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British Journal of Hospital Medicine... Nov 2023A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should... (Review)
Review
A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
Topics: Adult; Humans; Abscess; Drainage; Multicenter Studies as Topic; Observational Studies as Topic; Pain; Postoperative Period; Randomized Controlled Trials as Topic; Skin Diseases
PubMed: 38019208
DOI: 10.12968/hmed.2023.0308 -
BMC Pulmonary Medicine Sep 2021Although postoperative pulmonary infection (POI) commonly occurs in patients with esophageal cancer after curative surgery, a patient-specific predictive model is still...
BACKGROUND
Although postoperative pulmonary infection (POI) commonly occurs in patients with esophageal cancer after curative surgery, a patient-specific predictive model is still lacking. The main aim of this study is to construct and validate a nomogram for estimating the risk of POI by investigating how perioperative features contribute to POI.
METHODS
This cohort study enrolled 637 patients with esophageal cancer. Perioperative information on participants was collected to develop and validate a nomogram for predicting postoperative pulmonary infection in esophageal cancer. Predictive accuracy, discriminatory capability, and clinical usefulness were evaluated by calibration curves, concordance index (C-index), and decision curve analysis (DCA).
RESULTS
Multivariable logistic regression analysis indicated that length of stay, albumin, intraoperative bleeding, and perioperative blood transfusion were independent predictors of POI. The nomogram for assessing individual risk of POI indicated good predictive accuracy in the primary cohort (C-index, 0.802) and validation cohort (C-index, 0.763). Good consistency between predicted risk and observed actual risk was presented as the calibration curve. The nomogram for estimating POI of esophageal cancer had superior net benefit with a wide range of threshold probabilities (4-81%).
CONCLUSIONS
The present study provided a nomogram developed with perioperative features to assess the individual probability of infection may conducive to strengthen awareness of infection control and provide appropriate resources to manage patients at high risk following esophagectomy.
Topics: Aged; Esophageal Neoplasms; Esophagectomy; Female; Humans; Infections; Logistic Models; Lung Diseases; Male; Middle Aged; Nomograms; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Assessment
PubMed: 34488717
DOI: 10.1186/s12890-021-01656-7 -
BMC Surgery Dec 2017The purpose of this review was to identify the relationship between the gut microbiome and the development of postoperative complications like anastomotic leakage or a... (Review)
Review
BACKGROUND
The purpose of this review was to identify the relationship between the gut microbiome and the development of postoperative complications like anastomotic leakage or a wound infection. Recent reviews focusing on underlying molecular biology suggested that postoperative complications might be influenced by the patients' gut flora. Therefore, a review focusing on the available clinical data is needed.
METHODS
In January 2017 a systematic search was carried out in Medline and WebOfScience to identify all clinical studies, which investigated postoperative complications after gastrointestinal surgery in relation to the microbiome of the gut.
RESULTS
Of 337 results 10 studies were included into this analysis after checking for eligibility. In total, the studies comprised 677 patients. All studies reported a postoperative change of the gut flora. In five studies the amount of bacteria decreased to different degrees after surgery, but only one study found a significant reduction. Surgical procedures tended to result in an increase of potentially pathogenic bacteria and a decrease of Lactobacilli and Bifidobacteria. The rate of infectious complications was lower in patients treated with probiotics/symbiotics compared to control groups without a clear relation to the systemic inflammatory response. The treatment with synbiotics/probiotics in addition resulted in faster recovery of bowel movement and a lower rate of postoperative diarrhea and abdominal cramping.
CONCLUSIONS
There might be a relationship between the gut flora and the development of postoperative complications. Due to methodological shortcomings of the included studies and uncontrolled bias/confounding factors there remains a high level of uncertainty.
Topics: Digestive System Surgical Procedures; Gastrointestinal Microbiome; Humans; Postoperative Complications; Postoperative Period; Probiotics; Wound Infection
PubMed: 29202875
DOI: 10.1186/s12893-017-0325-8 -
Pain Research & Management 2021To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy.
AIM
To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy.
METHODS
We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups.
RESULTS
A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3-30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3-62). The inflammatory indicators of Group A were significantly higher than those of Group B (all < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. . The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.
