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Nigerian Journal of Clinical Practice Jul 2022Colorectal cancer (CRC) is the second most frequently diagnosed cancer in women and the third in men. Anaemia is a common condition in patients with CRC.
BACKGROUND
Colorectal cancer (CRC) is the second most frequently diagnosed cancer in women and the third in men. Anaemia is a common condition in patients with CRC.
AIM
In this study, we aimed to retrospectively analyse the relationship between preoperative anaemia (POA) and postoperative complications in patients with colorectal cancer (CRC) that underwent elective surgery.
PATIENTS AND METHODS
The data of patients who underwent elective curative surgery for CRC between January 2015 and December 2020 and had pathologically-proven cancer were evaluated retrospectively. We examined the effect of demographic characteristics of patients, preoperative haemoglobin, cancer localization (colon/rectum), American Society of Anaesthesiologist (ASA) classification, preoperative co-morbidity, surgical method (laparoscopic/open), stoma status, tumor stage, presence of preoperative anaemia on surgical site infection, pulmonary complications, renal complications, anastomotic leaks, and need for intensive care and re-operation in the postoperative period.
RESULTS
Of the 352 patients who underwent curative resection for CRC, 177 (50.3%) were diagnosed with POA. The median haemoglobin value was 10.7 g/dl in POA patients while it was 13.6 g/dl in the non-POA group. Regarding the localization of tumor, the patients with tumors on the right colon were more statistically significant in terms of POA (p < 0.05). Patients with POA had a higher rate of hypertension and coronary artery disease compared to patients without POA (p < 0.05). In patients with POA, surgical site infection and need for intensive care were statistically significant in the postoperative period compared to patients without POA (p < 0.05, P < 0.01, respectively). However, there was no significant difference between the two groups regarding pulmonary complications, renal complications, anastomotic leaks, and need for re-operation in the postoperative period.
CONCLUSION
We believe that POA should be corrected prior to surgery to reduce not only the need for intensive care but also surgical site infection in patients undergoing elective curative surgery for CRC.
Topics: Anastomotic Leak; Anemia; Colorectal Neoplasms; Female; Hemoglobins; Humans; Male; Postoperative Period; Retrospective Studies; Surgical Wound Infection
PubMed: 35859472
DOI: 10.4103/njcp.njcp_1664_21 -
Spine Apr 2022A retrospective cross-sectional study.
STUDY DESIGN
A retrospective cross-sectional study.
OBJECTIVE
This study aims to evaluate the effect size of postoperative glycemic variability on surgical outcomes among patients who have undergone one- to three-level lumbar fusion.
SUMMARY OF BACKGROUND DATA
While numerous patient characteristics have been associated with surgical outcomes after lumbar fusion, recent studies have described the measuring of postoperative glycemic variability as another promising marker.
METHODS
A total of 850 patients were stratified into tertiles (low, moderate, high) based on degree of postoperative glycemic variability defined by coefficient of variation (CV). Surgical site infections were determined via chart review based on the Centers for Disease Control and Prevention definition. Demographic factors, surgical characteristics, inpatient complications, readmissions, and reoperations were determined by chart review and telephone encounters.
RESULTS
Overall, a statistically significant difference in 90-day adverse outcomes was observed when stratified by postoperative glycemic variability. In particular, patients with high CV had a higher odds ratio (OR) of readmission (OR = 2.19 [1.17, 4.09]; P = 0.01), experiencing a surgical site infection (OR = 3.22 [1.39, 7.45]; P = 0.01), and undergoing reoperations (OR = 2.65 [1.34, 5.23]; P = 0.01) compared with patients with low CV. No significant association was seen between low and moderate CV groups. Higher CV patients were more likely to experience longer hospital stays (β: 1.03; P = 0.01). Among the three groups, high CV group experienced the highest proportion of complications.
CONCLUSION
Our study establishes a significant relationship between postoperative glycemic variability and inpatient complications, length of stay, and 90-day adverse outcomes. While HbA1c has classically been used as the principal marker to assess blood glucose control, our results show CV to be a strong predictor of postoperative adverse outcomes. Future high-quality, prospective studies are necessary to explore the true effect of CV, as well as its practicality in clinical practice. Nevertheless, fluctuations in blood glucose levels during the inpatient stay should be limited to improve patient results.Level of Evidence: 4.
