scholarly journals HYPOALBUMINEMIA AS AN INDEPENDENT PROGNOSTIC RISK FACTOR FOR ADVERSE POST OPERATIVE OUTCOMES IN AN EMERGENCY LAPAROTOMY IN ADULT PATIENTS

2020 ◽  
pp. 1-3
Author(s):  
Sahista Hetamkhan Belim ◽  
Vidhyasagar M. Sharma
Keyword(s):  
Risk Factor ◽  
Postoperative Morbidity ◽  
Surgical Stress ◽  
Wound Dehiscence ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Emergency Laparotomy ◽  
Strong Positive Correlation ◽  
Operative Outcomes

Background:Laparotomies are commonly performed surgeries in an emergency setting.The complications associated with these are a result of the activation of the surgical stress response,the magnitude and duration of which are proportional to the surgical injury.Albumin is an important negative phase reactant. The prevalence of hypoalbuminemia in surgical patients is quite common. Preoperative hypoalbuminemia is an independent risk factor for several adverse outcomes postoperatively, and it is one of the marker for nutritional status of the patient. Low level of albumin is a risk factor for postoperative morbidity and mortality of the patients. Objective: To study level of serum albumin and its correlation with postoperative morbidity and mortality. Materials and methods: 84 patients in the age group 18-75 years who underwent Emergency laparotomy were studied from March 2018 to April 2020 at GCS Medical College. Effect of hypoalbuminemia was estimated. Study group consisted of albumin level less than 3g/dl and control group of albumin more than 3g/dl. Both groups were studied for post-laparotomy complications and data was analysed. Results: Prevalence of hypoalbuminemia is common in patients undergoing emergency laparotomy. Hypoalbuminemia has strong positive correlation to post-operative adverse outcomes like seroma, wound dehiscence, wound infection, incisional hernia and mortality. Conclusion: Hypoalbuminemia is a significant and effective prognostic risk factor which predicts adverse post-operative outcomes in patients undergoing laparotomy.

scholarly journals Evaluation of the role of pre-operative albumin and its post-operative drop in the prediction of outcomes of emergency laparotomy

2020 ◽  
Vol 7 (4) ◽  
pp. 1234
Author(s):  
Devaprashanth Mohan Kumar ◽  
Sindhu Sivakumar
Keyword(s):  
Surgical Stress ◽  
Exploratory Laparotomy ◽  
Morbidity And Mortality ◽  
P Value ◽  
Emergency Laparotomy ◽  
Emergency Setting ◽  
Operative Morbidity ◽  
The Mean ◽  
Preoperative Albumin

Background: Laparotomies are commonly performed surgeries in an emergency setting. The complications associated with these are a result of the activation of the surgical stress response, the magnitude and duration of which are proportional to the surgical injury. Albumin is an important negative phase reactant. This study was an attempt to evaluate the effectiveness of measurement of pre-operative albumin and the post-operative drop in albumin levels in the prediction of post-operative morbidity and mortality following laparotomy.Methods: Albumin levels of 50 patients undergoing emergency exploratory laparotomy in Victoria Hospital were measured pre and post operatively. The percentage drop in albumin levels was noted. The outcomes were noted and classified according to Clavein Dindo Classification. Unpaired t-test and ANOVA test was used for statistical analysis. A p value of <0.05 was considered statistically significant.Results: 62% of the patients had hypoalbuminemia preoperatively. 58% of patients had post-operative complications. The mean preoperative albumin levels for patients without complications was 3.83 while that for patients with complications was 2.78 (p<0.05). The mean percentage drop in albumin values was 9.66% for patients without complications while it ranged from 14.79 (Clavein Dindo 1) - 24.27 (Clavein Dindo 5) for patients with complications (p=0.047). A negative correlation was noted between the preoperative albumin values and the duration of hospital stay while the drop in albumin levels showed a positive correlation with the duration of hospital stay.Conclusions: Measurement of albumin levels pre-operatively and in the immediate post-operative period following laparotomy can prove as a useful tool and an early indicator of morbidity and mortality following laparotomy. 

scholarly journals PRE-OPERATIVE BILIARY DRAINAGE IN THE PERIAMPULLARY NEOPLASIA - A SYSTEMATIC REVIEW

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Gustavo Costa Marques de LUCENA ◽  
Rinaldo Antunes BARROS
Keyword(s):  
Biliary Drainage ◽  
Postoperative Morbidity ◽  
Intervention Group ◽  
Experimental Studies ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Medical Subject Headings ◽  
Drainage Group

