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Journal of Investigative Surgery : the... Jul 2022Anastomotic devices, including linear staplers (LSs) and circular staplers (CSs), have been widely used after laparoscopic gastric surgery. However, it is controversial... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Anastomotic devices, including linear staplers (LSs) and circular staplers (CSs), have been widely used after laparoscopic gastric surgery. However, it is controversial whether linear stapling is superior to circular stapling for anastomosis. Thus, we conducted a meta-analysis to compare the aspects of postoperative complications, particularly anastomotic stricture and anastomotic leakage, on the use of the two techniques to assist clinical decision-making.
METHODS
We conducted a systematic search using Embase, PubMed, and Cochrane Library to evaluate studies that compared LSs and CSs after laparoscopic gastric surgery.
RESULTS
Pooled analysis suggested that patients who received LSs had fewer postoperative complications (P = 0.019), and anastomotic complications (P < 0.001), stricture (P = 0.001), and bleeding (P = 0.005). The subgroup analyses showed that LSs caused fewer anastomotic complications (P < 0.001), anastomotic strictures (P < 0.001), and postoperative hemorrhage (P = 0.007) in patients with gastric cancer than CS. In addition, LSs caused fewer incidences of overall morbidity (P = 0.042), anastomotic strictures (P = 0.023), postoperative hemorrhage (P < 0.001), wound infection (P < 0.001), and shorter length of hospital stay (P = 0.048) in patients with obesity. Furthermore, the subgroup analyses showed that the use of LS resulted in lower overall morbidity (P = 0.042), anastomotic stricture (P = 0.023), wound infection (P < 0.001), length of hospital stay (P = 0.048), and postoperative hemorrhage (P < 0.001) when applied in gastrojejunostomy, while LSs resulted in fewer anastomotic complications (P < 0.001), anastomotic stricture (P = 0.016) than CS when applied in esophagojejunostomy.
CONCLUSION
Compared with CSs, LSs yielded a lower incidence of overall morbidity, anastomotic complications, anastomotic stricture, bleeding, and wound infection, indicating that linear stapling is safer and more efficient than circular stapling when performing anastomosis after laparoscopic gastric surgery.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Gastric Bypass; Humans; Laparoscopy; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Suture Techniques; Wound Infection
PubMed: 35435081
DOI: 10.1080/08941939.2022.2058126 -
Transfusion Clinique Et Biologique :... Aug 2021Patients undergoing cardiac surgery are at high risk of postoperative bleeding, which is related to worse prognosis and survival. The use of ROTEM®, together with the...
Patients undergoing cardiac surgery are at high risk of postoperative bleeding, which is related to worse prognosis and survival. The use of ROTEM®, together with the implementation of a specific treatment algorithm, to reduce the risk of postoperative bleeding. An observational, comparative, cross-case study with historical controls. A total of 1772 consecutive patients admitted to intensive care unit after having undergone cardiac surgery, was divided into 3 groups: Group 1: Coagulation was only monitored by the classical coagulation test (control group). Group 2: Monitorization was done by ROTEM®, according to a protocol designed in our center. Group 3: VerifyNow® was added to ROTEM®, implementing a specific treatment algorithm. We observed a decreased of red blood cell transfusion (Group 1 55.5%, Group 2 52.7%, Group 3 46.6%, P<0.01). Postoperative results include a significant reduction in complications with a marked improvement in overall survival in the ROTEM® - guided groups. Conclusions: Monitoring of hemostasis by POCT'S (ROTEM® and VerifyNow®) in patients undergoing cardiac surgery and cardiac transplantation was associated with a decreased incidence of blood transfusion, postoperative clinical complications, and mortality.
Topics: Blood Coagulation Tests; Blood Transfusion; Cardiac Surgical Procedures; Humans; Postoperative Hemorrhage; Thrombelastography
PubMed: 33839299
DOI: 10.1016/j.tracli.2021.03.003 -
European Archives of... Nov 2021LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding...
PURPOSE
LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding postoperative complications and among relevant patients subgroups. In a large cohort of patients including relevant patient subgroups, we evaluated intra- and postoperative complications using LSJ.
METHODS
Single-centre register-based study evaluating 3346 patients undergoing hemi- or total thyroidectomy. We compared differences in intra- and postoperative complications using LSJ compared to conventional technique. Multivariate analyses were conducted to adjust for potential confounders.
