scholarly journals Pre-term Infants in Major Abdominal Surgery and Postoperative Outcome

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Respiratory Failure ◽  
Postoperative Complications ◽  
Observational Study ◽  
Abdominal Surgery ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Surgical Wound ◽  
Wound Sepsis ◽  
Term Infants ◽  
Initial Cohort

Abstract Background: A monocentric observational study was undertaken in pediatric surgical patients in neurosurgery, abdominal and orthopedic surgery to determine predictors of postoperative outcome. In this cohort of 594 patients with a mean age of 90.86±71.80 months there were 25 pre-terms aged less than 37 weeks. A description of postoperative outcome was undertaken in these pre-term infants. Objective: The objective of this study was to describe the characteristics in pre-term patients in this initial cohort. Methods: Secondary analysis of pre-term patients included in the initial retrospective observational study. The Ethics Committee approved the study. Results: 25 pre-terms aged <37 weeks were included with a mean weight of 2.43±0.75 kg in major neonatal abdominal surgery. 9 patient presented postoperative complications among which 1 had an intra-operative cardiac arrest, 4 had postoperative respiratory failure, 2 had pulmonary sepsis, 1 had surgical wound sepsis, 1 had septicemia and 1 had multi-organ sepsis. Conclusion: In this cohort of 25 critically ill pre-terms in major neonatal abdominal surgery, the most common postoperative complications concerned the respiratory system which included respiratory failure and pulmonary sepsis. There was no in-hospital mortality.

scholarly journals Major Abdominal Surgery, Neurosurgery, Orthopedic Surgery in Children aged between 10 and 18 Years and Postoperative Outcome

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Respiratory Failure ◽  
Abdominal Surgery ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Operative Management ◽  
Initial Study ◽  
Multiple Organ ◽  
Major Surgery ◽  
Emergency Interventions ◽  
American Society

Background: In a previously conducted monocentric retrospective study, predictors of postoperative outcome in children included American Society of Anesthesiologists score, transfusion, emergency interventions, surgery and age. A study has been undertaken to describe postoperative outcome in patients aged between 10 and 18 years included in the initial study in abdominal surgery, neurosurgery and orthopedics. Aims: To describe postoperative outcome in children aged between 10 and 18 years. Methods: Secondary analysis of postoperative outcome in children aged between 10 and 18 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee. Results: There were 221 children with a mean age of 165.5±24.3 months in abdominal surgery, neurosurgery and orthopedics. 16.3% patients had intra-operative or postoperative complications. Intra-operatively, 3.2% had hemorrhagic shock, 0.45% anaphylaxis and 0.45% respiratory failure. Postoperatively, 3.2% had neurologic failure, 2.3% respiratory failure, 0.45% cardio-circulatory failure, 0.45% endocrinal failure, 0.45% had hepatic failure, 0.45% multiple organ failure, and 0.45% had renal failure. In-hospital mortality rate was 0.45%. Conclusion: These results emphasize the importance of optimizing intra-operative management in critically ill patients in major surgery with goal directed therapies in order to improve postoperative outcome.

scholarly journals Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Observational Study ◽  
Organ Failure ◽  
Preterm Infants ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Preterm Children ◽  
Surgery Patient ◽  
Neurosurgical Patients ◽  
One Year

Abstract Background and Objective : An observational study conducted earlier to determine predictors of postoperative outcome in non-cardiac surgical pediatric patients showed that factors which influenced postoperative evolution were multiple. These included American Society of Anesthesiologists (ASA) score, transfusion, age, emergency surgery, and surgery. The objective was to describe in details outcomes in non-preterm children under one year old included in the initial study. Methods : Secondary analysis of the initial retrospective observational study in 594 patients with a mean age of 90.86±71.80 months. The Ethics Committee approved the study under the registration number 2017-CK-5-R1. Results : There were 97 non-preterm children included with a mean age of 4.4±3.5 months. Mean weight was 5.1±2.7 kilograms. There were 48 abdominal surgical patients (49.5%), 48 neurosurgical patients (49.5%) and 1 orthopedic surgery patient (1%). 30 patients had intra-operative and or postoperative complications (organ failure or sepsis) (30.9%). The most common intra-operative complication was hemorrhagic shock (5.2%); the most affected system in the postoperative period was the respiratory system in terms of organ failure and pulmonary sepsis with an overall rate of 12.4%; the most common postoperative infection was septicemia (7.2%). The rate of postoperative renal failure was 1%. There were 5 in-hospital deaths (5.2%). Conclusion : In this cohort of 97 non-preterm infants under one year old, the rate of patients with intra-operative and or postoperative complications was 30.9%. It is time to reconsider integrating goal directed therapies in intra-operative patient management to improve postoperative outcome.