Topics: Blood Glucose; Cross-Sectional Studies; Humans; Length of Stay; Postoperative Complications; Postoperative Period; Prospective Studies; Retrospective Studies; Spinal Fusion
PubMed: 34474452
DOI: 10.1097/BRS.0000000000004214 -
Veterinary Surgery : VS May 2021A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates. (Review)
Review
OBJECTIVE
A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates.
STUDY DESIGN
Systematic review.
METHODS
A broad bibliographic search was performed in three online databases through March 2020 for publications on postoperative antibiotic use after TPLO in dogs. Search terms included dog, canine, TPLO, tibial plateau leveling osteotomy, infection, antibiotic, and antimicrobial. Articles that met inclusion criteria were evaluated for level of evidence (LoE) by a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) classification and evaluation.
RESULTS
Thirteen studies met the inclusion criteria. Effect of antibiotic use was the primary question in four studies. Among those, 50% (2/4) were assigned a mOLE of 1b and a GRADE of moderate, while the other 50% (2/4) were assigned a mOLE of 4b or 4c with a GRADE of low. The two studies with the highest LoE did not provide evidence of the benefit of antibiotic usage. Results of only one study provided evidence to support the use of postoperative antibiotics. The remaining nine studies provided evaluation of antibiotic use secondarily and were all assigned a low LoE. Among these, 78% (7/9) provided evidence to support the use of postoperative antibiotics.
CONCLUSION
We found little evidence to support the use of postoperative antibiotics to reduce the risk of surgical site infections in dogs after TPLO. The answer to this clinical question is complicated by the lack of prospective studies and inconsistent treatment protocols in the evaluated studies.
CLINICAL SIGNIFICANCE
The clinical impact of postoperative antibiotic administration on infection rates after TPLO is uncertain.
Topics: Animals; Anti-Bacterial Agents; Dogs; Osteotomy; Postoperative Period; Surgical Wound Infection; Tibia
PubMed: 33709459
DOI: 10.1111/vsu.13603 -
Biological Trace Element Research Jun 2023Trace elements are essential micronutrients that take part in most antioxidant reactions in the body. In this study, we evaluated the levels of copper, chromium,...
Trace elements are essential micronutrients that take part in most antioxidant reactions in the body. In this study, we evaluated the levels of copper, chromium, manganese, selenium, magnesium, zinc, iron, and silicon in adult patients who undergone isolated on-pump coronary artery bypass with the occurrence of postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection; 51 adult patients (41 men, 10 women) underwent isolated coronary artery bypass grafting (CABG) under cardiopulmonary bypass. The mean age was 61,9 ± 8,0 years (range 45-82 years). Blood samples were collected preoperatively, postoperative first hour, postoperative first day, and fifth postoperative day for element analysis. Serum levels were determined by an Inductive Coupled Plasma Optical Emission Spectrometer (ICAP 6000). Serum copper, zinc, and selenium values, typically known as strong antioxidant elements in the body, decreased significantly during the first hour and first day of postoperative period compared to the preoperative period (p < 0.05). Also, postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection were observed to increase with the decrease in levels of trace elements (p < 0.05). The levels of these elements were observed to return to normal levels during the fifth postoperative day. The levels of trace elements decrease significantly after on-pump coronary artery bypass surgery. Our study results suggest that this could be one of the predisposing factors for increased postoperative atrial fibrillation, transient kidney injury, transient renal injury, and increased rate of wound infections for patients undergoing on-pump coronary artery bypass grafting.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Antioxidants; Atrial Fibrillation; Copper; Coronary Artery Bypass; Morbidity; Postoperative Complications; Postoperative Period; Risk Factors; Selenium; Trace Elements; Zinc
PubMed: 35902512
DOI: 10.1007/s12011-022-03368-3 -
ANZ Journal of Surgery May 2021Aim of this meta-analysis was to compare diagnostic accuracy C-reactive protein and procalcitonin between postoperative days 3 and 5 to predict infectious complications... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Aim of this meta-analysis was to compare diagnostic accuracy C-reactive protein and procalcitonin between postoperative days 3 and 5 to predict infectious complications post pancreatic surgery.
METHODS
A systemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of procalcitonin and C-reactive protein to predict infectious complications between postoperative days 3 and 5 following pancreatic surgery. A meta-analysis was performed using random-effect model and pooled predictive parameters.