RESULTS
Compared to the conventional technique, LSJ was associated with less postoperative drainage (OR 0.4, p = 0.02) and postoperative haemorrhage (OR 0.3, p = 0.02) among patients undergoing hemi- and total thyroidectomy with benign histology, respectively, but with increased risk of postoperative infection [3 (6.4%) vs. 0 (0.0%) patients, p = 0.04] among patients undergoing total thyroidectomy with malignant histology. LSJ was associated with reduced operation duration (- 12.2 min, p < 0.001, - 7.9 min, p < 0.001 and - 13.2 min, p = 0.002) and intraoperative blood loss (- 52.1 ml, p < 0.001, - 13.6 ml, p < 0.001 and - 12.9 ml, p = 0.02) compared to conventional technique among patients undergoing total and hemithyroidectomy with benign histology and hemithyroidectomy with malignant histology, respectively.
CONCLUSION
LSJ was associated with a reduced risk of postoperative haemorrhage and less postoperative drainage but increased risk of postoperative infection depending on the type of thyroidectomy and histology of the thyroid gland. LSJ was associated with only a small reduction in operation duration and intraoperative blood loss.
TRIAL REGISTRATION
The study was based on data prospectively registered in the Danish national database THYKIR.
Topics: Blood Loss, Surgical; Humans; Postoperative Complications; Postoperative Hemorrhage; Thyroid Gland; Thyroidectomy
PubMed: 33689021
DOI: 10.1007/s00405-021-06685-w -
Surgical Endoscopy Sep 2023Postoperative gastrointestinal bleeding (GIB) is a rare but serious complication of bariatric surgery. The recent rise in extended venous thromboembolism regimens as...
BACKGROUND
Postoperative gastrointestinal bleeding (GIB) is a rare but serious complication of bariatric surgery. The recent rise in extended venous thromboembolism regimens as well as outpatient bariatric surgery may increase the risk of postoperative GIB or lead to delay in diagnosis. This study seeks to use machine learning (ML) to create a model that predicts postoperative GIB to aid surgeon decision-making and improve patient counseling for postoperative bleeds.
METHODS
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used to train and validate three types of ML methods: random forest (RF), gradient boosting (XGB), and deep neural networks (NN), and compare them with logistic regression (LR) regarding postoperative GIB. The dataset was split using fivefold cross-validation into training and validation sets, in an 80/20 ratio. The performance of the models was assessed using area under the receiver operating characteristic curve (AUROC) and compared with the DeLong test. Variables with the strongest effect were identified using Shapley additive explanations (SHAP).
RESULTS
The study included 159,959 patients. Postoperative GIB was identified in 632 (0.4%) patients. The three ML methods, RF (AUROC 0.764), XGB (AUROC 0.746), and NN (AUROC 0.741) all outperformed LR (AUROC 0.709). The best ML method, RF, was able to predict postoperative GIB with a specificity and sensitivity of 70.0% and 75.4%, respectively. Using DeLong testing, the difference between RF and LR was determined to be significant with p < 0.01. Type of bariatric surgery, pre-op hematocrit, age, duration of procedure, and pre-op creatinine were the 5 most important features identified by ML retrospectively.
CONCLUSIONS
We have developed a ML model that outperformed LR in predicting postoperative GIB. Using ML models for risk prediction can be a helpful tool for both surgeons and patients undergoing bariatric procedures but more interpretable models are needed.
Topics: Humans; Retrospective Studies; Machine Learning; Gastrointestinal Hemorrhage; Logistic Models; Postoperative Hemorrhage; Bariatric Surgery
PubMed: 37311893
DOI: 10.1007/s00464-023-10156-0 -
Langenbeck's Archives of Surgery Aug 2023Reducing clinically relevant post-operative pancreatic fistula (CR-POPF) incidence after pancreatic resections has been a topic of great academic interest. Optimizing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Reducing clinically relevant post-operative pancreatic fistula (CR-POPF) incidence after pancreatic resections has been a topic of great academic interest. Optimizing post-operative drain management is a potential strategy in reducing this major complication.
METHODS
Studies involving pancreatic resections, including both pancreaticoduodenectomy (PD) and distal pancreatic resections (DP), with intra-operative drain placement were screened. Early drain removal was defined as removal before or on the 3rd post-operative day (POD) while late drain removal was defined as after the 3rd POD. The primary outcome was CR-POPF, International Study Group of Pancreatic Surgery (ISGPS) Grade B and above. Secondary outcomes were all complications, severe complications, post-operative haemorrhage, intra-abdominal infections, delayed gastric emptying, reoperation, length of stay, readmission, and mortality.
