Treatment Of Postoperative Complications Research Articles

Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators.

Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service. A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care. There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients' expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications. The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care. NCT05069103.

Chinese expert consensus on the prevention and treatment of complications of laser corneal refractive surgery (2024)

Laser corneal refractive surgery has been carried out in China for three decades. The safety, efficacy, predictability, and long-term stability of the surgery have been well established. In the past 10 years, with the wide use of small incision lenticule extraction (SMILE) and trans-epithelial photorefractive keratectomy (T-PRK), the number of corneal laser surgeries in China has increased significantly. Although severe postoperative complications are rare, there is still the possibility of complications. Once complications occur and are not treated in time and effectively, the visual acuity and visual quality of patients would be affected. Paying attention to preoperative risk factors, standardization of the surgery procedure, and timely diagnosis and treatment of postoperative complications can minimize the negative effects. Therefore, the Cornea Group of Ophthalmology Branch of Chinese Medical Association has organized experts and scholars in this field to establish a consensus on the prevention and treatment of complications in laser corneal refractive surgery, providing guidance for the related clinical work.

Assessment of arterial supply to the stomach after bariatric surgery using multidetector CT arteriography.

To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures. Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators. In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4mm, RGA 1.6 ± 0.5mm, and GEA 1.7 ± 0.4mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans. In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.

Surgical rehabilitation of patients with Crohn’s disease

Objective — to enhance the outcomes of surgical rehabilitation for patients with Crohn’s disease through the improvement and implementation of organisational measures as well as general and specialised surgical strategies.
 Materials and methods. The study focused on the development of organisational measures as well as general and specialised surgical rehabilitation procedures for Crohn’s disease. The research was conducted to determine the scope of radical surgical interventions for complications resulting from segmental lesions with extensive damage to the intestinal tract. The study also aimed to develop methods of restorative, reconstructive and restorative operations that would reduce the frequency of postoperative complications, disease recurrence, digestive disorders in the intestinal tract, malabsorption, and anal incontinence. Additionally, the study aimed to improve the functional outcomes and quality of life for operated patients.
 Results. A total of 53 patients with Crohn’s disease — 28 (52.8%) men and 25 (47.2%) women — were operated on using specially designed surgical rehabilitation techniques. The patients undergoing surgery ranged in age from 19 to 45. 32 (60.4%) patients had segmental resections, while 21 (39.6%) had extensive resections. 8 (15.1%) patients underwent restorative operations, while 40 (75.4%) had reconstructive operations. A lifelong ileostomy was formed in 5 (9.4%) patients. Postoperative complications were observed in 12 (22.6%) patients, and disease relapses in 5 (9.4%) patients. One (1.8%) patient died after surgery. Positive functional outcomes, including improved digestion in the intestinal tract, normal absorption, and preservation of anal retention, were noted following restorative and reconstructive‑restorative operations.
 Conclusions. Organisational measures as well as general and specialised surgical rehabilitation strategies for Crohn’s disease allowed for more effective diagnosis and treatment of postoperative complications, better prevention of disease recurrence, improved digestion in the intestinal tract, normalised absorption processes, and preservation of anal retention. Following the implementation of specially designed surgical rehabilitation techniques, 20.7% and 1.8% of patients experienced early and late postoperative complications, respectively. Additionally, there were occurrences of postoperative mortality in 1.8% of patients and relapses in 9.4%. Severe forms of reflux ileitis, postcolectomy syndrome, and secondary anal incontinence syndrome were not observed.

Comprehensive molecular and cellular characterization of endoplasmic reticulum stress-related key genes in renal ischemia/reperfusion injury.