Topics: Fracture Fixation, Internal; Humans; Lumbosacral Region; Postoperative Period; Retrospective Studies; Surgical Wound Infection
PubMed: 34659599
DOI: 10.1155/2021/2262837 -
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 -
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 -
Romanian Journal of Morphology and... 2018Sepsis is currently defined as the presence of organ dysfunction occurring as the result of a disturbed host response to a serious infection. Sepsis is one of the most... (Review)
Review
Sepsis is currently defined as the presence of organ dysfunction occurring as the result of a disturbed host response to a serious infection. Sepsis is one of the most common diseases, which cause mortality and a considerable absorber of healthcare resources. Despite progress in technology and improving knowledge of pathophysiology, the disease mechanism is still poorly understood. At present, diagnosis is based on non-specific physiological criteria and on the late identification of the pathogen. For these reasons, the diagnosis may be uncertain, treatment delayed or an immunomodulatory therapy cannot be established. An early and reliable diagnosis is essential to achieve better outcomes on disease progression. The host response to infection involves hundreds of many mediators of which have been proposed as biomarkers. There is a need for new diagnostic approaches for sepsis, new sepsis biomarkers that can aid in diagnosis, therapeutic decision and monitoring of the response to therapy. The differentiation of sepsis from non-infectious systemic inflammatory response syndrome is difficult, and the search for a highly accurate biomarker of sepsis has become one important objective of the medicine. The goal of our review is to summarize the recent advances on the most commonly studied serum biomarkers, evaluated in clinical and experimental studies, for early diagnosis of sepsis and their informative value in diagnosis, prognosis, or response to therapy. In this context, we have tracked the clinical utility of measuring serum biomarkers, such as procalcitonin, pro- and anti-inflammatory cytokines, C-reactive protein, leptin and their combinations. Currently, has not been identified an ideal biomarker to aid in the diagnosis of sepsis. It is hoped that the discovery of new serum markers, as well as their combinations, will serve for the diagnosis and prognosis of sepsis.
Topics: Biomarkers; Humans; Postoperative Period; Sepsis
PubMed: 29940615
DOI: No ID Found -
Revista Da Escola de Enfermagem Da U S P Nov 2018To identify and describe which dressings are recommended to prevent surgical site infection in hospitalized adult patients after cardiac surgeries. (Review)
Review
OBJECTIVE
To identify and describe which dressings are recommended to prevent surgical site infection in hospitalized adult patients after cardiac surgeries.
METHOD
Integrative review carried out in the databases MEDLINE, LILACS, CINAHL, Web of Science, Cochrane and Scopus. Studies related to dressing in the postoperative period of cardiac surgery were selected.
RESULTS
Seven articles were included, with the following dressings: negative pressure wound therapy, silver nylon dressing, transdermal delivery of continuous oxygen and impermeable adhesive drape. The dressings that led to reduction of infection were negative pressure and silver nylon dressings.
CONCLUSION
It was not possible to identify which dressing is most recommended, however, some studies show that certain types of dressings were related to the reduction of infection. Clinical trials with a rigorous methodological design and representative samples able to minimize the risk of bias should be conducted to evaluate the effectiveness of dressings in the prevention of surgical site infection.
Topics: Adult; Bandages; Cardiac Surgical Procedures; Humans; Postoperative Period; Surgical Wound Infection; Wound Healing
PubMed: 30517290
DOI: 10.1590/S1980-220X2017011803393 -
International Journal of Gynecological... Aug 2020The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The...
INTRODUCTION
The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy.
METHODS
This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without.
RESULTS
A total of 265 patients underwent splenectomy. Median age was 64 years (range 22-88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0-29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5-21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3-16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1-43). All patients demonstrated a continuous rise in platelets during postoperative days 0-15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1-15) vs non groups (6 days, range 1-16, P=0.049).
CONCLUSION
We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.
Topics: Adult; Aged; Aged, 80 and over; Cytoreduction Surgical Procedures; Female; Humans; Infections; Leukocyte Count; Leukocytosis; Middle Aged; Neoplasm Staging; Ovarian Neoplasms; Platelet Count; Postoperative Complications; Postoperative Period; Retrospective Studies; Splenectomy; Thrombocytosis; Time Factors; Venous Thromboembolism; Young Adult
PubMed: 32665236
DOI: 10.1136/ijgc-2020-001368 -
Brazilian Journal of Anesthesiology... 2020Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether... (Review)
Review
Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.
Topics: Anesthesia, Conduction; Anesthesia, Local; COVID-19; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; Postoperative Period
PubMed: 32600800
DOI: 10.1016/j.bjan.2020.05.002