ABSTRACT Introduction: Periampular neoplasms represent 5% of all cancers of the gastrointestinal tract with peak incidence in the 7th decade of life. The most common clinical picture is jaundice, weight loss and abdominal pain. Considering that cholestasis is related to postoperative complications, preoperative biliary drainage was developed to improve the postoperative morbidity and mortality of icteric patients with periampular neoplasias, whether resectable or not. Objective: To describe the outcome of patients with periampullary tumors undergoing preoperative biliary drainage with pancreatoduodenectomy. Method: The search was performed in the Medline/PubMed and Virtual Health Library databases by means of the combination of descriptors of the Medical Subject Headings. Inclusion criteria were clinical trials, cohorts, studies that analyze the morbidity and mortality of preoperative biliary drainage in Portuguese, English and Spanish. Exclusion criteria were studies published more than 10 years ago, experimental studies, systematic reviews and articles with WebQualis C or smaller journal in the area of Medicine I or Medicine III. Of the 196 references found, 46 were obtained for reading with quality assessed through the Checklist Strengthening the Reporting of Observational Studies in Epidemiology. Eight studies were selected for review. Results: A total of 1116 patients with a sample ranging from 48 to 280 patients and a mean age of 48 to 69 years were obtained. Of the eight studies, four observed a higher rate of bleeding in drained patients; three a higher rate of positive bile culture in the intervention group; site and cavitary infection, and biliopancreatic leaks were more common in the drainage group in two studies each. The death outcome and rate of reoperation were observed in larger numbers in the control group in one study each. Conclusion: Preoperative intervention leads to a higher rate of infectious complications and bleeding.

scholarly journals Cervical ureaplasma colonization affects intraamniotic inflammation in preterm labor with intact membrane: a cohort study

2021 ◽  
Author(s):  
Jin Gon Bae ◽  
Shin Kim ◽  
Il Seon Hwang ◽  
Ji Min Park ◽  
Jae Hyun Park
Keyword(s):  
Risk Factor ◽  
Preterm Labor ◽  
Independent Risk Factor ◽  
Adverse Outcomes ◽  
Control Group ◽  
Causative Role ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Intact Membrane ◽  
Histologic Chorioamnionitis

Abstract Background: A causative role between cervical ureaplasma colonization and adverse outcomes during pregnancy has remained controversial. We investigated whether cervical ureaplasma colonization affects the biochemically or histologically intraamniotic inflammation in preterm birth.Methods: Amniotic fluid was retrieved during delivery. Various chorioamnionitis-related cytokines (interleukin (IL)-1β, -6, -8, -10, and tumor necrosis factor-α) and regulators (matrix metalloproteins (MMP)-8 and MMP-9) were measured with Human Magnetic Luminex screening assay. We tested cervical swab specimens using real-time polymerase chain reaction assays for the detection of ureaplasma spp. colonization. Considering the clinical situation that causes intraamniotic infection, we arbitrarily divided into three categories of preterm labor with intact membrane, preterm premature rupture of membrane (PPROM), and control group with no exposure to preterm labor or preterm premature rupture of membrane.Results: The incidence of cervical ureaplasma colonization was 49.3% (136/276). The incidence of histologic chorioamnionitis was 27.5% (76/200). All differences in cytokines and regulators according to histologic chorioamnionitis were significant. Of the 153 cases that experienced preterm labor with intact membrane, IL-10, MMP-8, and MMP-9 levels in the ureaplasma positive group were significantly higher than those of the ureaplasma negative group. According to logistic regression analysis adjusted to preterm labor with intact membrane, PPROM, and gestational age at delivery, cervical ureaplasma colonization was an independent risk factor of histologic chorioamnionitis (odd ratio: 2.622, 95% confidence interval: 1.443-4.766).Conclusions: Cervical ureaplasma colonization augments biochemically intraamniotic inflammation in preterm labor with intact membrane, and was an independent risk factor of histologic chorioamnionitis.

SP3.2.3 The open abdomen is associated with increased morbidity and mortality after emergency laparotomy: a retrospective cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Charlotte Harrison ◽  
Charles Beresford ◽  
Tania Magro ◽  
Spyros Marinos ◽  
Rame Sunthareswaran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Primary Closure ◽  
Open Abdomen ◽  
District General Hospital ◽  
Abdominal Sepsis ◽  
Morbidity And Mortality ◽  
Emergency Laparotomy ◽  
Retrospective Case ◽  
Operative Outcomes ◽  
Hospital Patients

Abstract Aims The open abdomen following emergency laparotomy for peritoneal contamination is becoming an increasingly popular method of managing severe intra-abdominal sepsis. However, this approach has been associated with increased morbidity and mortality. The aim of this study is to compare patient populations and post-operative outcomes from patients undergoing primary closure or those managed with an open abdomen after emergency laparotomy. Methods A retrospective case note review was undertaken of all patients recorded on the NELA database over a five-year period at a district general hospital. Patients with no intra-abdominal contamination or who were palliated peri-operatively were excluded. Data collected included P-possum morbidity and mortality, post-operative complications (Clavien-Dindo), length of stay and in-hospital mortality. Results 811 NELA entries were reviewed; 313 were included with 79% (n = 248) undergoing primary closure. Cohorts were similar in age and sex. P-possum morbidity and mortality scores were significantly higher in the open abdomen group (89% vs 79%, p = 0.0003; 38% vs 24%, p = 0.0003, respectively). Of the outcome variables, significant complications (34% vs 11%, p = 0.001), length of stay (31 vs 18 days, p = 0.0001) and mortality (11% vs 4%, p = 0.001) were significantly higher in the open compared to closed abdomen group. Only 10% of patients undergoing primary closure required further surgery. Conclusions This study highlights that the open abdomen is used in higher risk patients, with significantly poorer outcomes. This approach, which confers a significant physiological burden requiring further intervention should be used with caution in selected cases.

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