Renal ischemia-reperfusion injury (RIRI) is an inevitable complication in the process of kidney transplantation and lacks specific therapy. The study aims to determine the underlying mechanisms of RIRI to uncover a promising target for efficient renoprotection. Four bulk RNA-seq datasets including 495 renal samples of pre- and post-reperfusion were collected from the GEO database. The machine learning algorithms were utilized to ascertain pivotal endoplasmic reticulum stress genes. Then, we incorporated correlation analysis and determined the interaction pathways of these key genes. Considering the heterogeneous nature of bulk-RNA analysis, the single-cell RNA-seq analysis was performed to investigate the mechanisms of key genes at the single-cell level. Besides, 4-PBA was applied to inhibit endoplasmic reticulum stress and hence validate the pathological role of these key genes in RIRI. Finally, three clinical datasets with transcriptomic profiles were used to assess the prognostic role of these key genes in renal allograft outcomes after RIRI. In the bulk-RNA analysis, endoplasmic reticulum stress was identified as the top enriched pathway and three endoplasmic reticulum stress-related genes (PPP1R15A, JUN, and ATF3) were ranked as top performers in both LASSO and Boruta analyses. The three genes were found to significantly interact with kidney injury-related pathways, including apoptosis, inflammatory response, oxidative stress, and pyroptosis. For oxidative stress, these genes were more strongly related to oxidative markers compared with antioxidant markers. In single-cell transcriptome, the three genes were primarily upregulated in endothelium, distal convoluted tubule cells, and collecting duct principal cells among 12 cell types of renal tissues in RIRI. Furthermore, distal convoluted tubule cells and collecting duct principal cells exhibited pro-inflammatory status and the highest pyroptosis levels, suggesting their potential as main effectors of three key genes for mediating RIRI-associated injuries. Importantly, inhibition of these key genes using 4-phenyl butyric acid alleviated functional and histological damage in a mouse RIRI model. Finally, the three genes demonstrated highly prognostic value in predicting graft survival outcomes. The study identified three key endoplasmic reticulum stress-related genes and demonstrated their prognostic value for graft survival, providing references for individualized clinical prevention and treatment of postoperative complications after renal transplantation.

Ileostomy and Colostomy in the Prevention and Treatment of Postoperative Complications in Colorectal Cancer

Введение. Целью исследования являлась оценка эффективности илеостомии и колостомии как метода предупреждения и лечения послеоперационных внутрибрюшных осложнений у больных колоректальным раком. Материалы и методы. Проведен анализ результатов лечения 224 больных, оперированных по поводу колоректального рака с локализацией в левых отделах толстой кишки в ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России в период с 2014 по 2022 гг. Из данной группы мы отобрали пациентов, которым была сформирована илеостома и колостома (57 больных). 24 больным была сформирована протективная колостома, 26 — протективная илеостома и 7 пациентам — лечебная или девиационная стома. Результаты. В задачу нашего исследования входила необходимость оценить насколько формирование протективной илеостомы или колостомы влияет на развитие внутрибрюшных осложнений в послеоперационном периоде при хирургическом лечении колоректального рака, а также определить эффективность формирования послеоперационных стом для предупреждения прогрессирования перитонита при развитии несостоятельности межкишечного анастомоза. Послеоперационные внутрибрюшные осложнения отмечались при формировании как протективной колостомы, так и илеостомы, однако статистически значимых данных за зависимость развития осложнений от вида стомы не получено (p > 0,05). Неблагоприятных исходов не было. Лечение осложнений, возникших в послеоперационном периоде носило комплексный характер. Основополагающим явилось применение наиболее эффективного метода лечения клинически выраженной несостоятельности толстокишечного анастомоза — полное отключение кишки путем формирования колостомы или илеостомы. Благодаря этим операциям, удалось купировать возникший перитонит. Также проведена оценка зависимости развития осложнений от сроков закрытия стомы, показавшая, что раннее (9-13 дней послеоперационного периода) устранение стомы приводит к увеличению частоты осложнений, связанных с несостоятельностью толстокишечного анастомоза (p < 0,05). Выводы. Илео- и колостомы имеют одинаковую эффективность как профилактики, так и лечения осложнений, связанных с несостоятельностью толстокишечного анастомоза, полноценно отключая нижележащие отделы кишечника (p > 0,05). Выбор типа кишечной стомы должен быть в первую очередь связан с безопасностью формирования в каждом конкретном случае. Формирование девиационной стомы при развившейся несостоятельности анастомоза и ассоциированных с ней осложнений является эффективным инструментом лечения. Раннее (9-13 дней послеоперационного периода) устранение стомы приводит к увеличению частоты осложнений, связанных с несостоятельностью толстокишечного анастомоза (p < 0,05).

