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Current Opinion in Pulmonary Medicine Jul 2015In the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with... (Review)
Review
PURPOSE OF REVIEW
In the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs.
RECENT FINDINGS
In the past, VATS was used to evacuate traumatic-retained hemothorax. Recent study has revealed further that lung repair during VATS could decrease complications after trauma. Management of fractured ribs could also be assisted by VATS. Early VATS intervention within 7 days after injury can decrease the rate of posttraumatic infection and length of hospital stay. In studies of the pathophysiology of animal models, N-acetylcysteine and methylene blue were used in animals with blunt chest trauma and found to improve clinical outcomes.
SUMMARY
Retained hemothorax derived from blunt chest trauma should be managed carefully and rapidly. Early VATS intervention is a well tolerated and reliable procedure that can be applied to manage this complication cost effectively.
Topics: Animals; Hemothorax; Humans; Length of Stay; Postoperative Period; Thoracic Injuries; Thoracic Surgery, Video-Assisted; Wounds, Nonpenetrating
PubMed: 25978625
DOI: 10.1097/MCP.0000000000000173 -
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 -
Scientific Reports Jul 2020To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (PCNL) through predicting and comparing post-PCNL infections...
To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (PCNL) through predicting and comparing post-PCNL infections based on nomograms, a retrospective cohort study was conducted among 969 cases who underwent PCNL from Dec 5, 2016 to Dec 25, 2017 in Kunming, Yunnan Province. We examined clinical features, urine routine, blood routine, blood biochemistry, imaging studies and operative information and recorded the examination results before surgery for univariate and multivariate logistic regression. We applied receiver operating characteristic curves, calibration curves, accuracy, specificity, sensitivity, positive predictive value and negative predictive value to evaluate and compare the models. Nomograms were used to visualize the different degrees of postoperative infection complications. The risk scores of the three groups were compared by diabetes mellitus distribution. Our results suggest that the more severe the infection is, the more accurate the model predicts and that the occurrence of severe infection mostly is related to the patients' homeostasis. Hence, we developed an online post-PCNL sepsis dynamic nomogram which can achieve visualization and dynamically predict the incidence of sepsis in postoperative patients.
Topics: Adult; Female; Humans; Male; Middle Aged; Nephrolithotomy, Percutaneous; Nomograms; Postoperative Complications; Postoperative Period; Retrospective Studies; Sepsis; Treatment Outcome
PubMed: 32647305
DOI: 10.1038/s41598-020-68430-3 -
Revista Da Associacao Medica Brasileira... Aug 2015to evaluate the cases of wound infections in orthopedic postoperative period.
OBJECTIVE
to evaluate the cases of wound infections in orthopedic postoperative period.
METHODS
postoperative patients who developed infection during the period from November 2012 to November 2013 were studied. Secretions were collected during surgery using sterile swabs, and sent for microbiological analysis.
RESULTS
during the period analyzed, 38 surgical procedures progressed to infection. The type of surgery presenting the largest number of infections was osteosynthesis, in 36 (94.7%) patients. Among the materials used, 18 (36%) surgeries that used external fixator were infected, and 17 (34%) using plate. The species of bacteria that caused the largest number of infections were Staphylococcus aureus, infecting 16 (43.9%) patients, followed by Acinetobacter baumannii, which infected four (10.5%) patients. Regarding the resistance profile of Gram-positive strains to antibiotics, 100% of Staphylococcus aureus strains were susceptible to vancomycin and 31.3%, to ceftriaxone. As for the Gram-negative bacteria, 100% of Acinetobacter baumannii strains were resistant to ceftriaxone, gentamicin and imipenem.
CONCLUSION
infection control in the postoperative period is necessary, using antibiotics correctly and consciously, avoiding resistance of bacterial agents.
Topics: Acinetobacter baumannii; Adolescent; Adult; Air Conditioning; Child; Child, Preschool; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Fracture Fixation, Internal; Humans; Infant; Infant, Newborn; Male; Middle Aged; Postoperative Period; Prospective Studies; Staphylococcus aureus; Surgical Wound Infection; Young Adult
PubMed: 26466216
DOI: 10.1590/1806-9282.61.04.341 -
Journal of Orthopaedic Surgery (Hong... 2020Although the neutrophil-lymphocyte ratio (NLR) is a simple biomarker for inflammation, its diagnostic value for predicting surgical site infection (SSI) after spinal... (Observational Study)
Observational Study
Postoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery.
