scholarly journals A COMPARATIVE STUDY BETWEEN THE INCIDENCE OF WOUND INFECTION AND BURST ABDOMEN BETWEEN DELAYED ABSORBABLE (VICRYL) AND MEDICATED VICRYL (VICRYL PLUS) SUTURE MATERIAL IN PATIENTS UNDERGOING MIDLINE INCISION LAPAROTOMY IN ACUTE ABDOMEN CASES IN THE EMERGENC

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Abhishek Jina ◽  
Abhinav Chaudhary ◽  
U C Singh
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Acute Abdomen ◽  
Suture Material ◽  
Significant Risk ◽  
Midline Incision ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Vicryl Suture

Midline laparotomy is frequently done in the emergency setting of any hospital and type of suture material used for the fascial closure of the abdominal wall influences the incidence of the postoperative complications. The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications. In addition, the effect of various risk factors on burst abdomen and wound infection was also evaluated.  Methods: 100 patients who have visited the emergency department of the hospital and underwent midline laparotomy were enrolled in this study. Results: Patients were divided into two groups depending on whether they have an intestinal perforation (group A, n=60) or intestinal obstruction (Group B, n=40). These two groups were further divided into two groups depending on the type of suture material used (plain Vicryl: group A1, B1 and medicated Vicryl: group A2, B2). Both these groups had an equal number of patients. The analysis of the data showed that compared to the non medicated suture material the rate of wound infection is considerably less in the cases of medicated polyglactin suture material. In addition, older age, diabetes, anemia, and malnutrition are the significant risk factor for wound infection (p<0.001s) while Older age, malnutrition, and cough were found to be highly significant risk factors for burst abdomen. Conclusion: The medicated suture material was proved to be more effective in preventing the burst abdomen and postoperative wound infections compared to the plain delayed absorbable Vicryl suture material. Keywords: delayed absorbable Vicryl, medicated Vicryl, burst abdomen, wound infection, a midline laparotomy

scholarly journals Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Xining Zhao ◽  
Jie Liu ◽  
Ying Wang ◽  
Yuying Yang ◽  
Yan Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Geriatric Patients ◽  
Cox Regression ◽  
Significant Risk ◽  
Related Factors ◽  
Factors Associated ◽  
Delayed Discharge ◽  
Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

scholarly journals A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

2017 ◽  
Vol 4 (6) ◽  
pp. 2014
Author(s):  
Rahul D. Kunju ◽  
Vinayak Thakkannavar ◽  
Shrivathsa Merta K. ◽  
Sachin H. G. ◽  
Allen Netto ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Wound Infection ◽  
Wound Closure ◽  
Tertiary Care ◽  
Fascial Closure ◽  
Emergency Laparotomy ◽  
Closure Technique ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Laparotomy Wound

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

Postoperative Nausea and Vomiting Following Craniotomy: Risk Factors and Complications in Context of Perioperative High-dose Dexamethasone Application

2019 ◽  
Vol 80 (05) ◽  
pp. 381-386
Author(s):  
Till Burkhardt ◽  
Patrick Czorlich ◽  
Klaus Christian Mende ◽  
Annika Treitz ◽  
Rainer Kiefmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Postoperative Nausea ◽  
Significant Risk ◽  
Postoperative Nausea And Vomiting ◽  
Significant Risk Factor ◽  
Nausea And Vomiting ◽  
High Dose ◽  
High Dose Dexamethasone ◽  
Csf Leaks

