719. Clinical Outcomes of Single versus Double Anaerobic Coverage for Intra-abdominal Infections

Abstract Background Double anaerobic coverage (DAC) is often used for intra-abdominal infections (IAIs) post-operatively. The primary objective of the study was evaluating length of hospital stay (LOS), in-hospital post-operative complications, and re-admission within 30 days of discharge due to post-operative complications in patients who received piperacillin/tazobactam plus metronidazole versus piperacillin/tazobactam for IAIs post-operatively. The secondary objective was comparing in-hospital mortality and hospital-acquired Clostridioides difficile infections (CDI) between the two groups. Methods This was a retrospective, cohort study including adults with surgically managed IAIs at an urban community hospital between January 1, 2016 and June 30, 2019. The following data were collected: age, sex, body mass index, comorbidities, Charlson Comorbidity Index (CCI), 5-day post-operative body temperature, American Society of Anesthesiologists (ASA) pre-operative assessment score, surgical wound classification, and IAI diagnosis. Multivariate analysis and aggregate resampling of the sampling distribution were conducted. An alpha of < 0.05 was considered statistically significant. Results Out of 163 patients, 96 patients received piperacillin/tazobactam plus metronidazole and 67 patients received piperacillin/tazobactam. The patients who received DAC were sicker with higher CCI (p=0.021) and 5-day post-operative body temperature (p=0.013). They were also at a higher risk for surgical site infections (p=0.002). Double anaerobic coverage was more often used for acute cholecystitis (p=0.0001) and gastrointestinal perforations (< 0.0001). After adjusting for these variables, DAC was associated with longer LOS (median 9 days vs. 4 days, p< 0.0001) and in-hospital post-operative complications (23% vs. 9%, p< 0.0001). There were more re-admissions within 30 days of discharge due to post-operative complications in the single anaerobic coverage group (4% vs. 1%, p=< 0.0001). In-hospital mortality (4% vs. 0%) and hospital-acquired CDI (1% vs. 0%) were only observed in DAC group. Conclusion Double anaerobic coverage was associated with no clinical benefit in surgically managed IAIs and in some cases may produce worse outcomes. Disclosures All Authors: No reported disclosures

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Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4562 ◽

2021 ◽

Vol 28 (05) ◽

pp. 652-655

Author(s):

Robina Ali ◽

Riffat Ehsan ◽

Ghazala Niaz ◽

Fatima Abid

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Uterovaginal Prolapse ◽

Prolapse Recurrence ◽

Gynecology And Obstetrics ◽

Duration Of Surgery ◽

Operative Complications ◽

Operative Recovery ◽

Post Operative Complications

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material & Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were <30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was <150ml while in 4(12.5%) it was estimated to be >150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

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Prevalence of hypomagnesemia in patients undergoing gynecological oncology surgery in tertiary care cancer institute of India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174404 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4355 ◽

Cited By ~ 1

Author(s):

Bikram Bhardwaj ◽

Ava Dipan Desai ◽

Bijal Manish Patel ◽

Chetna Deepal Parekh ◽

Shilpa Mukesh Patel

Keyword(s):

Serum Magnesium ◽

Gynecologic Oncology ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Gynecologic Malignancy ◽