A meta-analysis of the efficacy of Roux-en-Y anastomosis and jejunal interposition after total gastrectomy

BackgroundTo compare the clinical efficacy of two alimentary tract reconstruction methods—“P”-shape jejunal interposition (PJI) and Roux-en-Y anastomosis after total gastrectomy.MethodThe following search phrases were utilized to search PubMed, Cochrane Library, Embase, China Academic Journals Network Full-text Database (CNKI), and Wanfang Database as of April 2022: “gastrectomy,” “Roux-en-Y,” “interposition,” “total gastrectomy,” and “jejunal interposition.” Meta-analysis of the operation time, intraoperative blood loss, complication rate, and postoperative nutritional status of patients was performed using RevMan 5.4 software.ResultsA total of 24 studies and 1887 patients were included in the study. Among patients who received a total gastrectomy, the operation time in the PJI group was substantially longer than that in the Roux-en-Y group (WMD = 19.77, 95% CI: 5.84–33.70, P = 0.005). The incidence of postoperative reflux esophagitis in the PJI group was considerably reduced than that in the Roux-en-Y group (OR = 0.39, 95% CI: 0.28–0.56, P < 0.01). The probability of postoperative dumping syndrome in the PJI group was significantly lower than that in the Roux-en-Y group (OR = 0.27, 95% CI: 0.17–0.43, P < 0.01), and the postoperative body mass changes were significantly lower in the PJI group than in the Roux-en-Y group (WMD = 3.94, 95% CI: 2.24–5.64, P < 0.01). The PJI group had substantially higher postoperative hemoglobin, albumin, and total protein levels than the Roux-en-Y group (WMD = 13.94, 95% CI: 7.77–19.20, P < 0.01; WMD = 3.97, 95% CI: 2.58–5.37, P < 0.01; WMD = 5.31, 95% CI: 3.45–7.16, P < 0.01). The prognostic nutritional index was higher in the PJI group than in the Roux-en-Y group (WMD = 9.25, 95% CI: 7.37–11.13, P < 0.01).ConclusionPJI is a safe and effective reconstruction method and is superior to Roux-en-Y anastomosis in the prevention and treatment of postoperative complications and postoperative nutritional recovery in patients after total gastrectomy.

Kinesio Taping as an Adjunct Therapy in Postoperative Care after Extraction of Impacted Third Lower Molars—A Randomized Pilot Study

The study comprised a group of 30 patients, randomly divided into the test group (with KT, n = 15) or the control group (without KT, n = 15). The surgery was performed according to standard procedures. In the test group, KT was applied immediately after surgery. Pain, swelling, and trismus were assessed. The VAS scale was used to assess pain. Swelling was measured based on six reference points on the face using a tailor's meter, and a caliper was used to measure the distance between the upper and lower medial incisors of the upper and lower teeth to determine the extent of trismus. Measurements were performed three times: on the day of the surgery, on the second day following the surgery, and on the 7th day after the surgery. Pain intensity (day of procedures), maximum mouth opening (on the seventh day after the surgery), and the use of NSAIDs (day of surgery) were significantly lower (p < 0.05) in the test group than in the control group. Kinesio taping in addition to NSAIDs was found to be more effective than NSAIDs alone in increasing the degree of jaw opening, decreasing pain intensity, and reducing the non-steroid anti-inflammatory dosage in patients after impacted mandibular wisdom teeth surgery.

Frailty combined with nutritional risk score in predicting postoperative complications of elderly patients with gastrointestinal malignancies

