Role of Diagnostic Imaging in the Evaluation and Treatment of Post-operative Complications of the Urinary Tract

1991 ◽  
Vol 67 (2) ◽  
pp. 113-124 ◽  
Author(s):  
J. P. VACCARO ◽  
J. J. CRONAN
Keyword(s):  
Urinary Tract ◽  
Diagnostic Imaging ◽  
Operative Complications ◽  
Post Operative Complications

PS02.180: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OESOPHAGO-GASTRIC CANCER SURGERY: EVALUATION OF A SINGLE-CENTRE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 173-173
Author(s):  
Sophie Allen ◽  
Saurav Chakravartty ◽  
David Timbrell ◽  
Timothy Rockall ◽  
Pradeep Prabhu ◽  
...  
Keyword(s):  
High Risk ◽  
Exercise Testing ◽  
Conflicts Of Interest ◽  
Cardiopulmonary Exercise Testing ◽  
Low Risk ◽  
Test Results ◽  
Cardiopulmonary Exercise ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Cardiopulmonary exercise testing (CPEX) is an objective measure of functional capacity adapted to predict post-operative morbidity. CPEX may also identify optimisable cardio-respiratory comorbidity, prompting treatment modification or specialist referral. The role of CPEX in patient optimisation before oesophago-gastrectomy is yet to be evaluated. This study aims to assess the utility of CPEX in altering management and optimising patients prior to oesophago-gastrectomy. Methods All patients who underwent pre-operative CPEX testing and two phase oesophago-gastrectomy (January 2012 to January 2018) were included. All changes in patient management brought about by CPEX findings were evaluated. In addition, the role of validated risk-stratifying CPEX parameters (anaerobic threshold (AT), VO2 peak and FEV1) in predicting post-operative complications was assessed. Results 236 patients underwent surgery. Median AT and VO2 peak were 11.95(7–24)ml/kg/min and 773(403–1552)ml/min/m2 respectively. 46% (109/236) of patients (VO2 peak > 800ml/min/m2) were graded ‘low risk’, 42% (99/236) ‘intermediate risk’ (VO2 peak = 600–800ml/min/m2), and 12% (28/236) ‘high risk’ (VO2 peak < 600ml/min/m2) for developing post-operative cardio-pulmonary complications. Based on CPEX findings, management plans were altered in 84 patients (36%). Cardiac comorbidity was identified in 55 patients (23%) with immediate alteration of cardiac medications in 9% (21/236) and another 11% (27/236) requiring specialist cardiology review. Medication for respiratory optimisation was initiated in 3% (7/236) and formal respiratory review sought in 5% (12/236). ‘Intermediate’ and ‘high risk’ patients had similar rates of overall complication (63% vs 63%, P = 1.00), cardio-pulmonary complication (48% vs 47%, P = 0.17), anastomotic leak (11% vs 15%, P = 0.33) and 90-day mortality (6% vs 4%, P = 0.40) compared with ‘low risk’ groups. CPEX variables (AT, VO2 peak, FEV1) did not predict complications, length of critical care or overall stay on Receiver Operating Characteristic curves (AUROC < 0.5) and multivariate logistic regression models. Conclusion CPEX findings changed management in 36% of patients, enabling optimisation before oesophago-gastrectomy. ‘Confounding by intention’ is a bias reducing the strength of association between test results and post-operative complications due to the propensity to medically intervene on the basis of the test findings. This study highlights the possibility that the high intervention rate may explain the poor correlation between test results and post-operative outcome. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Role of Portable Incisional Negative Pressure Wound Therapy (piNPWT) in Reducing Local Complications of Post-bariatric Brachioplasty: A Case-Control Study

2021 ◽  
Author(s):  
Federico Facchin ◽  
Andrea Pagani ◽  
Paolo Marchica ◽  
Laura Pandis ◽  
Carlotta Scarpa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Body Contouring ◽  
Full Description ◽  
Wound Therapy ◽  
Level Of Evidence ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Due to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty. Patients and Methods 26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated. Results None of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery. Conclusion The piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals The Role of Serum Protein, Haemoglobin, and BMI as Predictors of Postoperative Morbidity and Mortality in Major Surgeries

2021 ◽  
pp. 728-735
Author(s):  
Karen Jaison ◽  
G. Muthukumaran
Keyword(s):  
Clinical Outcome ◽  
Serum Albumin ◽  
Nutritional Assessment ◽  
Morbidity And Mortality ◽  
Operative Morbidity ◽  
Post Surgery ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
Post Operative Complications

Background: Pre-operative nutritional assessment is necessary for all patients undergoing surgery in order to prevent post-operative complications. This is because wound healing is an anabolic process requiring adequate protein stores in our body. Serum albumin levels has been found to be a reliable tool in assessing the nutrition when used along with two other parameters namely, haemoglobin and body mass index. It is necessary to provide adequate nutritional support prior surgery for better clinical outcome post-operatively. Objectives: To assess role of pre-operative serum albumin, haemoglobin and BMI as predictors of post-operative morbidity and mortality in major open surgeries. Materials and Methods:Sixty patients more than 18 years of age posted for elective and emergency laparotomy in the general surgery ward were included in this study based upon the inclusion and exclusion criteria. Detailed history, clinical examination, anthropometry and nutritional assessment with pre-operative serum albumin, haemoglobin and BMI were done. Post-surgery the details of the procedure, anaesthesia, duration of surgery, duration of hospital stay and early post-operative complications were studied. The patients were followed up till they got discharged from the hospital. The data obtained was analysed. Results: Maximum number of post-operative complications were in the age group of 40-59 years (36.66%). Seroma followed by surgical site infections were the two most common complications seen among the study population. Most of the complications were seen among patients with                serum albumin <3.5gm/dl. Patients with hypoalbuminemia and anaemia had a tendency to develop more post-operative complications and this was found to be statistically significant. (p value <0.05) There was no significant relationship between abnormal BMI and complications in the present study. Conclusion: Pre-operative hypoalbuminemia <3.5gm/dl and anaemia were found to be independent risk factors for post-operative morbidity and mortality in major open surgeries. Although the relationship between BMI and complications was not found to be statistically significant, it is also essential to stabilise BMI prior to surgery for better clinical outcome.

scholarly journals Impact of albumin levels on clinical outcomes in children underwent abdominal surgery

2020 ◽  
Vol 60 (3) ◽  
pp. 149-53
Author(s):  
Rismala Dewi ◽  
Freddy Guntur Mangapul Silitonga ◽  
Irawan Mangunatmadja
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Serum Albumin ◽  
Clinical Outcomes ◽  
Postoperative Mortality ◽  
Increased Risk ◽  
Operative Complications ◽  
The Impact ◽  
Post Operative Complications

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear. Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery. Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality. Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ≤ 3.00 g/dL (P<0.001). Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.

scholarly journals 533 Predictive role of radiomic for post-operative complications of lymphadenectomy in ec patients

2020 ◽  
Author(s):  
Francesco Magni ◽  
Massimiliano Fambrini ◽  
Irene Paternò ◽  
Virginia Taddei ◽  
Flavia Sorbi ◽  
...  
Keyword(s):  
Operative Complications ◽  
Predictive Role ◽  
Post Operative Complications
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