Gynecological Malignancy ◽

Entire Cohort ◽

Post Operative Period ◽

Operative Complications ◽

Post Operative Complications

Background: Hypomagnesemia is an important but unknown risk factor for post-operative complications in patients undergoing surgery for presumed gynecological malignancy. This study aims to evaluate the prevalence of hypomagnesemia in patients undergoing surgery for presumed gynecological cancers referred to our tertiary care Cancer Institute.Methods: This is a prospective observational study of 100 patients admitted with provisional diagnosis of malignancy. They underwent surgery in one of the Gynecologic Oncology units at The Gujarat Cancer Research Institute, Ahmedabad from October 2016 to April 2017. Hypomagnesemia was defined a serum magnesium levels less than 1.8mg/dl.Results: The incidence of pre-operative hypomagnesemia in the entire cohort was 35%. Sixty three percent patients had normal pre-operative magnesium levels and hypermagnesemia was seen in 2% of study population. Patients with benign disease had 29.6% pre-operative hypomagnesemia compared with 39.6% in patients with gynecologic malignancy. Pre-operative hypomagnesemia and even falling levels in post-operative period are an important predictive marker for post-operative complications like increased post-operative pain, post-operative ileus, hypertension and even post-operative hypokalemia. Age, body mass index, hematocrit, surgical indication and length of hospital stay were not associated with hypomagnesemia. Patients undergoing neo-adjuvant chemotherapy before surgery had significant incidence of hypomagnesemia both pre-operatively and post-operatively.Conclusions: Hypomagnesemia is quite prevalent in patients of gynecologic-oncology undergoing surgery. Pre-operative hypomagnesemia and even falling levels in post-operative period have a bearing on the final surgical outcome. Hence pre-operative and post-operative magnesium levels may be included as a valuable marker in all patients undergoing surgery for gynecologic malignancy.

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Raja 42, a novel gamma lactam compound, is effective against Clostridioides difficile

PLoS ONE ◽

10.1371/journal.pone.0257143 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257143

Author(s):

Alexis Fong ◽

Megan Ross ◽

Justin Boudreau ◽

Reza Nokhbeh ◽

Kim Tilbe ◽

...

Keyword(s):

United States ◽

Therapeutic Agent ◽

The United States ◽

Primary Objective ◽

Clinical Isolates ◽

High Rate ◽

Clostridioides Difficile ◽

Lactam Antibiotic ◽

Enteric Infections ◽

Hospital Acquired

Clostridioides difficile infection (CDI) is the primary cause of hospital-acquired diarrhea, and responsible for over 500,000 enteric infections a year in the United States alone. Although most patients with CDI are successfully treated with metronidazole or vancomycin, the high rate of recurrence is still a serious problem, in which case these antibiotics are usually not very effective. The primary objective of this research is to develop a potentially effective therapeutic agent against C. difficile that are resistant to metronidazole or vancomycin. The susceptibility to metronidazole and vancomycin was examined with 194 C. difficile clinical isolates. Sixty of these isolates chosen based on a variety of criteria were examined for their susceptibility against the 4-chloro-1-piperidin-1ylmethyl-1H-indole-2,3-dione compound (Raja 42), a novel isatin–benzothiazole analogue containing a gamma-lactam structure, as we previously found that this novel compound is effective against a variety of different bacteria. Most of the 60 isolates were resistant to ceftriaxone and ciprofloxacin, raising the possibility that they might have been exposed previously to these or structurally similar antibiotics (e.g., β-lactam and quinolone compounds). Among the isolates, 48 (80%) and 54 (90%) were susceptible to metronidazole and vancomycin, respectively. Raja 42 was found to be effective against most of the isolates, especially so against metronidazole-resistant C. difficile. Most importantly, five isolates that show resistance to metronidazole and vancomycin were sensitive to Raja 42. Thus, Raja 42, a gamma lactam antibiotic, has the potential to effectively control C. difficile strains that are resistant to metronidazole and vancomycin.

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Evaluation of post-operative complications associated with tobacco use in thoracic surgery patients

International Surgery Journal ◽

10.18203/2349-2902.isj20213119 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2272

Author(s):

Mehmet Degirmenci ◽

Celal Kus

Keyword(s):

Postoperative Complications ◽

Thoracic Surgery ◽

Tobacco Use ◽

Intensive Therapy ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Thoracic Diseases ◽

