scholarly journals Current Insights: The Impact of Gut Microbiota on Postoperative Complications in Visceral Surgery—A Narrative Review

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2099
Author(s):  
Ann-Kathrin Lederer ◽  
Sophia Chikhladze ◽  
Eva Kohnert ◽  
Roman Huber ◽  
Alexander Müller
Keyword(s):  
Postoperative Complications ◽  
Gut Microbiota ◽  
Anastomotic Leakage ◽  
Surgical Site Infections ◽  
Diagnostic Value ◽  
Narrative Review ◽  
Visceral Surgery ◽  
Special Focus ◽  
Microbial Profile ◽  
The Impact

Postoperative complications are a major problem occurring in up to 50% of patients undergoing major abdominal surgery. Occurrence of postoperative complications is associated with a significantly higher morbidity and mortality in affected patients. The most common postoperative complications are caused by an infectious genesis and include anastomotic leakage in case of gastrointestinal anastomosis and surgical site infections. Recent research highlighted the importance of gut microbiota in health and disease. It is plausible that the gut microbiota also plays a pivotal role in the development of postoperative complications. This narrative review critically summarizes results of recent research in this particular field. The review evaluates the role of gut microbiota alteration in postoperative complications, including postoperative ileus, anastomotic leakage, and surgical site infections in visceral surgery. We tried to put a special focus on a potential diagnostic value of pre- and post-operative gut microbiota sampling showing that recent data are inhomogeneous to identify a high-risk microbial profile for development of postoperative complications.

Immunoglobulin levels in systemic lupus erythematosus: A narrative review

Lupus ◽  
2021 ◽  
pp. 096120332110047
Author(s):  
Ibrahim Almaghlouth ◽  
Sindhu R Johnson ◽  
Eleanor Pullenayegum ◽  
Dafna Gladman ◽  
Murray Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Narrative Review ◽  
Special Focus ◽  
Immunoglobulin Level ◽  
Systemic Lupus ◽  
External Threats ◽  
Self Tolerance ◽  
Low Levels ◽  
The Impact

Immunoglobulins play a fundamental role in the protection of the human body against internal and external threats. They also contribute to the immune system homeostasis and maintenance of self-tolerance. Hypogammaglobulinemia is occasionally encountered in routine clinical practice by rheumatologists. Low levels of immunoglobulins can occur as primary or secondary issues and may predispose patients to various forms of infection. However, the impact of the low immunoglobulin level abnormality varies with the underlying condition. In this narrative review, we shed light on the overall types and functions of immunoglobulins for clinicians. We discuss important principles of immunoglobulin measurements. We then consider the primary and secondary causes of low immunoglobulins with a special focus on hypogammaglobulinemia in patients with systemic lupus erythematosus (SLE).

P23 MALNUTRITION INDICES AS PROGNOSTIC FACTORS FOR POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Lidoriki Irene ◽  
Schizas Dimitrios ◽  
Mpaili Efstratia ◽  
Mpoura Maria ◽  
Hasemaki Natasha ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
High Risk ◽  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Cancer Patients ◽  
Preoperative Assessment ◽  
Low Risk ◽  
Major Complications ◽  
The Impact

Abstract Aim To investigate the impact of malnutrition on postoperative complications in esophageal cancer patients. Background and Methods Malnutrition is common in esophageal cancer patients due to the debilitating nature of their disease. Several methods of nutritional assessment have emerged as significant prognostic factors for short-and long-term outcomes in patients operated for esophageal cancer. The study sample consisted of 85 patients with esophageal (n=11) and gastroesophageal junction (n=74) cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and March 2019. Out of them, 65 patients underwent esophagectomy, while 20 patients underwent total gastrectomy. The assessment of nutritional status included the Geriatric Nutritional Risk Index (GNRI), the Patient Generated Subjective Global Assessment (PG-SGA) and sarcopenia. GNRI was based on preoperative values of patients’ serum albumin and body weight. The preoperative assessment of sarcopenia was based on Skeletal Muscle Index (SMI) derived from analysis of CT scans using SliceOmatic® Software version 4.3 (Tomovision, Montreal, Canada). Postoperative complications were graded according to Clavien-Dindo classification. Minor complications included categories I-II, whereas major complications included categories III-V. Results Thirty nine patients (47.6%) developed postoperative complications. More specifically, 21 patients (24.7%) developed minor complications and 18 patients (21.2%) developed major complications, while anastomotic leakage occurred in 10 patients (11.8%). Eighty patients (94.1%) had a high-risk GNRI (<92), while 5 patients (5.9%) had a low-risk GNRI (≥92). Forty four patients (51.8%) were diagnosed with sarcopenia. The mean PG-SGA score was 8.82 ± 5.57. Patients with a high-risk GNRI demonstrated significantly higher rate of overall complications compared to low-risk GNRI patients (100% vs 44.2%, p<0.05 respectively). Moreover, the rate of anastomotic leakage was significantly higher in the sarcopenia group than in the non-sarcopenia group (29% vs 3.4%, p<0.05). Nonetheless, PG-SGA was not significantly associated with postoperative outcomes. Conclusion Higher-risk scores on the GNRI are associated with an increased risk for developing postoperative complications, while sarcopenia is associated with higher risk for anastomotic leakage among esophageal cancer patients. Preoperative assessment of GNRI and sarcopenia should be performed in all patients in order to detect patients who are at greater risk of postoperative morbidity.

