and Risk of Postoperative Pneumonia

Residual postoperative paralysis from nondepolarizing neuromuscular blocking agents (NMBAs) is a known problem. This paralysis has been associated with impaired respiratory function, but the clinical significance remains unclear. The aims of this analysis were two-fold: (1) to investigate if intermediate-acting NMBA use during surgery is associated with postoperative pneumonia and (2) to investigate if nonreversal of NMBAs is associated with postoperative pneumonia. Surgical cases (n = 13,100) from the Vanderbilt University Medical Center National Surgical Quality Improvement Program database who received general anesthesia were included. The authors compared 1,455 surgical cases who received an intermediate-acting nondepolarizing NMBA to 1,455 propensity score-matched cases who did not and 1,320 surgical cases who received an NMBA and reversal with neostigmine to 1,320 propensity score-matched cases who did not receive reversal. Postoperative pneumonia incidence rate ratios (IRRs) and bootstrapped 95% CIs were calculated. Patients receiving an NMBA had a higher absolute incidence rate of postoperative pneumonia (9.00 vs. 5.22 per 10,000 person-days at risk), and the IRR was statistically significant (1.79; 95% bootstrapped CI, 1.08 to 3.07). Among surgical cases who received an NMBA, cases who were not reversed were 2.26 times as likely to develop pneumonia after surgery compared to cases who received reversal with neostigmine (IRR, 2.26; 95% bootstrapped CI, 1.65 to 3.03). Intraoperative use of intermediate nondepolarizing NMBAs is associated with developing pneumonia after surgery. Among patients who receive these agents, nonreversal is associated with an increased risk of postoperative pneumonia.

Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer.

Morbidity and mortality after esophagectomy are often related to anastomotic leakage or pneumonia. This study aimed to assess the relationship of intraoperative and postoperative vital parameters with anastomotic leakage and pneumonia after esophagectomy. Consecutive patients who underwent transthoracic esophagectomy with cervical anastomosis for esophageal cancer from January 2012 to December 2013 were analyzed. Univariable and multivariable logistic regression analyses were used to determine potential associations of hemodynamic and respiratory parameters with anastomotic leakage or pneumonia. From a total of 82 included patients, 19 (23%) developed anastomotic leakage and 31 (38%) experienced pneumonia. The single independent factor associated with an increased risk of anastomotic leakage in multivariable analysis included a lower minimum intraoperative pH (OR 0.85, 95% CI 0.77-0.94). An increased risk of pneumonia was associated with a lower mean arterial pressure (MAP) in the first 12hours after surgery (OR 0.93, 95% CI 0.86-0.99) and a higher maximum intraoperative pH (OR 1.14, 95% CI 1.02-1.27). Interestingly, no differences were noted for the MAP and inotrope requirement between patients with and without anastomotic leakage. A lower minimum intraoperative pH (below 7.25) is associated with an increased risk of anastomotic leakage after esophagectomy, whereas a lower postoperative average MAP (below 83mmHg) and a higher intraoperative pH (above 7.34) increase the risk of postoperative pneumonia. These parameters indicate the importance of setting strict perioperative goals to be protected intensively.

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery.

BackgroundOral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone–iodine) when administered before and after major elective surgery.MethodsSearches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI).ResultsOf 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39–0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52–0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49–2.09; p = 0.98).ConclusionsPerioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery.Trial RegistrationThis systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.

Risk factors for nosocomial pneumonia in patients with abdominal surgery

Abstract Background The risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. Material and methods A cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. Results The study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR = 2.34), smoking (OR = 9.48), chronic obstructive pulmonary disease (OR = 3.52), emergency surgery (OR = 2.48), general anaesthesia (OR = 3.18), surgical time 120 min or over (OR = 5.79), time in intensive care unit 7 days or over (OR = 1.23), time on mechanical ventilation greater than or equal to 4 days (OR = 5.93) and length of post-operative hospital stay of 15 days or over (OR = 1.20), were observed as independent predictors for the development of postoperative pneumonia. Conclusions Identifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR = 1.23; 95% CI 1.07–1.42) and a length postoperative hospital stay of 15 days or more (OR = 1.20; 95% CI 1.07–1.34) were the predictive factors most strongly associated with lung infection in this study.

Factores de riesgo para neumonía nosocomial en pacientes con cirugía abdominal

BackgroundThe risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. Material and methodsA cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. ResultsThe study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR=2.34), smoking (OR=9.48), chronic obstructive pulmonary disease (OR=3.52), emergency surgery (OR=2.48), general anaesthesia (OR=3.18), surgical time 120minutes or over (OR=5.79), time in intensive care unit 7 days or over (OR=1.23), time on mechanical ventilation greater than or equal to 4 days (OR=5.93) and length of post-operative hospital stay of 15 days or over (OR=1.20), were observed as independent predictors for the development of postoperative pneumonia. ConclusionsIdentifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR=1.23; 95% CI 1.07 - 1.42) and a length postoperative hospital stay of 15 days or more (OR=1.20; 95% CI 1.07 - 1.34) were the predictive factors most strongly associated with lung infection in this study.

Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival

ObjectiveLittle is known about risk factors and prognosis for postoperative pneumonia (POP) in patients undergoing therapeutic lung cancer (LC) surgery. MethodsWe followed a nationwide population-based cohort of 7479 patients with LC surgery in Denmark 1995–2011. We used logistic regression analysis to examine risk factors for POP within 30 days after surgery. Subsequent survival in patients with POP was analyzed with Cox regression. ResultsWe identified 268 (3.6%) patients with POP. Important risk factors included advanced age (age ≥80 years: (adjusted odds ratio [aOR] = 3.64; 95% CI: 2.17–6.12) as compared to patients aged 50–59 years), previous pneumonia (aOR = 2.68; 95% CI: 2.02–3.56), obesity (aOR = 1.91; 95% CI: 0.99–3.69), chronic pulmonary disease (aOR = 1.90; 95% CI: 1.40–2.57), alcoholism (aOR = 1.56; 95% CI: 0.81–3.01), and atrial fibrillation (aOR = 1.42; 95% CI: 0.82–2.45). Overall thoracoscopic surgery halved the risk of POP and the highest risk of POP was seen in pneumonectomy performed in open thoracotomy. Among patients surviving the 30-day postoperative period, 31–365 day mortality was 21.6% in POP patients vs. 16.8% in non-POP patients, and 1–5-year mortality was 62.2% vs. 53.0%. Adjusted 31–365 day hazard ratio (HR) of death with POP was 1.31 (95% CI: 1.00–1.73), and 1–5 year HR was 1.22 (95% CI 0.98–1.53). ConclusionMajor risk factors for POP following LC surgery are advanced age, previous pneumonia, obesity, chronic pulmonary disease, alcoholism, and atrial fibrillation. POP is a clinical marker for decreased LC survival.

Perioperative Microbiologic Monitoring of Sputum on Postoperative Day One as a Predictor of Pneumonia After Hepatectomy

BackgroundThe purpose of this study was to retrospectively evaluate microbial examination of sputum on postoperative day one (POD1) and to determine risk factors for postoperative pneumonia (POP) after hepatectomy. MethodsTwo hundred ninety-four patients who expectorated sputum on POD1 after hepatectomy between 2003 and 2014 were investigated. Sputum samples were submitted for microbial examination. Risk factors for POP were identified using multivariable analysis. ResultsOne hundred fifty-eight (53.7 %) of 294 patients had bacteria in their sputum on POD1. POP was observed in 24 (8.2 %) patients, with increased mortality in the patients with POP (0.74 vs 12.5 %, p < 0.01). Multivariate analysis demonstrated that a Brinkman index of >400 and bacteria in sputum on POD1 were independent risk factors for POP. Bacterial homology in sputum obtained on POD1 and onset day of POP was found in 13 of the 24 (54.2 %) patients with POP. In particular, in 13 patients with POP caused by methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, homology was confirmed in 9 patients (69.2 %). ConclusionA Brinkman index ≥400 and bacteria in sputum on POD1 increased the risk of POP. Presence of bacteria in sputum on POD1 may be useful in determining early treatment against POP after hepatectomy.

Risk factors for postoperative pneumonia after gastrectomy for gastric cancer.

The number of elderly patients undergoing gastrectomy for gastric cancer is increasing. Yet, although elderly patients are at high risk of postoperative pneumonia, no study has sufficiently investigated which clinicopathological factors are significant risk factors for the development of this complication after gastrectomy with lymph node dissection. We reviewed the medical records of 750 patients who underwent gastrectomy between January 2010 and May 2012, to establish the incidence of postoperative pneumonia (Clavien-Dindo grade II or higher). Univariate and multivariate analyses were performed to identify the risk factors for postoperative pneumonia. Thirty-two patients (4.3%) suffered postoperative pneumonia, diagnosed as grades I, II, IIIa, and IVa, in 2 (0.3%), 28 (3.7%), 1 (0.2%), and 1 (0.2%) patient(s), respectively. Univariate analysis revealed that age (≥75years), sex (male), diabetes mellitus (DM), a history of smoking, and impairment of respiratory function were significantly associated with postoperative pneumonia. Multivariate analysis revealed that age, impaired postoperative respiratory function, DM, and blood transfusion were independent risk factors for postoperative pneumonia. Age, impaired postoperative respiratory function, DM, and blood transfusion were identified as independent risk factors for postoperative pneumonia after gastrectomy.

PTU-223 Conversion to open surgery from laparoscopy: to ‘try and fail’ or ‘not try at all’?: Abstract PTU-223 Table 1

Introduction Clarification as to whether conversion to open surgery during laparoscopic colectomy leads to adverse clinical outcomes when compared to laparoscopic surgery that is completed will help establish if the minimally invasive approach should routinely be attempted in most instances with open surgery reserved for only when this were to fail. Method The National Surgery Quality Improvement Program 2012 database was used for analysis of patients who underwent laparoscopic colectomy. Patients were categorised into those who completed laparoscopic procedures, who had laparoscopic procedures with conversion to open, and who had open procedures. Analysis was carried out using chi-squared test, fisher exact test, and logistic regression. Results Of the 16,648 patients included, 7409 (44.50%) underwent open surgery. Of the 9239 who underwent laparoscopic colectomy, 1147 (12.41%) had conversion to open procedure. Strongest association with conversion was found with emergency procedures, preoperative sepsis and septic shock. The other associated factors were male sex, history of CHF, COPD, hypertension, steroid use and disseminated cancer. Post-operatively, compared to the patients who had laparoscopic procedure those who had conversion to open procedure had a higher risk of surgical and medical complications (see Table 1). However, when compared to patients who completed open surgery straightaway, patients who had conversion to open surgery had a higher risk for superficial SSI. While other complications were comparable to open surgery, converted patients had a lower risk of post-operative pneumonia, re-intubation, need for ventilation > 48 h, bleeding that required transfusion, sepsis, septic shock and return to the operating room. Conclusion While patients who have open conversion have worse outcomes than those who complete laparoscopic colectomy, outcomes for converted patients are not significantly worse than for comparable patients who undergo open surgery straightaway. Considering the benefits of the minimally invasive approach, laparoscopic colectomy may reasonably be attempted in any patient, even when completion may not be assured, with conversion reserved for when this is not feasible. Disclosure of interest None Declared.