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

2021 ◽  
Author(s):  
Claudine Kumba ◽  
Lotfi Miladi
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 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 in 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%), abdominal sepsis and septicemia in two patients (1.7%) respectively.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 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 Liver Transplantation in Children and Impact of Intra-operative Goal Directed Therapies on Postoperative Outcome

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Liver Transplantation ◽  
Point Of Care ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Initial Study ◽  
Abdominal Sepsis ◽  
Postoperative Outcomes ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Intraoperative Management

Abstract Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken.Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement.Methods: Secondary analysis of liver transplanted patients included in the initial study.Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients).Conclusion: There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

scholarly journals Liver Transplantation in Children and Impact of Intra-operative Goal Directed Therapies on Postoperative Outcome

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Liver Transplantation ◽  
Point Of Care ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Initial Study ◽  
Abdominal Sepsis ◽  
Postoperative Outcomes ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Intraoperative Management

Abstract Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken.Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement.Methods: Secondary analysis of liver transplanted patients included in the initial study.Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients).Conclusion:There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

scholarly journals Exploratory Laparotomy and Intestinal Resection in Children: Intraoperative Goal Directed Therapy and Intraoperative and Postoperative Outcomes

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Secondary Analysis ◽  
Intestinal Resection ◽  
Exploratory Laparotomy ◽  
Initial Study ◽  
Abdominal Sepsis ◽  
Multiple Organ ◽  
Postoperative Outcomes ◽  
Emergency Situations ◽  
American Society

Abstract Background: Reported independent predictors of intraoperative and postoperative complications were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection.Objectives: To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization.Methods: Secondary analysis of the initial study. The Ethics Committee approved the study.Results: There were 54 patients with a median age of 15.5[0-172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus.Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had intraoperative hemorrhagic shock. Two (3.7%) patients had postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had intraoperative transfusion. The in-hospital mortality rate was 3.7% in two patients.Conclusion: Intraoperative goal-directed therapies need to be developed and included in these surgical settings for intraoperative and postoperative optimization.

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

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Anesthetic Management ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Postoperative Outcomes ◽  
Goal Directed Therapy ◽  
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: 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 means in children are necessary for a better postoperative outcome in this surgical setting.

scholarly journals Exploratory Laparotomy, Intestinal Resection In Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Secondary Analysis ◽  
Intestinal Resection ◽  
Exploratory Laparotomy ◽  
Optimization Methods ◽  
Initial Study ◽  
Postoperative Outcomes ◽  
Emergency Situations ◽  
Study Results ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Reported independent predictors of intraoperative and postoperative complications were Age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection. Objectives To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization. Methods Secondary analysis of the initial study. The Ethics Committee approved the study. Results There were 54 patients with a median age of 15.5[0–172] months. Thirty-seven (68.5%) patients had an intestinal resection, nine (16.7%) had an exploratory laparotomy and eight (16.8%) patients had a laparotomy for volvulus.

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 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 Postoperative Outcomes in Ustekinumab-Treated Patients Undergoing Abdominal Operations for Crohn’s Disease: Single-Center Series

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Amy L Lightner ◽  
Fabian Grass ◽  
Ahmad Alsughayer ◽  
Molly M Petersen ◽  
Laura E Raffals ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Medical Center ◽  
Abdominal Sepsis ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Tobacco Exposure ◽  
Abdominal Operation ◽  
The Impact

Abstract Introduction The impact of ustekinumab on adverse postoperative outcomes in Crohn’s disease (CD) remains largely unknown. We determined the difference in 90-day postoperative complication rates among CD patients exposed to ustekinumab within 12 weeks prior to an abdominal operation as compared to patients not exposed to biologic therapy. Methods A retrospective chart review of all adults with CD who underwent an abdominal operation between October 1, 2017 and December 31, 2018 at a single tertiary medical center was performed. Data collection included patient demographics, concurrent immunosuppression, serum laboratory values, operative values, and 90-day outcomes including superficial surgical site infection (sSSI), intra-abdominal sepsis, overall infectious complications, readmission, and reoperation rates. The primary outcome was the 90-day rate of intra-abdominal sepsis. Results Fifty-seven CD patients received ustekinumab and 277 received no biologic therapy in the 12 weeks prior to major abdominal surgery. Ustekinumab-exposed patients were younger, less likely to have diabetes mellitus or active tobacco exposure, were more often obese, and more often taking a concurrent immunomodulator. Ustekinumab remained an independent predictor of intra-abdominal sepsis on multivariable logistic regression. Immunomodulator exposure was associated with significantly increased rates of sSSI and overall complication rates. Conclusions Ustekinumab is associated with increased rates of 90-day postoperative intra-abdominal sepsis following a major abdominal operation for CD.

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

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Anesthetic Management ◽  
Secondary Analysis ◽  
Postoperative Outcome ◽  
Postoperative Outcomes ◽  
Transfusion Requirements ◽  
Study Results ◽  
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, catecholamine-secreting characteristic of the tumor. We undertook a secondary analysis in a previously 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 Secondary analysis of children who had 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 broncho-laryngospasm and difficult intubation respectively. 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 respectively. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality. Conclusion Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation, intraoperative optimal management with validated means in children are necessary for a better postoperative outcome in this surgical setting.

Sign in / Sign up

Export Citation Format

Share Document