Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim w...Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.展开更多
Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection...Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months展开更多
The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inad...The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.展开更多
Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categ...Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.展开更多
BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant ...BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.展开更多
BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing...BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.展开更多
BACKGROUND Gastric cancer,a prevalent malignancy,poses a severe threat to the health of residents in China.Timely intervention in early stages can extend patients’survival.AIM To analyze clinical characteristics of p...BACKGROUND Gastric cancer,a prevalent malignancy,poses a severe threat to the health of residents in China.Timely intervention in early stages can extend patients’survival.AIM To analyze clinical characteristics of patients with early gastric cancer and efficacy and risk of complications associated with endoscopic resection.METHODS This study included 175 patients with early gastric cancer treated at our hospital,with no restrictions on sex or age.General data,pathological information,and endoscopic biopsy results were obtained.The clinical characteristics of early gastric cancer were analyzed,and endoscopic resection was performed.Postoperative efficacy and incidence of complications were monitored.Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 8.0 software.RESULTS A total of 175 patients with early gastric cancer were included,with 75.43%(n=132)males and 24.57%(n=43)females.38.29%(n=67)and 35.43%(n=62)of patients had a history of smoking and alcohol consumption,respectively.Comorbidities included diabetes(8.57%,n=15),coronary heart disease(10.29%,n=18),and hypertension(43.43%,n=76),which was highly prevalent.A history of abdominal surgery and family history of digestive system cancer accounted for 21.14%and 17.14%,respectively.The most common lesion location was the antral part of the stomach(52.00%,n=91),followed by the gastric angle,body,and fundus.The pathological types were predominantly high-grade intraepithelial neoplasia(28.00%,n=49)and well-differentiated adenocarcinoma(26.86%,n=47),followed by moderately differentiated adenocarcinoma,high-moderately differentiated adenocarcinoma,and moderate-lowly differentiated adenocarcinoma.89.14%of the patients had intestinal metaplasia and 85.14%had atrophy.After endoscopic resection,re-examination revealed that 13 patients had cancer cells at the tissue margin,with a positive margin rate of 7.43%.Postoperative complications included no cases of gastrointestinal obstruction,but incisional infection(2.86%,n=5),gastric perforation(1.14%,n=2),and gastric bleeding(4%,n=7)were present,with an overall incidence of 8.00%.CONCLUSION Analysis of the clinical characteristics indicated that early gastric cancer is more prevalent in males with a history of hypertension,with lesions most commonly occurring in the antral region of the stomach.The pathological types are often high-grade intraepithelial neoplasia and well-differentiated adenocarcinoma,with over 85%of patients having comorbid intestinal metaplasia and atrophy.Despite endoscopic resection,a positive margin rate persisted,indicating a probability of residual cancer at the margins.Postoperative complications,such as gastrointestinal obstruction,incisional infection,gastric perforation,and gastric bleeding can occur and require timely symptomatic treatment.展开更多
BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and com...BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.展开更多
With the development of the social economy and the continuous improvement of people’s living standards,the number of coronary heart disease patients is on the rise,even affecting some younger groups.When a patient’s...With the development of the social economy and the continuous improvement of people’s living standards,the number of coronary heart disease patients is on the rise,even affecting some younger groups.When a patient’s coronary artery stenosis endangers their life,doctors usually recommend coronary artery stent surgery to effectively improve myocardial ischemia and prevent sudden death.After a successful operation,it is necessary to clarify the key points of clinical nursing and prevent complications.Starting from the situation after coronary heart disease stent implantation,this article analyzes the key points of clinical nursing and proposes specific strategies for preventing complications,aiming to improve the surgical effect and provide a reference for complication prevention activities.展开更多
Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complicati...Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.展开更多
Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, d...Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.展开更多
Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were ran...Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.展开更多
AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were ...AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were searched to identify studies comparing postoperative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios(OR) and confidence intervals(CI) for each outcome measure of interest. RESULTS: A total of 14 studies were included for metaanalysis, comprising a total of 5425 patients with CD 1024(biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications(OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection(OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak(OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis(OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation(OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.展开更多