Introduction Postoperative nausea and vomiting (PONV) is common in patients after craniotomy and may lead to severe postoperative complications. The aim of this study was to identify risk factors and postoperative complications associated with PONV in the context of perioperative high-dose dexamethasone administration. Patients and Methods In this prospective single-center study, all patients planned for elective craniotomy for supra- and infratentorial lesions were eligible to be included. Any PONV in a 24-hour period after craniotomy was recorded and analyzed with regard to time to postoperative complications and the administration of perioperatively administered high-dose dexamethasone. Results The overall PONV rate of 421 patients during a 9-month period was 18.1% (76 patients). Multivariate analysis revealed a significant association of PONV with female sex, infratentorial localization, age, and history of PONV. There was no association between PONV and postoperative complications such as intracranial hemorrhage, cerebrospinal fluid (CSF) leaks, or pneumonia. Perioperative administration of high-dose dexamethasone for prophylactic prevention of edema was the only significant risk factor for postoperative complications (odds ratio [OR]: 3.34; confidence interval [CI], 1.39–8.05; p < 0.01) with a highly significant association with the occurrence of CSF leaks (OR: 6.85; CI, 1.62–29.05; p < 0.01). Conclusion The low PONV rate of 18.1% in this study may be the result of the frequent perioperative administration of high-dose dexamethasone for the prevention of edema. Our data indicate that perioperative high-dose dexamethasone is significantly associated with CSF leaks and can therefore not be recommended on a regular basis.

scholarly journals The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yong Lin ◽  
Mei-Fang Chen ◽  
Hui Zhang ◽  
Ruo-Meng Li ◽  
Liang-Wan Chen
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Aortic Dissection ◽  
Significant Risk ◽  
Type A ◽  
Cerebral Disease ◽  
Effective Prevention ◽  
Type A Aortic Dissection ◽  
Cerebral Complications ◽  
Significant Difference

Abstract Background Postoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD). The aim of this study was to evaluate the risk factors for PCC in these patients and to provide a scientific basis for effective prevention of PCC. Methods In this retrospective case-control study, 125 patients with AAD who underwent thoracotomy in our department from October 2017 to October 2018 in the department of cardiovascular surgery, Fujian Medical University Union Hospital were divided into two groups: patients with PCC (n = 12), and patients without PCC (n = 113). The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed. Results The patients with PCC were significantly older than the patients without PCC (P = 0.016), and the incidence of the preoperative cerebral disease history in the patients with PCC was significantly higher than those of the PCC (−) group (P = 0.024). The Euro SCORE II of patients with PCC was dramatically higher than the patients without PCC (P = 0.005). There were significant differences between the two groups in terms of the duration of cardiopulmonary bypass (CPB) (P = 0.010) and the length of moderate hypothermic circulatory arrest (MHCA) combined with selective cerebral perfusion (SCP) (P = 0.000). The monitoring of rcSO2 indicated that there was significant difference between the two groups in terms of the bilateral baseline (P = 0.000). Patients with PCC were observed to have experienced significantly longer intubation times (P = 0.000), ICU stays (P = 0.001), and postoperative hospital stays (P = 0.009), and they also had dramatically higher rates of pulmonary infection (P = 0.000), multiple organ dysfunction syndrome (P = 0.041) and tracheotomy (P = 0.022) after surgeries. The duration of MHCA+SCP (OR:9.009, P = 0.034) and the average baseline value of rcSO2 (OR:0.080, P = 0.009) were ultimately identified as significant risk factors. Conclusions PCC has a serious influence on the prognoses of patients following surgical treatment with AAD. The duration of MHCA+SCP and the average baseline value of rcSO2 were the independent risk factors for PCC.

Evaluation of risk factors for postoperative complications in rectal cancer patients

2020 ◽  
Vol 92 (4) ◽  
pp. 1-5
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Maciej Grajek ◽  
Adam Idasiak ◽  
Andrzej Tukiendorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Rectal Cancer ◽  
Coronary Artery ◽  
Postoperative Complications ◽  
Significant Risk ◽  
Neutrophil To Lymphocyte Ratio ◽  
Anastomotic Leaks ◽  
Lymphocyte Ratio ◽  
Artery Disease

