The impact of compensated and decompensated cirrhosis on the postoperative outcomes of patients undergoing hernia repair

ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

Download Full-text

Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110367 ◽

2021 ◽

Vol 142 ◽

pp. 110367

Author(s):

Yarrow Scantling-Birch ◽

Guy Martin ◽

Sathyan Balaji ◽

Jacqueline Trant ◽

Ian Nordon ◽

...

Keyword(s):

Psychological Distress ◽

Endovascular Aneurysm Repair ◽

Postoperative Outcomes ◽

Short Term ◽

Aneurysm Repair ◽

The Impact

Download Full-text

The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

World Journal of Surgery ◽

10.1007/s00268-021-06073-9 ◽

2021 ◽

Author(s):

M. Runkel ◽

T. D. Diallo ◽

S. A. Lang ◽

F. Bamberg ◽

M. Benndorf ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Visceral Obesity ◽

The Body ◽

Postoperative Outcomes ◽

Sarcopenic Obesity ◽

Colorectal Metastases ◽

Complication Rates ◽

The Impact ◽

Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

Download Full-text

Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2018/5710641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Sivesh K. Kamarajah ◽

Behrad Barmayehvar ◽

Mustafa Sowida ◽

Amirul Adlan ◽

Christina Reihill ◽

...

Keyword(s):

Risk Stratification ◽

Glomerular Filtration ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Major Complication ◽

Postoperative Outcomes ◽

Queen Elizabeth Hospital ◽

Complication Rates ◽

Significant Difference ◽

The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

Download Full-text

Post-operative pain after laparoscopic ventral hernia repair, the impact of mesh soakage with bupivacaine solution versus normal saline solution: A randomised controlled trial (HAPPIEST Trial)

Journal of Minimal Access Surgery ◽

10.4103/jmas.jmas_50_19 ◽

2020 ◽

Vol 16 (4) ◽

pp. 328

Author(s):

Noman Shahzad ◽

Tabish Chawla ◽

Khabir Ahmad ◽

JehangirFarman Ali

Keyword(s):

Randomised Controlled Trial ◽

Hernia Repair ◽

Normal Saline ◽

Ventral Hernia Repair ◽

Saline Solution ◽

Controlled Trial ◽

Solution Versus ◽

Post Operative Pain ◽

Randomised Controlled ◽

The Impact

Download Full-text

The Impact of COVID-19 Infection on the Postoperative Outcomes in Pancreatic Cancer Patients

In Vivo ◽

10.21873/invivo.12383 ◽

2021 ◽

Vol 35 (2) ◽

pp. 1307-1311

Author(s):

NICOLAE BACALBASA ◽

CAMELIA DIACONU ◽

CORNEL SAVU ◽

CARMEN SAVU ◽

OVIDIU STIRU ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Postoperative Outcomes ◽

The Impact

Download Full-text

The Impact of the Preoperative Anxiety and Depression Levels on Postoperative Outcomes in Stage II / III Gastric and Colorectal Cancer Patients

Southern Clinics of Istanbul Eurasia ◽

10.14744/scie.2021.04875 ◽

2021 ◽

Author(s):

selçuk gülmez

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Preoperative Anxiety ◽

Stage Ii ◽

Postoperative Outcomes ◽

Anxiety And Depression ◽

Colorectal Cancer Patients ◽

The Impact

Download Full-text

A new modified technique in complicated umbilical hernia repair in patients with decompensated cirrhosis: a single center Experience

The Egyptian Journal of Surgery ◽

10.4103/ejs.ejs_18_20 ◽

2020 ◽

Vol 39 (2) ◽

pp. 498

Author(s):

Taha Yassein ◽

Mohamed Mless ◽

Islam Ayoup ◽

Mohammad Taha ◽

Eman Sayed ◽

...

Keyword(s):

Hernia Repair ◽

Umbilical Hernia ◽

Decompensated Cirrhosis ◽

Single Center ◽

Modified Technique ◽

Single Center Experience ◽

Umbilical Hernia Repair

Download Full-text

Postoperative Prophylactic Antibiotics Reduce Surgical Site Infection Rates after Ventral Hernia Repair: A Systematic Review

The American Surgeon ◽

10.1177/000313481908501128 ◽

2019 ◽

Vol 85 (11) ◽

pp. 1228-1233

Author(s):

Pablo A. Baltodano ◽

Anmol Chattha ◽

Philip K. Johnson ◽

Justin Kittredge ◽

Joseph A. Ricci ◽

...

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Prophylactic Antibiotics ◽

Control Group ◽

Infection Rates ◽

The Impact ◽

Independent Assessment

SSIs after ventral hernia repair (VHR) represent a significant complication. The impact of postoperative prophylactic antibiotics on the SSI rates after VHRs is unclear. A systematic review of PubMed and Web of Science databases from inception through March 2016 investigating the effect of postoperative prophylactic antibiotics after VHRs was performed. Strict inclusion and exclusion criteria were implemented, and the methodological quality of the included studies was assessed. After systematic independent assessment of 216 citations, four studies, involving 344 patients, met the inclusion criteria. Among the included studies, 164 patients received >24 hours of postoperative prophylactic antibiotics, whereas 180 patients were controls. The overall incidence of SSI among patients receiving postoperative antibiotics was 14.6 per cent (95% confidence interval [CI], 9.9 to 20.9) which compares favorably with the control group: 35.5 per cent (95% CI, 28.9 to 42.7) (odds ratio: 0.3, 95% CI: 0.2 to 0.5, P < 0.01). Among patient's receiving postoperative antibiotics, the pooled average duration of postoperative antibiotic treatment was 6.2 ± 0.4 days. Based on the available evidence, the use of postoperative prophylactic antibiotics seems to be associated with lower SSI rates after VHRs. Future prospective randomized controlled trials should be conducted to further confirm the efficacy of this prophylactic intervention.

Download Full-text