scholarly journals Nutrition in the Intensive Care Unit—A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2851
Author(s):  
Aileen Hill ◽  
Gunnar Elke ◽  
Arved Weimann
Keyword(s):  
Critically Ill ◽  
Feeding Strategy ◽  
Interdisciplinary Approach ◽  
Nutrition Therapy ◽  
Narrative Review ◽  
Optimal Timing ◽  
Special Focus ◽  
Prognostic Impact ◽  
Specific Patient ◽  
The Impact

Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

scholarly journals Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ines Unterfrauner ◽  
Laura A. Hruby ◽  
Peter Jans ◽  
Ludwig Steinwender ◽  
Mazda Farshad ◽  
...  
Keyword(s):  
Public Health ◽  
Wound Healing ◽  
Postoperative Complications ◽  
Orthopedic Surgery ◽  
Cox Regression ◽  
Surgical Site Infections ◽  
Level Of Evidence ◽  
Health Measures ◽  
Hygiene Measures ◽  
The Impact

Abstract Background A total lockdown for pandemic SARS-CoV-2 (Covid-19) entailed a restriction of elective orthopedic surgeries in Switzerland.  While access to the hospital and human contacts were limited, hygiene measures were intensified. The objective was to investigate the impact of those strict public health guidelines on the rate of intra-hospital, deep surgical site infections (SSI), wound healing disorders and non-infectious postoperative complications after orthopedic surgery during the first Covid-19 lockdown. Methods In a single-center study, patients with orthopedic surgery during the first Covid-19 lockdown from March 16, 2020 to April 26, 2020 were compared to cohorts that underwent orthopedic intervention in the pre- and post-lockdown periods of six months each. Besides the implementation of substantial public health measures (promotion of respiratory etiquette and hand hygiene), no additional infection control bundles have been implemented. Results 5791 patients were included in this study. In multivariate Cox regression analyses adjusting for the large case-mix, the lockdown was unrelated to SSI (hazard ratio (HR) 1.6; 95% confidence interval (CI) 0.6–4.8), wound healing disorders (HR 0.7; 95% CI 0.1–5.7) or other non-infectious postoperative complications (HR 0.7, 95% CI 0.3–1.5) after a median follow-up of seven months. Conclusion The risks for SSI, wound healing disorders and other complications in orthopedic surgery were not influenced by the extended public health measures of the total Covid-19 lockdown. Trial registration BASEC 2020–02646 (Cantonal Ethics Commission Zurich). Level of evidence: Level III.

Effect of Smoking on Short-term Postoperative Complications After Elective Upper Extremity Surgery

Hand ◽  
2020 ◽  
pp. 155894472092663
Author(s):  
Michael A. Del Core ◽  
Junho Ahn ◽  
Ann S. Golden ◽  
Robert L. Bass ◽  
Douglas Sammer ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Postoperative Complications ◽  
Upper Extremity ◽  
Surgical Site Infections ◽  
National Database ◽  
Short Term ◽  
Improvement Program ◽  
Current Smoking ◽  
The Impact ◽  
Surgical Site Complications