Operative Complications ◽

Poor Outcomes ◽

Post Operative Complications

Background: Tobacco can make thoracic diseases more complicated by affecting their respiratory functions. Smoking causes many diseases that require surgical treatment and affects surgical results. The aim of the study was to determine the relationship between tobacco use and post-operative complications in thoracic surgery patients and contribute to public health.Methods: In this study, 754 patients were evaluated retrospectively. Patient characteristics and tobacco use habits of the patients were determined. Postoperative complications, admission to the intensive therapy unit, intubation, death, and length of stay in hospital were defined as surgical outcomes. These results were compared and analyzed with tobacco use.Results: The patients consisted of 536 (71.1%) men and 218 (28.9%) women. Tobacco use was more common in men (X2=223.216, p<0.001) and younger ages (X2=45.342, p<0.001). Complications occurred in 96 patients, 76 (79.2%) of whom used tobacco. Tobacco use (p<0.001, OR=3.547), ASA score (p=0.029, OR=2.004), major surgeries (p<0.001, OR=4.458), and minimally invasive surgeries (p=0.027, OR=2.323) are associated with complications. Length of hospital stay is related to the amount of tobacco (p<0.001, OR=3.706), size of surgery (p<0.001, OR=14.797), over 65 years (p<0.001, OR=2.635), and infectious diseases (p=0.039, OR=1.939).Conclusions: Tobacco use is related to poor outcomes in thoracic surgery patients, and it is a severe health problem, especially at young ages. Tobacco control programs should be supported to prevent the effects of tobacco use on thoracic diseases and postoperative complications.

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Clinical predictors and outcome of bowel resection in paediatric intussusception

African Health Sciences ◽

10.4314/ahs.v20i3.52 ◽

2020 ◽

Vol 20 (3) ◽

pp. 1463-1470

Author(s):

Akinlabi E Ajao ◽

Taiwo A Lawal ◽

Olakayode O Ogundoyin ◽

Dare I Olulana

Keyword(s):

Developing Countries ◽

Abdominal Pain ◽

Hospital Stay ◽

Bowel Resection ◽

Length Of Hospital Stay ◽

Clinical Predictors ◽

College Hospital ◽

Duration Of Symptoms ◽

Operative Complications ◽

Post Operative Complications

Introduction: Surgery remains the mainstay in treating intussusception in developing countries, with a correspondingly high bowel resection rate despite a shift to non-operative reduction in high-income countries. Objective: To assess factors associated with bowel resection and the outcomes of resection in childhood intussusception. Methods: A review of children with intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on the need for bowel resection and analysis done using the SPSS version 23. Results: 121 children were managed for intussusception during this period. 53 (43.8%) had bowel resection, 61 (50.4%) did not require resection and 7 (5.8%) were unknown. 40 (75.5%) of the resections were right hemi-colectomy. The presence of fever, abdominal pain, distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were associated with the need for bowel resection (p < 0.05). However, only age and abdominal pain independently predicted need for resection. Bowel resection was more associated with development of post-operative complications and prolonged hospital stay (p < 0.05). Conclusion: Infants presenting with abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Resection in intussusception significantly increased post-operative complications and length of hospital stay. Keywords: Paediatric intussusception; bowel resection; developing countries.

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PS02.008: MINIMAL INVASIVE OSEOPHAGECTOMY FOR CARCINOMA OESOPHAGUS BY USING WITH AN INNOVATIVE TECNIQUE: OUR EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.008 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 122-122

Author(s):

Suraj Pawar

Keyword(s):

Esophageal Carcinoma ◽

Large Scale ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Length Of Hospital Stay ◽