RESULTS
Nine studies met the inclusion criteria and were included for analysis. The studies had a total of 8574 patients, comprising 1946 in the early removal group and 6628 in the late removal group. Early drain removal was associated with a significantly lower risk of CR-POPF (OR: 0.24, p < 0.01). Significant reduction in risk of post-operative haemorrhage (OR: 0.55, p < 0.01), intra-abdominal infection (OR: 0.35, p < 0.01), re-admission (OR: 0.63, p < 0.01), re-operation (OR: 0.70, p = 0.03), presence of any complications (OR: 0.46, p < 0.01), and reduced length of stay (SMD: -0.75, p < 0.01) in the early removal group was also observed.
CONCLUSION
Early drain removal is associated with significant reductions in incidence of CR-POPF and other post-operative complications. Further prospective randomised trials in this area are recommended to validate these findings.
Topics: Humans; Pancreatectomy; Device Removal; Pancreas; Postoperative Complications; Postoperative Hemorrhage; Intraabdominal Infections
PubMed: 37587225
DOI: 10.1007/s00423-023-03053-6 -
European Journal of Cardio-thoracic... Mar 2020Post-lobectomy bleeding is uncommon and rarely studied. In this study, we aimed to determine the incidence of post-lobectomy haemorrhage and compare the outcomes of...
OBJECTIVES
Post-lobectomy bleeding is uncommon and rarely studied. In this study, we aimed to determine the incidence of post-lobectomy haemorrhage and compare the outcomes of reoperation and non-operative management.
METHODS
We conducted a single-institution review of lobectomy cases from 2009 to 2018. The patients were divided into two groups based on the treatment for postoperative bleeding: reoperation or transfusion of packed red blood cells with observation. Transfusion correcting intraoperative blood loss was excluded. One or more criteria defined postoperative bleeding: (i) drop in haematocrit ≥10 or (ii) frank, sustained chest tube bleeding with or without associated hypotension. Covariates included demographics, comorbidities and operative characteristics. Outcomes were operative mortality, complications, length of hospital stay and readmission within 30 days.
RESULTS
Following 1960 lobectomies (92% malignant disease, 8% non-malignant), haemorrhage occurred in 42 cases (2.1%), leading to reoperation in 27 (1.4%), and non-operative management in 15 (0.8%). The median time to reoperation was 17 h. No source of bleeding was identified in 44% of re-explorations. Patients with postoperative haemorrhage were more often male (64.3% vs 41.2%; P < 0.01) and more likely to have preoperative anaemia (45.2% vs 26.5%; P = 0.01), prior median sternotomy (14.3% vs 6.0%; P = 0.04), an infectious indication (7.1% vs 1.8%; P = 0.01) and operative adhesiolysis (45.2% vs 25.8%; P = 0.01). Compared with non-operative management, reoperation was associated with fewer units of packed red blood cells transfusion (0.4 vs 1.9; P < 0.001), while complication rates were similar and 30-day mortality was absent in either group.
CONCLUSIONS
Haemorrhage after lobectomy is associated with multiple risk factors. Reoperation may avoid transfusion. A prospective study should optimize timing and selection of operative and non-operative management.
Topics: Humans; Incidence; Male; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Reoperation; Retrospective Studies
PubMed: 31562514
DOI: 10.1093/ejcts/ezz266 -
The Journal of Laryngology and Otology Jul 2023Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24... (Review)
Review
OBJECTIVE
Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24 hours after an operation has long been attributed to post-operative infection; however, there is little evidence to support this hypothesis and the associated use of antibiotics in the current literature.
METHOD
This study looked at the aetiology and evidence-based management of post-tonsillectomy haemorrhage, and investigated the impact of bacterial infection and antimicrobials on the pathogenesis and clinical course of this complication.
RESULTS
A number of peri-operative risk factors for post-tonsillectomy haemorrhage exist, and infective pathologies, including recurrent or chronic tonsillitis and group A streptococcus on blood cultures, may predispose to bleeding. Very few studies have shown a link between post-tonsillectomy haemorrhage and objective markers of infection such as pyrexia, raised inflammatory markers or positive microbiology cultures. The role of antibiotics in secondary post-tonsillectomy haemorrhage remains controversial, and numerous randomised, controlled trials of peri-operative antibiotics have shown no significant difference in bleeding rates between antibiotics and controls.
CONCLUSION
Further trials investigating the role of antibiotics and more robust studies investigating the presence of bacterial infection at the time of bleeding may be required to determine the true role of infection in post-tonsillectomy haemorrhage.