ObjectiveExploring the predictive power of frailty combined with nutritional risk on postoperative complications in elderly gastrointestinal malignancies patients. MethodsElderly patients who underwent gastrointestinal cancer surgery at Gastrointestinal Surgery Department of the Affiliated Hospital of Binzhou Medical University from August 2021 to June 2022 were selected as the research subjects. The patients' frailty and nutritional status were assessed using the Fried Frailty Scale and the NRS2002 Nutritional Risk Scale within 24 h of admission. Observing and recording the diagnosis and treatment of postoperative complications during the hospitalization. Results202 patients were enrolled, including 119 patients (58.91%) with nutritional risk and 89 patients (44.06%) with frailty. Frailty was an independent risk factor for postoperative complications [OR = 5.904, 95%CI (3.103, 11.233)]. The AUC value of frailty assessment was 0.780, which was greater than the AUC value of NRS2002 score of 0.705 (P < 0.01). The AUC value of frailty assessment combined with NRS-2002 score was 0.844, which was significantly higher than that alone (P < 0.01). ConclusionsThe ability of frailty to predict postoperative complications is better than the NRS-2002 score. Frailty combined with nutritional risk assessment can increase the predictive power of postoperative complications in elderly gastrointestinal malignancies patients.

Advances in Biomechanical Properties of Mandibular Fractures

By consulting the relevant research data about the biomechanical properties of mandible at home and abroad, and combining with the relevant experimental operations of biomechanical tests, this paper aims to provide a basis for the treatment of mandibular fractures and the prevention and treatment of postoperative complications, further standardize the selection of treatment schemes for mandibular fractures, provide a theoretical basis for optimizing surgical schemes and preventing postoperative complications, and provide reference for related research in mandibular mechanics.

The Experience of Using Multipotent Mesenchymal Stromal Cells in the Treatment of Severe Recurrent Cholangitis in Children with Biliary Atresia after Kasai Surgery.

This article describes the experience of application of multipotent mesenchymal stromal cells in the complex therapy of severe recurrent cholangitis in 2 children with biliary atresia after Kasai surgery. In both children, hepatic cellular insufficiency and portal hypertension developed against the background of long-term inflammatory process poorly controlled by standard therapy, which was the indication for liver transplantation. During the course of mesenchymal stromal cells therapy, the relief of the inflammatory process and functional recovery of the liver were achieved. At the time of preparing the article, the follow-up of two children since the start of multipotent mesenchymal stromal cell therapy was 3 years 9 months and 2 years 6 months. No recurrence of cholangitis was observed in the patients during the follow-up period, the liver function was preserved. There are no indications for liver transplantation at this moment. Thus, despite the fact that the mechanisms of therapeutic action of multipotent mesenchymal stromal cells in biliary atresia require further investigation, we obtained promising results suggesting the possibility of using mesenchymal stromal cells in the treatment of postoperative complications in children with biliary atresia.

The Fast Track Surgery in Perioperative Nursing of HoLEP Operation

Objective: The Fast-track surgery for transurethral holmium laser prostatectomy a perioperative nursing research study.&#x0D; Methods: We performed a retrospective analysis of transurethral holmium laser enucleation of the prostate in 89 patients with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) who were admitted to and treated at our hospital between 2018 and 2019. Measures such as early postoperative feeding and early catheter removal, adequate preoperative preparation, psychological counseling, intraoperative warming, unobstructed lavage, ensuring postoperative sleep, indwelling analgesic pump, and prevention and treatment of postoperative complications, as well as a successful job in postoperative health guidance and discharge guidance, were all implemented, and the extubation was performed, during the perioperative period in which advanced fast track surgery was used.&#x0D; Results: All 89 patients who underwent holmium laser enucleation of the prostate made a full recovery, with only one experiencing post-operative recurrent hyphema, five experiencing post-operative urinary tract infection, and ten experiencing transient and urge urinary incontinence; all were discharged after conservative treatment.&#x0D; Conclusion: Using fast track surgery as a guide for perioperative care of HoLEP surgeries might lessen the number of issues that arise after surgery and help patients get back to normal quicker.