There have been increasing concerns regarding the safety of perioperative anti-tumour necrosis factor (anti-TNF) α agents. We performed a literature review to evaluate the post-operative complications associated with...There have been increasing concerns regarding the safety of perioperative anti-tumour necrosis factor (anti-TNF) α agents. We performed a literature review to evaluate the post-operative complications associated with perioperative anti-TNF use in patients with inflammatory bowel disease. A comprehensive review was performed with a literature search utilizing Pub Med, Cochrane, OVID and EMBASE databases according to published guidelines. To date, there are only data for infliximab. There are three published studies which have assessed post-operative complications with perioperative infliximab use in patients with Crohn' s disease (CD), four studies in ulcerative colitis (UC) patients, and one study on both CD and UC patients. Two out of the three studies in CD patients showed no increased post-operative complications associated with perioperative infliximab. Two out of four studies in UC patients also did not show an increase in post-operative complications, and the combined study with CD and UC patients did not show an increased risk as well. Studyresults could not be combined secondary to significant differences in study designs, patient population and definition of their endpoints. There appears to be a risk of post-operative complications associated with TNF therapy in some patients. Based on these data, careful patient selection and prospective data collection should be performed.展开更多
This paper shows how a public eye and research hospital in Turkey initiated Six Sigma principles to reduce the number of complications occurring after penetrating keratoplasty surgeries. Data were collected for nine y...This paper shows how a public eye and research hospital in Turkey initiated Six Sigma principles to reduce the number of complications occurring after penetrating keratoplasty surgeries. Data were collected for nine years. To analyse the complications among 55 patients (59 eyes) underwent penetrative keratoplasty, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table and Failure, Mode and Effect Analysis (FMEA) were implemented. Sources and root causes of eleven types of complications were identified and reported. For a successful penetrating keratoplasty surgery patient’s anatomy, suitability of donor cornea, experience of ophthalmic surgeon, sterilization and hygiene, and performance of the equipment were determined to be the “critical-to-quality” factors. The complication with the highest hazard score was found to be the glaucoma. The process sigma level of the process was measured to be 3.1418. The surgical team concluded that all types of post-operative complications should be significantly reduced by taking the necessary preventive measures.展开更多
Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is sca...Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.展开更多
BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal compl...BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.展开更多
AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,re...AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.展开更多
Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studie...Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy.The causes of pancreatic fluid leakage are;the parenchymal and/or thermal injury to the pancreas,and blunt injury to the pancreas by compression and retraction.Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery.Several studies have reported associations between D-AMY and POPF after gastrectomy,and the high value of D-AMY on postoperative day(POD)1 was an independent risk factor.To improve both sensitivity and specificity,attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers.Although several studies have shown a high predictive ability of POPF,it has not necessarily been exploited in clinical practice.Many problems remain unresolved;ideal timing for measurement,optimal cut-off value,and means of intervention after prediction.Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.展开更多
Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transp...Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.展开更多
文摘Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.
文摘Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months
文摘The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.
文摘Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.
文摘BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.
基金Supported by National Natural Science Foundation of China,No.82073160.
文摘BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.
文摘BACKGROUND Gastric cancer,a prevalent malignancy,poses a severe threat to the health of residents in China.Timely intervention in early stages can extend patients’survival.AIM To analyze clinical characteristics of patients with early gastric cancer and efficacy and risk of complications associated with endoscopic resection.METHODS This study included 175 patients with early gastric cancer treated at our hospital,with no restrictions on sex or age.General data,pathological information,and endoscopic biopsy results were obtained.The clinical characteristics of early gastric cancer were analyzed,and endoscopic resection was performed.Postoperative efficacy and incidence of complications were monitored.Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 8.0 software.RESULTS A total of 175 patients with early gastric cancer were included,with 75.43%(n=132)males and 24.57%(n=43)females.38.29%(n=67)and 35.43%(n=62)of patients had a history of smoking and alcohol consumption,respectively.Comorbidities included diabetes(8.57%,n=15),coronary heart disease(10.29%,n=18),and hypertension(43.43%,n=76),which was highly prevalent.A history of abdominal surgery and family history of digestive system cancer accounted for 21.14%and 17.14%,respectively.The most common lesion location was the antral part of the stomach(52.00%,n=91),followed by the gastric angle,body,and fundus.The pathological types were predominantly high-grade intraepithelial neoplasia(28.00%,n=49)and well-differentiated adenocarcinoma(26.86%,n=47),followed by moderately differentiated adenocarcinoma,high-moderately differentiated adenocarcinoma,and moderate-lowly differentiated adenocarcinoma.89.14%of the patients had intestinal metaplasia and 85.14%had atrophy.After endoscopic resection,re-examination revealed that 13 patients had cancer cells at the tissue margin,with a positive margin rate of 7.43%.Postoperative complications included no cases of gastrointestinal obstruction,but incisional infection(2.86%,n=5),gastric perforation(1.14%,n=2),and gastric bleeding(4%,n=7)were present,with an overall incidence of 8.00%.CONCLUSION Analysis of the clinical characteristics indicated that early gastric cancer is more prevalent in males with a history of hypertension,with lesions most commonly occurring in the antral region of the stomach.The pathological types are often high-grade intraepithelial neoplasia and well-differentiated adenocarcinoma,with over 85%of patients having comorbid intestinal metaplasia and atrophy.Despite endoscopic resection,a positive margin rate persisted,indicating a probability of residual cancer at the margins.Postoperative complications,such as gastrointestinal obstruction,incisional infection,gastric perforation,and gastric bleeding can occur and require timely symptomatic treatment.