scholarly journals Major Abdominal Surgery, Neurosurgery, Orthopedic Surgery in Children aged between 10 and 18 years and Postoperative Outcome

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Respiratory Failure ◽  
Abdominal Surgery ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Operative Management ◽  
Initial Study ◽  
Multiple Organ ◽  
Major Surgery ◽  
Emergency Interventions ◽  
American Society

Abstract BackgroundIn a previously conducted monocentric retrospective study, predictors of postoperative outcome in children included American Society of Anesthesiologists score, transfusion, emergency interventions, surgery and age. A study has been undertaken to describe postoperative outcome in patients aged between 10 and 18 years included in the initial study in abdominal surgery, neurosurgery and orthopedics.AimsTo describe postoperative outcome in children aged between 10 and 18 years.MethodsSecondary analysis of postoperative outcome in children aged between 10 and 18 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee.ResultsThere were 221 children with a mean age of 165.5±24.3 months in abdominal surgery, neurosurgery and orthopedics.16.3% patients had intra-operative or postoperative complications. Intra-operatively, 3.2%had hemorrhagic shock, 0.45% anaphylaxis and 0.45% respiratory failure. Postoperatively,3.2% had neurologic failure, 2.3% respiratory failure, 0.45% cardio-circulatory failure, 0.45%endocrinal failure, 0.45% had hepatic failure, 0.45% multiple organ failure, and 0.45% had renal failure. In-hospital mortality rate was 0.45%.ConclusionThese results emphasize the importance of optimizing intra-operative management in critically ill patients in major surgery with goal directed therapies in order to improve postoperative outcome.

scholarly journals Postoperative complications after major abdominal surgery in preterm infants: A single institute record

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Respiratory Failure ◽  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Preterm Infants ◽  
Secondary Analysis ◽  
Major Abdominal Surgery ◽  
Operative Complications ◽  
The Mean ◽  
Preterm Born ◽  
Post Operative Complications

Abstract Backgrounds: Post-operative complications in pediatric surgery are important issues, especially that after major abdominal surgery for preterm infants: complications sometimes lead to mortality/morbidity even though the surgical procedures were successful. We here attempted to demonstrate and record post-operative complications in preterm infants after major abdominal surgery. This is a secondary analysis of our cohort (n=594) previously reported regarding pediatric postoperative complications (not confined to preterm infants). Methods: Of 594 patients, 25 preterm (born <37 weeks of gestation) infants underwent major abdominal surgery. We identified their characteristics, especially the postoperative complications. The Ethics Committee approved this study.Results: The mean weight was 2.43±0.75 kg. Of 25, nine suffered postoperative complications: postoperative respiratory failure (n=4), pulmonary sepsis (n=2), and the followings were observed in one patient: intra-operative cardiac arrest, wound sepsis, septicemia, and multi-organ sepsis. There was no in-hospital mortality.Conclusion: In preterm infants undergoing major abdominal surgery, the most common postoperative complication was respiratory; respiratory failure and pulmonary sepsis. This data is roughly the same as that observed in the previous studies, which made us reconfirm the importance of the vigilance on respiratory complications in this population.

scholarly journals An analytical observational study on the prognostic implication of postoperative serial serum lactate level for complications and predicting length of intensive therapy unit stay after major abdominal surgery

2021 ◽  
Vol 9 (5) ◽  
pp. 1428
Author(s):  
Moumita Mondal ◽  
Sankari Santra ◽  
Rajat Choudhuri ◽  
Amartya Das
Keyword(s):  
Respiratory Failure ◽  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Intensive Therapy ◽  
Wound Dehiscence ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Intensive Therapy Unit ◽  
Significant Difference ◽  
Lactate Levels