PURPOSE
Although the neutrophil-lymphocyte ratio (NLR) is a simple biomarker for inflammation, its diagnostic value for predicting surgical site infection (SSI) after spinal decompression surgery has not been extensively investigated. We aimed to determine the predictive value of NLR for SSI in patients undergoing spinal decompression surgery.
METHODS
We performed a retrospective observational study of patients who underwent spinal decompression surgery. Consecutive 254 patients were divided into an SSI group and a non-SSI group based on the presence of SSI. We evaluated which markers, including NLR, differed significantly between groups. We then determined the diagnostic cutoff values of these markers for the prediction of SSI based on the significance in the univariate analysis.
RESULTS
The incidence of SSI was 7 of 254 patients (2.8%). Univariate analysis showed that there were significant differences in the C-reactive protein (CRP) level at 1 day postoperatively; neutrophil and lymphocyte percentage and NLR at 3-4 days postoperatively; and CRP level, white blood cell count, neutrophil count and percentage, lymphocyte percentage, and NLR at 6-7 days postoperatively between SSI and non-SSI groups. Among these markers, the cutoff values of lymphocyte percentage and NLR at 3-4 days postoperatively for the prediction of SSI were ≤15.1% and ≥4.91, respectively. The cutoff values of lymphocyte percentage and NLR at 6-7 days postoperatively were ≤19.8% and ≥3.21, respectively.
CONCLUSIONS
Lymphocyte percentage and NLR at 3-4 and 6-7 days postoperatively were useful markers for the early prediction of SSI in patients who had undergone spinal decompression surgery. These parameters may aid in identifying patients at higher risk of SSI after spinal decompression surgery.
Topics: Aged; Decompression, Surgical; Female; Humans; Lymphocytes; Male; Neutrophils; Postoperative Period; Predictive Value of Tests; Retrospective Studies; Spinal Diseases; Surgical Wound Infection
PubMed: 32431207
DOI: 10.1177/2309499020918402 -
PloS One 2022To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were...
PURPOSE
To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined.
METHODS
A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications.
RESULTS
Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%.
CONCLUSION
In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.
Topics: Aged; Body Temperature; Communicable Diseases; Comorbidity; Female; Fever; Hepatectomy; Humans; Incidence; Length of Stay; Liver Diseases; Logistic Models; Male; Middle Aged; Odds Ratio; Postoperative Period; Predictive Value of Tests; Retrospective Studies; Risk Factors; Serum Albumin
PubMed: 35025947
DOI: 10.1371/journal.pone.0262113 -
International Journal of Surgery... Jan 2015Obese patients with general surgical emergencies provide unique challenges to the emergency surgical teams. Acute appendicitis is the most common adult acute surgical... (Review)
Review
BACKGROUND
Obese patients with general surgical emergencies provide unique challenges to the emergency surgical teams. Acute appendicitis is the most common adult acute surgical emergency encountered in practice. This systematic review evaluates the role of laparoscopic appendicectomy in obese by comparing the outcomes of laparoscopic appendicectomy in obese versus non-obese and the laparoscopic versus open appendicectomy in obese patients.
METHODS
Relevant comparative studies were identified from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PubMed (1990-2013). Primary outcomes evaluated were mortality, overall morbidity and duration of surgery. Secondary outcomes evaluated were superficial (superficial wound infection) and deep surgical site infection (intra-abdominal abscesses), conversion to open surgery, and cost of the procedure.
RESULTS
Seven retrospective cohort studies and one prospective randomized controlled trial met the inclusion criteria. There was no statistically significant difference in the primary and secondary outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy. Laparoscopic appendicectomy in obese patients is associated with reduced mortality (risk ratio [RR]: 0.19 (95% CI 0.12-0.30), reduced overall morbidity (RR: 0.49 (95% CI: 0.47-0.51)), reduced superficial wound infections (RR: 0.27 (95% CI 0.21-0.35)), shorter operating times and post-operative length of hospital stay, compared to open appendicectomy. Methodological quality of the included studies is low.
CONCLUSION
Laparoscopic appendicectomy appears to be a safer alternative approach to open surgery in obese adult patents. There is no significant difference in the outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy.