RESULTS
Fifteen studies consisting of 2212 patients were included in the final meta-analysis. Pooled sensitivity, specificity, area under curve and diagnostic odds ratio (DOR) for day 3 C-reactive protein were 62%, 67%, 0.772 and 6.54, respectively. Pooled sensitivity, specificity, area under curve and DOR for day 3 procalcitonin were 74%, 79%, 0.8453 and 11.03, respectively. Sensitivity, specificity, area under the curve and DOR for day 4 C-reactive protein were 60%, 68%, 0.8022 and 11.90, respectively. Sensitivity, specificity and DOR of postoperative day 5 procalcitonin level for predicting infectious complications were 83%, 70% and 12.9, respectively. Pooled sensitivity, specificity, Area Under Receiver Operating Curve and DOR were 50%, 70%, 0.777 and 10.19, respectively.
CONCLUSION
Postoperative procalcitonin is a better marker to predict postoperative infectious complications after pancreatic surgeries.
Topics: Biomarkers; C-Reactive Protein; Humans; Infections; Pancreas; Postoperative Complications; Postoperative Period; Procalcitonin; ROC Curve; Sensitivity and Specificity
PubMed: 33576156
DOI: 10.1111/ans.16639 -
Scientific Reports Jul 2023We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term...
We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term mortality. A retrospective cohort study was conducted and multivariate logistic regression was applied to determine the effect of demographic characteristics (sex, age, AO/OTA classification, height, weight, body mass index), medical history (hypertension, ischemic heart disease, diabetes mellitus, thyroid malfunction, cancer, osteoporosis, smoking) lab data (Complete blood cell, blood sugar, Blood Urea Nitrogen, Creatinine, Na, and K), surgery-related factors (Anesthesia time and type, implant, intraoperative blood transfusion, postoperative blood transfusion, and operation time), duration of admission to surgery and anticoagulant consumption on short-term mortality and complication and long-term mortality. Three hundred ten patients from November 2016 to September 2020 were diagnosed with an intertrochanteric fracture. 3.23% of patients died in hospital, 14.1% of patients confronted in-hospital complications, and 38.3% died after discharge till the study endpoint. ΔNumber of Neutrophiles is the primary determinant for in-hospital mortality in multivariate analysis. Age and blood transfusion are the main determinants of long-term mortality, and Na before surgery is the primary variable associated with postoperative complications. Among different analytical factors Na before surgery as a biomarker presenting dehydration was the main prognostic factor for in hospital complications. In hospital mortality was mainly because of infection and long-term mortality was associated with blood transfusion.
Topics: Humans; Retrospective Studies; Hip Fractures; Postoperative Complications; Postoperative Period; Morbidity; Treatment Outcome; Risk Factors
PubMed: 37495718
DOI: 10.1038/s41598-023-38667-9 -
International Journal of Gynecological... Apr 2023To examine the incidence of perioperative blood transfusion and association with 30 day postoperative outcomes in gynecologic cancer surgery.
OBJECTIVE
To examine the incidence of perioperative blood transfusion and association with 30 day postoperative outcomes in gynecologic cancer surgery.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all gynecologic oncology cases from 2013 to 2019. Clinical and surgical characteristics and 30 day postoperative complications were retrieved. The primary outcome was 30 day composite morbidity, based on the occurrence of one or more of the 18 adverse events. Secondary outcomes were 30 day mortality, length of stay in hospital, and composite surgical site infection, defined as superficial, deep, or organ space surgical site infection. The χ test and logistic regression analyses were performed to compare the outcomes of patients with and without perioperative blood transfusion.
RESULTS
There were 62 531 surgical gynecologic oncology cases with an overall transfusion incidence of 9.4%. The transfusion incidence was significantly higher at 22.4% with laparotomy compared with 1.7% with minimally invasive surgery (p<0.0001). On multivariable analysis for laparotomy patients, blood transfusion was predictive of composite morbidity (adjusted odds ratio (OR) 1.65, 95% confidence interval (CI) 1.48 to 1.85) and length of stay in hospital ≥5 days (adjusted OR 9.02, 95% CI 8.21 to 9.92). In advanced ovarian cancer patients (n=3890), the incidence of perioperative blood transfusion was 40.8%. On multivariable analysis, perioperative blood transfusion was the most predictive factor for composite morbidity (adjusted OR 1.67, 95% CI 1.35 to 2.07) and length of stay in hospital ≥7 days (adjusted OR 9.75, 95% CI 7.79 to 12.21).