Background: There is a paucity of literature exploring the impact of smoking on short-term complications, readmissions, and reoperations after elective upper extremity surgery using a large multicenter national database. We hypothesized that smokers will have an increased rate of complications, readmissions, and reoperations compared with a cohort of nonsmokers undergoing elective upper extremity surgery. Methods: Patient data were collected from the American College of Surgeons National Surgical Quality Improvement Program database between the years 2012 and 2017. Patients were included if they underwent elective surgery of the upper extremity using 338 predetermined Current Procedural Terminology codes. The data collected were divided into patient demographics, comorbidities, perioperative variables, and 30-day complications. Current smoking status was defined as smoking within 1 year prior to surgery. The incidence of surgical complications, reoperations, and readmissions was compared between the 2 cohorts using multivariable regression analysis. Results: Of the 107 943 patients undergoing elective surgeries of the upper extremity, 73 806 met the inclusion criteria. Of these, 57 986 (78.6%) were nonsmokers in the year prior to surgery, and 15 820 (21.4%) were current smokers. Between these groups, current smokers were younger ( P < .001), more often men ( P < .001), had lower body mass index ( P < .001), and more often underwent procedures that involved bone manipulation ( P < .001). Multivariate regression analysis defined current smoking as significantly associated with overall surgical site complications, superficial surgical site infections, deep surgical site infections, reoperation, and readmission. Conclusion: Current smoking was significantly associated with an increase in all surgical site complications, readmissions, and reoperations after elective upper extremity surgery. Surgeons should consider smoking a modifiable risk factor for postoperative complications and appropriately counsel patients on outcomes and complications given the elective nature of upper extremity surgery.

Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: Supplementary exploratory analysis of JCOG9907.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 155-155 ◽  
Author(s):  
Hiroya Takeuchi ◽  
Junki Mizusawa ◽  
Ken Kato ◽  
Kozo Kataoka ◽  
Hiroyasu Igaki ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Preoperative Chemotherapy ◽  
Postoperative Morbidity ◽  
Clinical Stage ◽  
Thoracic Esophagus ◽  
Prognostic Impact ◽  
Transthoracic Esophagectomy ◽  
Term Survival ◽  
The Impact

155 Background: Although the impact of postoperative complications, especially infectious complications (IC), on long-term survival after transthoracic esophagectomy remains controversial to date, we hypothesized that postoperative IC may affect tumor recurrence and survival of the patients (pts) undergoing transthoracic esophagectomy. Methods: The data from JCOG9907 (Ando N; Ann Surg Oncol 2012) was used to estimate the influence of IC on the outcome of current standard preoperative chemotherapy followed by surgery for clinical stage II/III squamous cell carcinoma of the thoracic esophagus. IC were classified into three: pneumonia, anastomotic leakage, and the others. OS and PFS were estimated by landmark method at 6 months from randomization. Univariate and multivariate analyses using Cox proportional hazard model were performed to assess the impact of postoperative complications on the survival after right-transthoracic esophagectomy with extended lymphadenectomy. Results: Among the 152 analyzed pts, the incidence of overall IC was 36%, among which pneumonia and anastomotic leakage were observed both in 14%. OS of pts with any IC (n=54) was shorter than that of pts without IC (HR 1.66, 95%CI [1.02-2.71]) and PFS also tended to be shorter in pts with any IC (HR 1.44, [0.92-2.23]). OS of pts with pneumonia (n=22) was shorter than that of pts without pneumonia (HR 1.82, [1.01-3.29]), and PFS also tended to be shorter in pts with pneumonia (HR 1.50, [0.85-2.62]). OS of pts with anastomotic leakage (n=21) were nearly identical to that for pts without leakage (HR 1.06, [0.52-2.13]) and PFS was slightly shorter in pts with leakage (HR 1.28, [0.71-2.32]). Multivariate analysis revealed that pneumonia tended to compromise OS and PFS (HR 1.66, [0.87-3.17] and HR 1.37, [0.75-2.51]). Conclusions: This study reveals that postoperative morbidity, especially pneumonia may deteriorate the survival of pts undergoing esophagectomy after preoperative chemotherapy. Achieving esophagectomy without postoperative complications might prolong OS and PFS. Clinical trial information: NCT00190554.

scholarly journals The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review

Cells ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 475 ◽  
Author(s):  
Yuki Ishikawa ◽  
Chikashi Terao
Keyword(s):  
Rheumatoid Arthritis ◽  
Environmental Factors ◽  
Cigarette Smoking ◽  
Cyclic Peptide ◽  
Bone Destruction ◽  
Narrative Review ◽  
Special Focus ◽  
Main Role ◽  
Genetic And Environmental Factors ◽  
The Impact