Topics: Acute Disease; Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Obesity; Operative Time; Postoperative Period; Surgical Wound Infection
PubMed: 25498498
DOI: 10.1016/j.ijsu.2014.11.052 -
British Heart Journal Sep 1987Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The... (Review)
Review
Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The development of a new valvar lesion and bulky vegetations seen on echocardiography helped to identify Brucella endocarditis occurring during systemic brucellosis. The aortic valve was affected in all four patients, and in one the mitral valve was also affected. Medical treatment did not cure the patients and all needed valve replacement--for haemodynamic deterioration in three and because a further embolism was feared in one. Antibiotics were continued for six to nine months after operation. There was no early or late mortality and no recurrence after a follow up of 15 months.
Topics: Adult; Anti-Infective Agents; Brucellosis; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Period
PubMed: 3311098
DOI: 10.1136/hrt.58.3.279 -
Transplantation Proceedings Oct 2020Obese renal transplant recipients (body mass index [BMI] ≥30 kg/m) are at risk of delayed graft function and postoperative complications, such as infections or... (Observational Study)
Observational Study
BACKGROUND
Obese renal transplant recipients (body mass index [BMI] ≥30 kg/m) are at risk of delayed graft function and postoperative complications, such as infections or delayed wound healing. There is also a tendency to exclude extremely obese patients from transplantation (KTx). Nonetheless, no association between obesity and increased mortality has been reported. The aim of this study is to evaluate the effect of BMI on the most common surgical and infectious complications after KTx.
MATERIALS AND METHODS
An observational study in 872 patients transplanted from 2010-2017 was conducted. Median BMI was 24.6 (13.9-34.3), and 8.3% of the group was obese. Patient records were searched for early postoperative complications: lymphocele or hematoma (>33 mL), urinary leakage, or urinary tract infection (UTI). Mann-Whitney U and χ or Fisher exact tests were used. P < .05 was considered statistically significant. The study complies with the Helsinki Congress and the Istanbul Declaration.
RESULTS
Renal primary nonfunction was observed in 1.4% (12/872) of patients. Surgical or infectious complications occurred in 52.7% (453/860) of patients. No correlation between BMI and complication rate was noted. Complications were observed in 56.9% (41/72) of obese vs 52.3% (412/788) of nonobese patients (P = .448), including lymphocele in 15.3% vs 16.4% (P = .810), hematoma in 22.2% vs 19.2% (P = .530), urinary leakage in 1.4% vs 4.6% (P = .203), and UTI in 31.9% vs 32.9% (P = .873), respectively.
CONCLUSIONS
Recipient's BMI has no significant association with the most common surgical complications after KTx. There is no need to delay KTx in moderately obese patients.
Topics: Adult; Body Mass Index; Female; Humans; Kidney; Kidney Diseases; Kidney Transplantation; Lymphocele; Male; Middle Aged; Obesity; Postoperative Complications; Postoperative Period; Urinary Tract Infections; Young Adult
PubMed: 32252995
DOI: 10.1016/j.transproceed.2020.02.110 -
Annals of African Medicine 2021Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common...
INTRODUCTION
Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common form of TB. In India, patients usually present late after the onset of neurological symptoms, for which surgical management is essential for recovery. In our study, we have evaluated the outcome of forty patients of STB who underwent posterior decompression and instrumentation.
METHODS
Forty patients with STB who underwent posterior decompression and instrumentation were reviewed. All cases were followed up for 18 months. The groups were compared by parameters such as improvement in pain, improvement in kyphosis, and neurological recovery. Visual Analog Scale (VAS) score and american spinal cord injury assosciation (ASIA) score are used for the assessment.
RESULTS
VAS score was significantly decreased postoperatively (mean: 1.28) as compared to preoperative values (mean: 7.25). Erythrocyte sedimentation rate (ESR) was significantly decreased postoperatively (mean: 30.95) as compared to preoperative values (76.15). Cobb's angle was significantly decreased immediate postoperatively (mean: 7.8) as compared to preoperative values (mean: 24.8). There was no deterioration of neurological symptoms in any of the patients.
CONCLUSION
Surgical intervention in Pott's spine with posterior decompression and stabilization, whenever indicated, gives good improvement in pain, decreases kyphotic deformity, and in most cases, also improves neurology.
Topics: Adolescent; Adult; Aged; Bone Transplantation; Debridement; Decompression, Surgical; Humans; India; Kyphosis; Lumbar Vertebrae; Male; Middle Aged; Postoperative Period; Radiography; Retrospective Studies; Spinal Fusion; Treatment Outcome; Tuberculosis, Spinal; Visual Analog Scale; Young Adult
PubMed: 34558444
DOI: 10.4103/aam.aam_2_20