Background: Post-operative microcirculatory alteration causes hypoperfusion, tissue hypoxia and organ dysfunction, resulting in significant morbidity and mortality. Increase in serum lactate level in response to tissue hypoxia may serve as a cost effective tool to assess status of all organ dysfunction being sensitive but not organ specific and may help in early prognostication. Aim of this study was to investigate the association of blood lactate levels during the first 24 hours after surgery with postoperative morbidity and mortality, with length of ITU stay and to correlate the lactate values at various time points with different postoperative complications (POC).Methods: 150 patients undergoing elective abdominal surgery were included. Blood lactate (mmol/lit) levels were measured immediately on admission to the Intensive Therapy Unit (ITU) and at 6, 12, and 24 hours of admission. The parameters of clinical outcome included were mortality, shock, Acute kidney injury (AKI), respiratory failure, wound dehiscence and length of ITU stay. Heart Rate, Mean Arterial Pressure, spo2, Temperature and Urine output were also measured.Results: There was statistically significant difference in the lactate levels measured at the above mentioned point of time (0, 6, 12 and 24h) in cases with death and without fatal outcome, with and without respiratory failure, with and without AKI, with and without shock and in cases with and without wound dehiscence (p<0.05). There was a statistically significant difference in urine output, duration of ITU stay and duration of intubation (p<0.05).Conclusions: Increased serum lactate levels were significantly associated with postoperative complications, mortality and length of ITU stay in patients undergoing major elective abdominal surgery.

scholarly journals Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Tumor Resection ◽  
Intestinal Resection ◽  
Postoperative Outcome ◽  
Initial Study ◽  
Hospital Death ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundAnticipating postoperative evolution in surgical patients is an important issue in our daily practice.We have demonstrated in a previous study that predictors of postoperative outcome are multiple including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A detailed description of postoperative outcome was undertaken in children aged between 6 and 10 years included in the initial study.ObjectiveTo describe postoperative outcome in children aged between 6 and 10 years included in the initial cohort in abdominal surgery, neurosurgery and orthopedics.MethodsSecondary analysis of postoperative outcome in children aged between 6 and 10 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee.ResultsThere were 88 patients with a mean age of 98.7±13.8 months.The most common surgical interventions were scoliosis in 23 patients (26.1%), femoral osteotomy 7 patients (7.9%), limb tumor resection 7 patients (7.9%), intracerebral tumor resection 6 patients (6.8%), intestinal resection 5 patients (5.6%), Chiari’s malformation 4 patients (4.5%), pelvic osteotomy 4 patients (4.5%) and renal transplantation 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3) and 13 (14.8%) were ASA grade 4. 22(25%) patients had intra-operative and or postoperative complications (organ dysfunction or sepsis). 2 patients (2.3%) had intra-operative hemorrhagic, 1 patient (1.1%) had an intra-operative difficult intubation and 1 patient experienced intra-operative anaphylaxis. 9 patients (10.2%) had postoperative neurologic failure and 2 (2.3%) postoperative cardio-circulatory failure. 3 patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). Median total length of hospital stay was 9 days [5-16].Conclusion25% of the patients had intra-operative and or postoperative complications and most of them were ASA grade ³3. Integrating goal directed therapies to optimize intra-operative management in these patients is a necessary implementation to improve postoperative outcome in surgical pediatric patients.

scholarly journals Scoliosis in Children: Impact of Goal Directed Therapies on Intra-operative and Postoperative Outcomes

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Secondary Analysis ◽  
Initial Study ◽  
Abdominal Sepsis ◽  
Postoperative Outcomes ◽  
Scoliosis Surgery ◽  
Complication Rates ◽  
Wound Sepsis ◽  
Intraoperative Complication ◽  
Initial Cohort ◽  
Surgical Setting

Abstract Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased.A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and is presented here.Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement implementation measures.Methods: Secondary analysis of patients undergoing scoliosis surgery. The study was approved by the Ethics Committee.Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in one patient (0.9%).The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in three patients (2.6%), and abdominal sepsis and septicemia in two patients (1.7%).twelve patients (10.3%) had reoperations.Fifty-six patients (48.3%) had intraoperative transfusion.There was no in-hospital mortality.Conclusion: Integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.

scholarly journals Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Anesthetic Management ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Postoperative Outcomes ◽  
Transfusion Requirements ◽  
Intraoperative Management ◽  
Outcome Improvement ◽  
Challenging Situation ◽  
Surgical Setting

Abstract Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection.Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement.Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study.Results: There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncholaryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality.Conclusion: In this cohort, 43.8% of the patients had intraoperative and/or postoperative complications in terms of organ dysfunction or sepsis. A total of 81.3% of the patients received intraoperative transfusion. Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated tools in children could be necessary for a better postoperative outcome in this surgical setting.

scholarly journals Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yingke He ◽  
Lydia Weiling Li ◽  
Ying Hao ◽  
Eileen Yilin Sim ◽  
Kai Lee Ng ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Observational Study ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Postoperative Morbidity ◽  
Preoperative Assessment ◽  
Major Abdominal Surgery ◽  
Assessment Clinic ◽  
Point Increase

Abstract Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

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