Topics: Humans; Tonsillectomy; Tonsillitis; Postoperative Hemorrhage; Bacterial Infections; Anti-Bacterial Agents
PubMed: 36511242
DOI: 10.1017/S0022215122002547 -
Clinical Otolaryngology : Official... Jan 2021The aim of this study was to assess the current post-tonsillectomy haemorrhage and return to theatre rates in Scotland.
OBJECTIVES
The aim of this study was to assess the current post-tonsillectomy haemorrhage and return to theatre rates in Scotland.
DESIGN
National cross-sectional study.
PARTICIPANTS AND SETTING
Tonsillectomy outcomes data were collated for all NHS patients undergoing tonsillectomy in Scotland between 1998-2002 and 2013-2017.
MAIN OUTCOME MEASURES
Using Information Services Division (ISD) Scotland retrospective data, 30-day re-admission and 30-day return to theatre rates allowed an assessment of post-tonsillectomy haemorrhage rates. Data were validated through comparison with an audit conducted in NHS Greater Glasgow & Clyde between 2015 and 2016.
RESULTS
Tonsillectomy was performed in 27 819 patients between 1998 and 2002, and 23 184 patients between 2013 and 2017. 30-day re-admission rates increased considerably between the 1998-2002 and 2013-2017 cohorts, from 4.7% to 12.1% in paediatric patients, and 9.8%-19.9% in adult patients. Similarly, 30-day "return to theatre rates" increased between the two cohorts, from 1.2% to 1.7% in paediatric patients, and 3.6%-4.9% in adult patients. Re-admission and return to theatre rates were similar across Health Boards for both adult and paediatric tonsillectomies in each cohort.
CONCLUSIONS
Current 30-day re-admission and return to theatre rates are significantly higher than the majority of reported series to date. The rising rate of tonsillectomy haemorrhage between cohorts is likely to be multifactorial, possibly reflecting an underestimation of previous rates and the changing profile of the tonsillectomy patient. A detailed audit of current practice is needed to investigate these tonsillectomy outcomes, which are similar across all Health Boards in Scotland. Of most significance are the implications for accurate patient consent and non-elective ENT service provision.
Topics: Adolescent; Adult; Child; Child, Preschool; Cross-Sectional Studies; Female; Hospitalization; Humans; Male; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Risk Factors; Scotland; Tonsillectomy; Young Adult
PubMed: 32686267
DOI: 10.1111/coa.13608 -
Oral Surgery, Oral Medicine, Oral... Nov 2020This literature review was performed to assess the risk of bleeding in dental implantation procedures in patients taking antiplatelet drugs (APs), oral anticoagulants... (Review)
Review
OBJECTIVES
This literature review was performed to assess the risk of bleeding in dental implantation procedures in patients taking antiplatelet drugs (APs), oral anticoagulants (OACs) and direct oral anticoagulants (DOACs).
STUDY DESIGN
MEDLINE and SCOPUS databases were searched for English language publications through October 2019, using the keywords "dental implants," "dental implantation," "anticoagulants," "platelet aggregation inhibitors," and "hemorrhage." Reference lists of relevant articles were also hand searched. Collected data regarding dental implantation procedures, type of medications (APs, OACs and DOAC), and postoperative bleeding episodes were analyzed.
RESULTS
Nine studies were included in the review. Postoperative bleeding occurred in 10 (2.2%) of 456 of cases involving dental implant placements; in all of those cases, bleeding was controlled with the use of local hemostatic agents. The bleeding incidence in patients on antiplatelet medications was 0.4% (range 1 of 253 to 1 of 261). Among those taking oral anticoagulants, the bleeding incidence was 5.7% (range 6 of 105 to 6 of 113), and among those on direct oral anticoagulants, the bleeding incidence was 3.3% (3 of 90). The numbers of more extensive surgical procedures (i.e., sinus lift and bone augmentation procedures) were small, and additional information regarding the surgery, the specific antithrombotic used, or bleeding was often not provided, so further analysis was not possible.
CONCLUSIONS
Evidence supports continuing OACs, DOACs, or APs during dental implant surgery.
Topics: Administration, Oral; Anticoagulants; Dental Implants; Fibrinolytic Agents; Hemostatics; Humans; Postoperative Hemorrhage
PubMed: 32811791
DOI: 10.1016/j.oooo.2020.07.012 -
Neurology India 2022
Topics: Epidermal Cyst; Humans; Neoplasms; Postoperative Hemorrhage
PubMed: 35263953
DOI: 10.4103/0028-3886.338686