PECULIARITIES OF POSTOPERATIVE PERIOD OF PATIENTS WITH ESOPHAGEAL CANCER AND GASTROESOPHAGEAL CANCER

Abstract. Introduction. To date, complete cure from esophageal cancer/MS/and gastroesophageal cancer/GER/can only be achieved surgically. At the same time, the five-year survival rate of patients is from 25 to 35 % according to various authors. At the same time, postoperative mortality in MS and GER reaches 15%, and only in leading clinics it is 3–9 %. In the treatment of cancer of these localizations, there are many controversial issues, namely the issue of optimal surgical access in cancer of various anatomical departments of the esophagus and GER, the volume of lymphodissection, the reconstructive stage of surgery, the relation to splenectomy. There is insufficient information on the prevention and treatment of postoperative complications.&#x0D; Purpose. Establish the nature of postoperative complications in patients with MS and GER and study the possibilities of preventing their development.&#x0D; Materials and methods. The results of surgical treatment of 219 pa-tients with esophageal cancer/MS/and gastroesophageal cancer/ GER/are presented. The patient underwent surgical interventions according to the method of Lewis/98/and Osava-Garlock/121/. The formation of esophageal-gastric anastomosis was carried out manually without the use of cross-linking devices. Preferred plastic submerged esophageal-gastric anastomosis, which has high reliability and good functional properties. Postoperative complications and factors that cause them were analyzed. The clinical case of diagnosis and treatment of gastric graft rotation is presented.&#x0D; Research results. Complications in the postoperative period occurred in 34.95 % of patients. The leading place was occupied by somatic complications: cardiovascular 17.1% and pulmonary 12.0 %. Complications from esophageal ventricular anastomosis occurred in only 4 (1.8%) patients, and in no case this led to the death of the patient. Intrapleural bleeding from the chest wall (1.4 %) and gastric cookies (1.0%) were very rare. There are also complications in the form of gastric graft rotation and complete obstruction. This complication was eliminated by the imposition of gastroenteroanastomosis on the abdominal gland of the stomach in laparotomy.&#x0D; Deaths were caused in 3 (1.4 %) patients with cardiovascular insufficiency and in 1 (0.5 %) patient with TELA.&#x0D; Conclusions. Prominent in the structure of postoperative complications are therapeutic: cardiovascular and pulmonary, they account for more than 80% of all complications. The most common cardiovascular complication is a heart rhythm disorder.&#x0D; The method of formation of esophageal anastomosis is a separate independent side of the problem. The search for the optimal method continues. However, in our opinion, the result depends not so on the method used, but how this method corresponds to the principles of optimal healing of anastomosis and the correctness of its technical performance.&#x0D; For the prevention of transplant rotation during surgery, control of its location, both from the chest and abdominal cavity, is necessary, so the latter is sutured only after the formation of esophageal-gastric anastomosis.&#x0D; In gastric graft rotation, urgent surgery is shown to perform drainage surgery.

Medical tactics for bleeding after oncological interventions on the pancreas

About 60% of malignant tumors of the hepatopancreatoduodenal region are represented by neoplasms of the pancreas, accounting for 10% of the total number of malignant tumors of the gastrointestinal tract. Simultaneously with the accumulation of experience, the improvement of the instruments used and the improvement of the supply of medical institutions, the number of cases of surgical treatment of pancreatic neoplasms is growing. The geography of these interventions is expanding. Accordingly, the issues of prevention and treatment of postoperative complications during these interventions, including such a dangerous complication as bleeding, are becoming increasingly important. Postoperative bleeding is diagnosed in 22% of operated patients with a given localization of a malignant neoplasm. The review analyzes modern views on the etiology, diagnosis and treatment of bleeding after resection interventions for pancreatic tumors.

Case Report: Delayed onset of severe acute facial swelling following bimaxillary osteotomy surgery

This case report will discuss a 20-year-old male who presented to the Accident and Emergency (A&amp;E) department at a district general hospital (DGH) with severe bilateral submandibular facial swelling four days following bimaxillary osteotomy surgery to correct his mandibular prognathism and maxillary retrognathism.The patient had previously undergone both bilateral sagittal split (BSSO) and LeFort 1 osteotomy surgery for the correction of a severe class 3 skeletal discrepancy following orthodontic treatment. The osteotomy was stabilised with titanium fixation plates. Following the surgical treatment, the patient received a regime of co-amoxiclav antibiotic prophylaxis and dexamethasone to combat post-operative inflammation. After an uneventful surgery and a single night in hospital post-operative inpatient stay, the patient was discharged with oral antibiotics and chlorhexidine mouth rinse along with their regular inhalers for his medical history including mild well controlled asthma.Four days following the surgery, the patient presented to A&amp;E complaining of sudden onset severe dysphagia, trismus, and bilateral submandibular and submental facial swelling, only noticed on waking. This case report will discuss the indications of a bimaxillary osteotomy as well as the management and treatment of post-operative complications following this surgery.