Lateral Position ◽

Thoracoscopic Approach ◽

Invasive Esophagectomy ◽

Operative Complications ◽

Post Operative Complications

Abstract Background Minimally invasive esophagectomy(MIE) is associated with lower morbidity and mortality compared to open procedures. In order to retain the benefits and overcome disadvantages of the left lateral decubitious and fully prone positions, a modified semiprone position was developed at our centre.We aim to describe our growing experience of operating patients of esophageal carcinoma with MIE in a semiprone position. Methods A retrospective review of hospital records of all patients who underwent MIE for esophageal carcinoma at our oncological surgical centre from January 2007 till December 2017 was done. A modified semi-prone position (dorsolateral) was developed i.e. left lateral position with an inclination of 45 degrees with the horizontal. All surgeries were performed under general + Epiduralanesthesia with a double lumen endotracheal tube. Esophageal mobilization was done by thoracoscopic approach in a semiprone position andthoracoscopic 2 field lymhadenectomy was done and end-to-end cervical anastomosis was done in the neck. From the records, we obtained intraoperative parameters and post-operative complications. A multidisciplinary follow-up was established for all patients for a period of 2 `to 5 years. Results Retrospective data of 214 patients was included in this study. Mean length of hospital stay was 15.46 ± 4.48 days (range from 3 to 33 days) and mean number of lymph nodes dissected were 15.64 ± 5.98 (range 0 to 32). The mean blood loss was 282.92 ± 197.22 ml. Operative time for the total surgical procedure and 211.29 ± 54.62 minutes. Only 7% of the patients had intra-operative complications like arrhythmia, azygous vein bleeding, cardiac arrhythmia, hypotension, splenic bleeding, and others. Most common immediate post-operative complications were pulmonary related (22.7%) and wound infections (8.7%). Approximately 6% of the patients died in the early and delayed post operative period Conclusion MIE with mediastinal lymphadenectomy in the semiprone position is a feasible, convenient and safe option which can combine the benefits of the two conventional left lateral and prone approaches. Further large scale studies are required to support our findings. Disclosure All authors have declared no conflicts of interest.

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Impact of hospital type and surgical volume on outcomes of biliary cancer resection.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16168 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16168-e16168

Author(s):

Jasmeet Kaur ◽

Waqas Qureshi ◽

Vaibhav Sahai

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Healthcare Cost ◽

Hospital Volume ◽

Teaching Hospitals ◽

Biliary Cancer ◽

Cancer Resection ◽

Operative Complications ◽

Teaching Status ◽

Post Operative Complications

e16168 Background: The mainstay of treatment for patients with early-stage biliary cancer (gallbladder or cholangiocarcinoma) is surgical resection. Herein, we evaluated the predictors for biliary cancer resection outcome and association with hospital volume and teaching status. Methods: A national representative cohort of 18485 biliary cancer patients was included for the years 2016 – 2018 from the national inpatient sample database. The study population included patients ≥ 18 years diagnosed with biliary cancer who underwent elective surgical resection (ICD 10). Hospitals were categorized based on teaching status (yes, if ACGME approved residency program, member of the council of teaching hospitals, or with residents to beds ratio of .25 or higher, versus non-teaching); and hospital volume (high if ≥ 20 biliary cancer surgeries performed per year, otherwise low). The primary outcome was biliary resection and the secondary outcomes included post-operative complications, in-hospital mortality, length of stay (< or ≥ 7 days), and health care cost (< or ≥ median) based on hospital teaching status and biliary cancer surgical volume. Association with outcomes was assessed using multivariable logistic regression models adjusted for age, sex, race, household income, service payer, Elixhauser co-morbidity score, hospital volume, teaching status, bed size, location, and region. Results: Out of 18,485 patients hospitalized with biliary cancer, 7,030 patients underwent elective biliary cancer resection during the study period. Patients undergoing resection were likely to have higher than national household median income with Medicare as primary insurance payor. In multivariate adjusted logistic regression models, high volume centers showed significantly lower length of stay (adjusted odds ratio (aOR) 0.73; 95% CI 0.54 - 0.97; p=0.03), and lower in-hospital mortality (aOR 0.28; 95% CI 0.15 - 0.80; p=0.01), but no significant difference in post-operative complications or healthcare cost compared to low volume centers. Surgeries performed in a teaching hospital were associated with decreased risk of post-operative complications (aOR 0.74; 95% CI 0.55 - 1.0; p=0.05), significant decrease in in-hospital mortality (aOR 0.44; 95% CI 0.27 - 0.69; p=0.001), but higher inflation-adjusted healthcare cost (aOR 1.77; 95% CI 1.37-2.26; p<0.001) with no difference in length of stay. Conclusions: Patients who underwent elective biliary cancer surgery at a teaching or high-volume hospital had a significant decrease in their risk of in-hospital mortality. Additionally, surgeries at teaching hospitals were associated with a significantly lower post-operative complication rate compared to similar procedures at a non-teaching hospital, although teaching hospitals did have a significantly higher healthcare cost when adjusted for length of stay.