Purpose The complications of surgical treatment for rectal cancer, particularly anastomotic leaks after anterior resection, are a significant clinical problem. We retrospectively analysed preoperative factors that may affect the occurrence of complications. Material and methods A total of 392 rectal cancer patients were included in a retrospective analysis. A total of 257 anterior resections (AR) and 135 abdominoperineal resections (APR) were performed. The risk factors for early postoperative complications were analysed by logistic regression and receiver operating characteristic curves. Results The significant risk factors for severe complications (grade 3B and higher on the Clavien-Dindo scale) in the multivariate analysis were neutrophil to lymphocyte ratio > 5 (p = 0.047) in the AR group, age of the patients (p = 0.031) in the APR group, and coronary artery disease in both groups (p = 0.03, p = 0.011, respectively). There were no risk factors for anastomotic leaks in the AR group before the analysis was divided into early and late leaks. In the univariate analysis, the statistically significant risk factors for early leaks were preoperative neutrophil to lymphocyte ratio > 5 and peripheral blood platelet count, while late leaks were associated with coronary artery disease; however, in the multivariate analysis, these factors were not statistically significant. Conclusions The risk factors for severe postoperative complications were neutrophil to lymphocyte ratio> 5, advanced age of the patients and coronary artery disease. The different risk factors for early and late anastomotic leaks after anterior resection may indicate their different aetiologies.

scholarly journals Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial

Hernia ◽  
2021 ◽  
Author(s):  
M. Albertsmeier ◽  
A. Hofmann ◽  
P. Baumann ◽  
S. Riedl ◽  
C. Reisensohn ◽  
...  
Keyword(s):  
Suture Material ◽  
Standard Of Care ◽  
Short Term ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Short Stitch

Abstract Purpose The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material. Methods Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes. Results At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768–1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379–0.6617), p = 0.0115]. Conclusions Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique. Trial registry NCT01965249, registered October 18, 2013.

scholarly journals Individualization of risk factors for postoperative complication after lung cancer surgery: a retrospective study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nozomu Motono ◽  
Masahito Ishikawa ◽  
Shun Iwai ◽  
Yoshihito Iijima ◽  
Katsuo Usuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Thoracic Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Smoking History ◽  
Postoperative Arrhythmia ◽  
Male Sex

Abstract Background The risk factors for postoperative complications after pulmonary resection in patients with non-small cell lung cancer (NSCLC) have not been elucidated. Methods Clinical data of 956 patients with NSCLC were analyzed. Patient factors such as sex, age, comorbidities, smoking history, respiratory function, and the lobe involved in lung cancer and operative factors such as operative approach and operative procedures were collected and analyzed. Results Male sex (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.09–2.75, p = 0.01), coexistence of asthma (OR 2.68, 95% CI 1.19–6.02, p = 0.01), low percentage of forced expiratory volume in 1 s (FEV1) (OR 1.41, 95% CI 1.02–1.95, p = 0.03), and lobectomy or greater resection (OR 2.47, 95% CI 1.66–3.68, p < 0.01) were identified as significant risk factors for postoperative complications. Male sex (OR 1.98; 95% CI 1.03–3.81, p = 0.03) and complete video-assisted thoracic surgery and robot-assisted thoracic surgery (OR 1.64; 95% CI 1.09–2.45; p = 0.01) were identified as significant risk factors for postoperative air leakage. Coexistence of asthma (OR 9.97; 95% CI 3.66–27.38; p < 0.01) was identified as a significant risk factor for postoperative atelectasis or pneumonia. Lobectomy or greater resection (OR 19.71; 95% CI 2.70–143.57; p < 0.01) was identified as a significant risk factor for postoperative arrhythmia. Conclusion Male sex, coexistence of asthma, low percentage of FEV1, and operative procedure were significant risk factors for postoperative complications. Furthermore, risk factors varied according to postoperative complications.

Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

2019 ◽  
Vol 33 (09) ◽  
pp. 912-918 ◽  
Author(s):  
Kevin Rezzadeh ◽  
Omar A. Behery ◽  
Benjamin S. Kester ◽  
Tara Dogra ◽  
Jonathon Vigdorchik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Significant Risk ◽  
Operation Time ◽  
Significant Risk Factor ◽  
Perioperative Outcomes ◽  
Patellofemoral Arthroplasty ◽  
Short Term ◽  
Hospital Stays

AbstractThere is a paucity of literature regarding the short-term readmission, reoperation, and complication rates of patellofemoral arthroplasty (PFA). The purpose of this study is to determine the incidence and risk factors of 30-day postoperative complications in patients undergoing PFA. A retrospective cohort study of subjects who underwent PFA from 2010 to 2015 was performed using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Perioperative outcomes and 30-day postoperative complications were ascertained, and patient demographics and comorbidities were analyzed using linear and binomial logistic regression analyses to determine risk factors for postoperative complications. Among the 1,069 patients identified in the NSQIP database, there was a 30-day readmission rate of 4.3% and a 30-day reoperation rate of 1.5%. The leading complications identified were bleeding requiring transfusion (11.7%), urinary tract infection (0.8%), and deep vein thrombosis (DVT) (0.8%). Younger age was a risk factor for superficial wound infection (p = 0.012). Older age was a significant risk factor for longer hospital stays, readmission, bleeding requiring transfusion, urinary tract infection, and pneumonia (p < 0.05 for all). Male sex was a risk factor for longer operation time and DVT (p = 0.001 and p = 0.017, respectively), while female sex was associated with greater incidence of bleeding requiring transfusion (p = 0.049). Elevated body mass index (BMI) was a risk factor for longer hospital stays, greater total operation time, and bleeding requiring transfusion (p < 0.001, p < 0.001, and p = 0.001, respectively). Nonwhite race was a significant risk factor for readmission (p = 0.008). This represents the largest study on early readmissions and the associated risk factors after PFA. PFA 30-day readmission and reoperation rates were <5%. Older age and elevated BMI were both identified as risk factors for adverse perioperative outcomes, including longer operation times, longer hospital stays, and bleeding requiring transfusion.

scholarly journals Analysis of Risk Factors for Incisional Hernias and its Management

2018 ◽  
Vol 10 (2) ◽  
pp. 16-20
Author(s):  
S R Paudel ◽  
B R Neupane ◽  
N V Gurung ◽  
A Acharya ◽  
A Chapagain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Wound Infection ◽  
Mesh Repair ◽  
City Hospital ◽  
Midline Incision ◽  
Primary Surgery ◽  
Western Regional ◽  
One Year ◽  
Age Range

Introduction: Incisional hernia is a common problem after abdominal surgery. Patients present with pain, swelling and intestinal obstruction. It may be repaired by either anatomical suturing or mesh repair.Methods: It is a prospective observational study conducted in Western Regional Hospital and Fewa City Hospital, Pokhara from 2013 to 2016. A total of consecutive 100 patients admitted in these hospitals during the study period were included.Results: Incisional hernia is more common in females (M : F = 1 : 3.8), and in 30 - 50 years age group (60%). Major risk factors were wound infection (30%), overweight (25%), and postoperative cough (10%). It is found to be more associated with gynecological (65%), than gastrointestinal operations, and more so with lower abdominal midline incision (65%). It is found to occur mostly within one year (60%) of primary surgery than later. Even 24% of the patients had first symptom within six months. Mesh repair (92%) was the preferred standard surgical treatment for incisional hernia.Conclusion: Overweight females of age range between 30 - 50 years with history of gynecological operations by lower abdominal midline incision are more prone to develop incisional hernia. This incidence increases when there is wound infection. Mesh repair is the choice of operation for incisional hernia. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 16-20

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions

2003 ◽  
Vol 13 (4) ◽  
pp. 522-527 ◽  
Author(s):  
K. N. Gaarenstroom ◽  
G. G. Kenter ◽  
J. B. Trimbos ◽  
I. Agous ◽  
F. Amant ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Late Complication ◽  
Significant Risk ◽  
Early Complications ◽  
Groin Dissection ◽  
Wound Breakdown ◽  
Vena Saphena Magna ◽  
Node Metastases ◽  
Inguinofemoral Lymphadenectomy

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.

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