Analysis of prognosis factors of postoperative cardiac complications in colorectal cancer patients with comorbid coronary artery disease

Objective: To examine the prognosis factors of postoperative cardiac complications in colorectal cancer patients co-morbidated with coronary artery disease. Methods: Clinical data of 449 patients colorectal cancer patients co-morbidated with coronary artery disease accepted redical surgery from April 2013 to April 2020 at Department of General Surgery, Peking Union Medical College Hospital were analyzed retrospectively. There were 306 males and 143 females, aging (68.7±8.9) years (range: 44 to 89 years). Postoperative acute coronary syndrome, new-onset arrhythmia and heart failure that causes clinical symptoms were recorded as cardiac complications. t test, χ2 test and Fisher exact test were used for univariate analysis of prognosis factors of postoperative cardiac events. The variables with P<0.05 were included in the multivariate Logistic regression was used to determine the independent prognosis factors. Results: After surgery, 44 patients (9.8%) suffered from at least one cardiac event, including 30 patients with acute coronary syndrome, 19 patients with new-onset arrhythmia and 9 patients with heart failure. There were 3 deaths in the cohort within 30 days after surgery. Two patients died from cardiac-related complications, and one from septic shock due to postoperative anastomotic leaks. On Univariate analysis showed that cardiac complications were associated with age ≥80 years, co-morbidated diabetes, emergency surgery, re-operation, anastomotic leakage, intestinal flora disorder and elevation of preoperative neutrophil-lymphocyte ratio (χ2: 4.308 to 12.219, all P<0.05). Multivariate Logistic regression analysis identified age ≥80 years(OR=3.195, 95%CI: 1.379 to 7.407, P=0.007), co-morbidated diabetes (OR=2.551, 95%CI: 1.294 to 5.025, P=0.007), emergency surgery (OR=4.717, 95%CI: 1.052 to 20.833, P=0.043), and elevated preoperative neutrophil-lymphocyte ratio (OR=1.114, 95%CI: 1.018 to 1.218, P=0.018) as independent prognosis factors for cardiac complications. Conclusions: Emergency surgery, advanced age, co-morbidated type 2 diabetes and elevated preoperative neutrophil-lymphocyte ratio may increase the risk of postoperative cardiac complications in colorectal cancer patients with coronary artery disease. Surgeons should strictly master surgical indications, pay attention to preoperative assessment, perioperative monitoring, and diagnosis and treatment of postoperative complications in order to reduce the risk of complications.

MO353: Extracorporeal Blood Purification of Complications After Aortic Valve Replacement. Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement

Abstract BACKGROUND AND AIMS Complications after cardiac surgery have serious negative consequences, prolonging the average ICU stay days and costs. Prevention and treatment of complications after aortic valve replacement is a serious problem. According to numerous authors, the incidence of complications after aortic valve replacement varies from 10 to &amp;gt;60% of cases. Development of complications is associated with a higher hospital mortality rate, the risk of infection and a more complex course of the disease. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery; however, it can still exceed 40% among those patients who develop a postoperative complication and can reach 50% in patients requiring extracorporeal blood purification therapy. Impaired renal function or active infectious process has significant prognostic consequences, which are the cause of up to 40% of deaths. The aim of this work is to structure or compare complications in immediate postoperative period after aortic valve replacement by the surgical and transcatheter method. METHOD Retrospective analysis of 267 medical records. All patients in study were after aortic valve replacement, hospitalized in JSC NSCC Nur-Sultan, Kazakhstan, from 1 January 2020 to 31 October 2021. A total of 127 patients SAVR, 137 patients TAVR. Of those, 3 patients were excluded from the study due to chronic haemodialysis. Inclusion criteria: informed consent to participate in research. Age is&amp;gt;18 years old. Prosthetics of the aortic valve by the SAVR or TAVR methods. Treatment of postoperative complications by the extracorporeal blood purification methods. Exclusion criteria: refusal to participate in research. Age is &amp;lt;18 years old. Chronic dialysis. Active bleeding. The patients were divided into two groups: group 1—patients after aortic valve replacement by the TAVR method and group 2—patients after open surgery aortic valve—SAVR. Indications for extracorporeal blood purification methods: acute kidney injury (AKI), acute liver injury, the systemic inflammatory response syndrome (SIRS) and cytokine storm. RESULTS Period from 2020 to 2021. TAVR group—137 patients, male―65 (47.45%), female—72 (52.55%), the average age of patients was 69.2±11.16 years. In the SAVR group, there were 127 patients, of which male 43 (33.9%) and female 84 (66.1%), the average age was 47.04 ± 13.67 years. CONCLUSION Complications and mortality rate are more common after open surgery SAVR than after TAVR. Extracorporeal blood purification methods are required after an open valve replacement. Extracorporeal blood purification methods are an effective way to treat complications such as AKI and SIRS after aortic valve replacement.