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Microsurgical Resection of Foramen Magnum Meningioma: Multi-institutional Retrospective Case Series and Proposed Surgical Risk Scoring System.

10.21203/rs.3.rs-253670/v1 ◽

2021 ◽

Author(s):

Nida Fatima ◽

John H. Shin ◽

William T. Curry ◽

Steven D. Chang ◽

Antonio Meola

Keyword(s):

Hospital Stay ◽

Complication Rate ◽

Length Of Hospital Stay ◽

Foramen Magnum ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Operative Complications ◽

Microsurgical Resection ◽

Post Operative Complications

Abstract Purpose Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications. Methods A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18 cm3 (range, 1.77–57.9 cm3) and median follow-up of 36 months (range, 0.30–180.0 months). Tumors were resected though suboccipital approach (58.8%) or transcondylar approach (39.3%). Results Gross-total resection (GTR) was achieved in 80.4%, while local tumor control in 98% of cases. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5 days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications. Conclusion Microsurgical resection allows for high GTR rate and local tumor control rate, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.

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Risk Factors and Molecular Epidemiology of Complicated Intra-Abdominal Infections With Carbapenem-Resistant Enterobacteriaceae: A Multicenter Study in China

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz574 ◽

2020 ◽

Vol 221 (Supplement_2) ◽

pp. S156-S163 ◽

Cited By ~ 1

Author(s):

Jiao Liu ◽

Lidi Zhang ◽

Jingye Pan ◽

Man Huang ◽

Yingchuan Li ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Hospital Mortality ◽

Molecular Epidemiology ◽

Carbapenem Resistance ◽

Resistance Mechanisms ◽

Carbapenem Resistant ◽

Abdominal Infections ◽

Hospital Acquired ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with poor patient outcomes. Data on risk factors and molecular epidemiology of CRE in complicated intra-abdominal infections (cIAI) in China are limited. This study examined the risk factors of cIAI with CRE and the associated mortality based on carbapenem resistance mechanisms. Methods In this retrospective analysis, we identified 1024 cIAI patients hospitalized from January 1, 2013 to October 31, 2018 in 14 intensive care units in China. Thirty CRE isolates were genotyped to identify β-lactamase-encoding genes. Results Escherichia coli (34.5%) and Klebsiella pneumoniae (21.2%) were the leading pathogens. Patients with hospital-acquired cIAI had a lower rate of E coli (26.0% vs 49.1%; P < .001) and higher rate of carbapenem-resistant Gram-negative bacteria (31.7% vs 18.8%; P = .002) than those with community-acquired cIAI. Of the isolates, 16.0% and 23.4% of Enterobacteriaceae and K pneumoniae, respectively, were resistant to carbapenem. Most carbapenemase-producing (CP)-CRE isolates carried blaKPC (80.9%), followed by blaNMD (19.1%). The 28-day mortality was 31.1% and 9.0% in patients with CRE vs non-CRE (P < .001). In-hospital mortality was 4.7-fold higher for CP-CRE vs non-CP-CRE infection (P = .049). Carbapenem-containing combinations did not significantly influence in-hospital mortality of CP and non-CP-CRE. The risk factors for 28-day mortality in CRE-cIAI included septic shock, antibiotic exposure during the preceding 30 days, and comorbidities. Conclusions Klebsiella pneumoniae had the highest prevalence in CRE. Infection with CRE, especially CP-CRE, was associated with increased mortality in cIAI.

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