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and subsequent proliferation of synovial tissues, which eventually leads to cartilage and bone destruction without effective treatments. Anti-citrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) are two main characteristic autoantibodies found in RA patients and are associated with unfavorable disease outcomes. Although etiologies and causes of the disease have not been fully clarified yet, it is likely that interactive contributions of genetic and environmental factors play a main role in RA pathology. Previous works have demonstrated several genetic and environmental factors as risks of RA development and/or autoantibody productions. Among these, cigarette smoking and HLA-DRB1 are the well-established environmental and genetic risks, respectively. In this narrative review, we provide a recent update on genetic contributions to RA and the environmental risks of RA with a special focus on cigarette smoking and its impacts on RA pathology. We also describe gene–environmental interaction in RA pathogenesis with an emphasis on cigarette smoking and HLA-DRB1.

scholarly journals Increased Risk of Complications After Pancreatoduodenectomy in Uninephrectomized Patients

2018 ◽  
Vol 103 (7-8) ◽  
pp. 386-395
Author(s):  
Tadataka Takagi ◽  
Masayuki Sho ◽  
Satoshi Nishiwada ◽  
Takahiro Akahori ◽  
Minako Nagai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Postoperative Complications ◽  
Kidney Injury ◽  
Surgical Site Infections ◽  
Morbidity Rate ◽  
Control Group ◽  
Study Objective ◽  
Soft Pancreas ◽  
Increased Risk ◽  
The Impact

Objective: The study objective is to investigate the impact of unilateral nephrectomy on the complications after pancreatoduodenectomy (PD). Summary of background data: Preoperative renal insufficiency is a risk factor for postoperative complications and mortality after various types of surgery. However, the specific postoperative risks in uninephrectomized (UN) patients are largely unknown. Methods: Between January 2010 and June 2014, a total of 177 patients underwent PD at the Department of Surgery, Nara Medical University. Among them, 7 patients (4.0%) were UN. We retrospectively evaluated the influence of the UN status on the postoperative complications. Results: The rate of acute kidney injury in the UN group was significantly higher than that in the control group (28.6% versus 1.2%; P = 0.017). In addition, the rates of surgical site infection of the organ/space (57.1% versus 9.0%; P = 0.006) and sepsis (42.9% versus 3.5%; P = 0.003) in UN group were significantly higher. Even on a reanalysis of only patients with soft pancreas, the significance remained. Conclusions: The UN status has a significant impact on the rate of morbidities, such as acute kidney injury and various infectious complications, including surgical site infections of organ/space, sepsis, and cholangitis after PD. Appropriate intervention should be implemented to decrease the morbidity rate for UN patients.

scholarly journals Energy availability in female athletes with disabilities: a narrative review

2018 ◽  
Vol 11 (1) ◽  
pp. 195
Author(s):  
Claudia Ridel Juzwiak ◽  
Daniel Paduan Joaquim ◽  
Ciro Winckler
Keyword(s):  
Bone Health ◽  
Female Athletes ◽  
Narrative Review ◽  
Screening Methods ◽  
Special Focus ◽  
Energy Availability ◽  
Menstrual Dysfunction ◽  
Athletes With Disabilities ◽  
And Performance ◽  
The Impact

Research on female athletes has increased, with the main focus on Low Energy Availability (LEA) and Female Athlete Triad (TRIAD), however there is a gap in knowledge about LEA and related conditions such as eating disorder, menstrual dysfunction and bone health in athletes with disabilities. The literature suggests that those athletes, depending on the type of disability, have a higher risk of developing LEA. In this way, the objective of this review is to describe the impact of LEA on health and performance of female athletes, with special focus on athletes with disabilities. A narrative review of the literature was conducted using as search terms LEA and TRIAD components - bone health and menstrual dysfunction - in female athletes. The narrative review yielded 24 studies on the subject, of those, 10 original studies, in which LEA was diagnosed in female athletes, only one referring to athletes with disabilities. Literature indicates the complexity in estimating EA, since the methods used to determine its components may present inaccuracies, especially for athletes with disabilities. Further researched is needed to assess EA in female athletes, especially with disabilities, as well as the improvement of EA's assessment and screening methods.

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