Chinese expert surgical procedure consensus on open pericardial devascularization(2021)

Although the treatment strategy of esophageal and gastric varices bleeding in portal hypertension has been diversified and multidisciplinary now,the surgical treatment represented by pericardial devascularization operation will still play an important and irreplaceable role in China. In order to standardize the surgical procedure,guide clinical practice and improve the level of surgical treatment of portal hypertension,Chinese Society of Spleen and Portal Hypertension Surgery,Chinese Surgical Society,Chinese Medical Association organized Chinese experts to formulate this consensus. The main contents include:the position of surgical treatment,surgical indications and contraindications,preoperative evaluation,key points and precautions of surgical procedure,perioperative treatment,prevention and treatment of postoperative complications. The consensus emphasizes the standardization of surgical treatment of portal hypertension,pay attention to the prevention and treatment of postoperative portal vein thrombosis,and expect to provide surgeons with clinical guidance.

Hetero‐Integration of Silicon Nanomembranes with 2D Materials for Bioresorbable, Wireless Neurochemical System (Adv. Mater. 14/2022)

Neurochemical Analyzers In article number 2108203, Chul-Ho Lee, Dong Pyo Jang, Suk-Won Hwang, and co-workers demonstrate a soft, wireless, and bioresorbable neurochemical system that is designed to determine various concentrations of neurotransmitters as well as to monitor peripheral physiologies in a simultaneous manner. Such technology is motivated by the need for assessment and treatment of postoperative complications that may occur over a certain period of time after neurological surgeries.

Cost-Effectiveness Analysis of the Application of a Porcine-Derived Fibrin Sealant for the Treatment of Cerebrospinal Fluid Leak in China

This study aimed to evaluate the cost-effectiveness of a porcine-derived fibrin sealant (PFS) for treating cerebrospinal fluid (CSF) leaks in cranial surgery compared with sutures alone from the perspective of public hospital management in China. A decision tree model of cranial surgery patients with intraoperative CSF leak was constructed in R 3.6.3. The cost-effectiveness of using PFS with dural sutures was compared versus using sutures alone. Efficacy and safety data were obtained from a randomized controlled, single-blinded clinical trial that enrolled 200 patients (NCT03110783). Effectiveness was measured as the success rate of CSF leak treatment and the rate of postoperative complication. Hospital procurement costs were used to provide cost measurements from the hospital administrator's perspective. The PFS strategy had a higher success rate of CSF leak treatment (97.81% vs 49.21%) and a lower complication rate (9.49% vs 14.29%), based on results from the clinical trial. Using PFS also resulted in cost savings amounting to $374.97 in additional intraoperative CSF leak repairs ($18.07 vs $393.04) and $66.68 in postoperative complication treatment ($131.90 vs $198.58). Both one-way sensitivity analysis and probabilistic sensitivity analysis confirmed that the model results were stable against input variations. The decision tree analysis revealed that using PFS in conjunction with sutures was associated with improved clinical performance and lower overall costs. PFS in combination with sutures is the dominant strategy for treating CSF leak from the perspective of hospital decision-makers.