文摘BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.
文摘With the development of the social economy and the continuous improvement of people’s living standards,the number of coronary heart disease patients is on the rise,even affecting some younger groups.When a patient’s coronary artery stenosis endangers their life,doctors usually recommend coronary artery stent surgery to effectively improve myocardial ischemia and prevent sudden death.After a successful operation,it is necessary to clarify the key points of clinical nursing and prevent complications.Starting from the situation after coronary heart disease stent implantation,this article analyzes the key points of clinical nursing and proposes specific strategies for preventing complications,aiming to improve the surgical effect and provide a reference for complication prevention activities.
文摘Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.
文摘Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.
文摘Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.
文摘AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were searched to identify studies comparing postoperative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios(OR) and confidence intervals(CI) for each outcome measure of interest. RESULTS: A total of 14 studies were included for metaanalysis, comprising a total of 5425 patients with CD 1024(biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications(OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection(OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak(OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis(OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation(OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.
文摘There have been increasing concerns regarding the safety of perioperative anti-tumour necrosis factor (anti-TNF) α agents. We performed a literature review to evaluate the post-operative complications associated with perioperative anti-TNF use in patients with inflammatory bowel disease. A comprehensive review was performed with a literature search utilizing Pub Med, Cochrane, OVID and EMBASE databases according to published guidelines. To date, there are only data for infliximab. There are three published studies which have assessed post-operative complications with perioperative infliximab use in patients with Crohn' s disease (CD), four studies in ulcerative colitis (UC) patients, and one study on both CD and UC patients. Two out of the three studies in CD patients showed no increased post-operative complications associated with perioperative infliximab. Two out of four studies in UC patients also did not show an increase in post-operative complications, and the combined study with CD and UC patients did not show an increased risk as well. Studyresults could not be combined secondary to significant differences in study designs, patient population and definition of their endpoints. There appears to be a risk of post-operative complications associated with TNF therapy in some patients. Based on these data, careful patient selection and prospective data collection should be performed.
文摘This paper shows how a public eye and research hospital in Turkey initiated Six Sigma principles to reduce the number of complications occurring after penetrating keratoplasty surgeries. Data were collected for nine years. To analyse the complications among 55 patients (59 eyes) underwent penetrative keratoplasty, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table and Failure, Mode and Effect Analysis (FMEA) were implemented. Sources and root causes of eleven types of complications were identified and reported. For a successful penetrating keratoplasty surgery patient’s anatomy, suitability of donor cornea, experience of ophthalmic surgeon, sterilization and hygiene, and performance of the equipment were determined to be the “critical-to-quality” factors. The complication with the highest hazard score was found to be the glaucoma. The process sigma level of the process was measured to be 3.1418. The surgical team concluded that all types of post-operative complications should be significantly reduced by taking the necessary preventive measures.
文摘Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.
文摘BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.
文摘AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.
基金We are grateful to the nonprofit organization Epidemiological and Clinical Research Information Network(ECRIN)for providing their valuable support with this work.
文摘Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy.The causes of pancreatic fluid leakage are;the parenchymal and/or thermal injury to the pancreas,and blunt injury to the pancreas by compression and retraction.Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery.Several studies have reported associations between D-AMY and POPF after gastrectomy,and the high value of D-AMY on postoperative day(POD)1 was an independent risk factor.To improve both sensitivity and specificity,attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers.Although several studies have shown a high predictive ability of POPF,it has not necessarily been exploited in clinical practice.Many problems remain unresolved;ideal timing for measurement,optimal cut-off value,and means of intervention after prediction.Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.
文摘Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.