CONCLUSION
Perioperative blood transfusion is associated with increased composite morbidity and prolonged length of stay in hospital. Preoperative patient optimization and institutional practices should be reviewed to improve the use of blood bank resources and adherence to restrictive blood transfusion protocols.
Topics: Humans; Female; Surgical Wound Infection; Genital Neoplasms, Female; Gynecologic Surgical Procedures; Blood Transfusion; Postoperative Period; Postoperative Complications; Retrospective Studies; Length of Stay
PubMed: 36792167
DOI: 10.1136/ijgc-2022-004228 -
International Journal of Surgery... Aug 2022Although diabetes mellitus (DM) is considered to be an important prognostic factor in spinal surgery, the relationship between these two factors remains unclear. The... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Although diabetes mellitus (DM) is considered to be an important prognostic factor in spinal surgery, the relationship between these two factors remains unclear. The purpose of this study was to investigate whether diabetes is associated with an increased risk of postoperative complications in patients undergoing spinal surgery.
METHODS
We systematically searched the PubMed, Embase, and Cochrane Library for relevant articles published on or before December 25, 2021. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis. The primary outcome was the risk of postoperative complications following spinal surgery, including postoperative infection and reoperation. Furthermore, we conducted subgroup analyses and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results.
RESULTS
A total of 40 cohort studies including 2,998,891 participants met the inclusion criteria. Meta-analysis showed that diabetes was significantly associated with postoperative infection (OR 2.21, 95% CI 1.70-2.88, p < 0.001) and reoperation (OR 1.35, 95% CI 1.12-1.64, p = 0.002). Furthermore, the results also found that diabetes was significantly associated with surgery-related death (OR 1.61, 95% CI 1.13-2.30, p = 0.008) and transfusions (OR 1.39, 95% CI 1.11-1.75, p = 0.005), whereas diabetes failed to account for nervous system complications (OR 1.12, 95% CI 0.82-1.52, p = 0.470) and embolism (OR 1.15, 95% CI 0.83-1.60, p = 0.386) for patients following spine surgery. These results were further confirmed by the trim-and-fill procedure and leave-one-out sensitivity analyses.
CONCLUSIONS
Diabetes appears to be a risk factor for postoperative infection and reoperation for patients following spinal surgery. Special attention should be devoted to reducing the occurrence of postoperative complications in diabetic patients undergoing spinal surgery.
Topics: Diabetes Mellitus; Humans; Neurosurgical Procedures; Postoperative Complications; Postoperative Period; Reoperation
PubMed: 35918006
DOI: 10.1016/j.ijsu.2022.106789 -
Scientific Reports Mar 2022Perioperative administration of tranexamic acid (TXA) is thought to be related to decreased postoperative implant-associated infection rates; however, the relationship...
Perioperative administration of tranexamic acid (TXA) is thought to be related to decreased postoperative implant-associated infection rates; however, the relationship remains unclear. We explored the inhibitory effect of TXA on infection both in vitro and in vivo. We investigated biofilm formation after TXA administration through different detection methods, all of which showed that TXA reduces biofilm formation in vitro and was further proven to be associated with decreased protein and polysaccharide contents in biofilms. We observed decreased biofilm on implants and decreased bacteria in the infection area with strengthened neutrophil accumulation in the mouse implant-associated infection model. Our results suggest that TXA protects against implant-associated infection by reducing biofilm formation in infected tissues.
Topics: Animals; Antifibrinolytic Agents; Biofilms; Blood Loss, Surgical; Humans; Mice; Postoperative Complications; Postoperative Period; Tranexamic Acid
PubMed: 35318416
DOI: 10.1038/s41598-022-08948-w -
Clinics in Orthopedic Surgery Mar 2022Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for...
BACKGROUND
Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days.
METHODS
We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]).
RESULTS
A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; = 0.018).
CONCLUSIONS
Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
Topics: Arthroplasty, Replacement, Hip; C-Reactive Protein; Female; Hip Prosthesis; Humans; Male; Postoperative Complications; Postoperative Period; Retrospective Studies; Sex Characteristics
PubMed: 35251541
DOI: 10.4055/cios21110