Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.

Visceral Obesity Determined by CT As a Predictor of Short-term Postoperative Complications in Ovarian Cancer

Objective: To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.Methods: Medical records were reviewed for patients with ovarian cancer. Visceral fat area, subcutaneous fat area and total fat area were measured on a single slice at the level of L3/4 of a preoperative CT scan. Univariable and multivariable analyses were performed to investigate the correlation between visceral obesity and short-term complications and to analyze the risk factors for complications after surgery.Results: Of the 130 patients, 53.8% (70/130) were presented visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.3 years old vs. 52.3 years old, p = 0.001). The proportion of patients with hypertension was slightly higher (37.1% vs. 11.7%, p = 0.001). The total fat area and subcutaneous fat area were higher in patients with visceral obesity (296.9 ± 72.1 vs. 173.1 ± 67.3, p < 0.001; 168.8 ± 55.5 vs. 121.6 ± 54.3, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). Time from surgery to adjuvant chemotherapy for patients with visceral obesity has been delayed (24 days vs. 20 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR 4.770, p < 0.001) and operation time (OR 1.008, p < 0.001) were independent predictors of postoperative complications. Conclusion: Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

Postoperative fever secondary to enoxaparin usage with pork allergy

Postoperative fevers are common in hospitalised patients and warrant workup beyond the early post-op period. A 50-year-old man was admitted after sustaining a tibial plateau fracture. Fevers began 3 days after external fixation and persisted through a second surgery despite initial negative workup. Careful review of medications revealed enoxaparin as the instigating agent of a febrile drug reaction, and the fevers resolved after discontinuing the drug. On further questioning, it was discovered the patient had an allergy to pork, from which the main components of enoxaparin are typically derived. To our knowledge, this is the first reported enoxaparin-induced fever in the setting of a pork allergy. Enoxaparin-induced fevers should be considered in patients with unexplained post-op fever. Our case demonstrates the importance of analysing newly administered medications. Simple detailed history may significantly reduce patient morbidity and help to broaden differentials during investigation.

“THE STUDY TO ASSESS AN INCIDENCE OF FEVER IN POST-OPERATIVE PATIENTS ADMITTED IN SURGICAL ICU AT NATIONAL CANCER INSTITUTE, DHARAMPETH, NAGPUR.”

INTRODUCTION: Postoperative fever is one of the most common problems seen in the postoperative ward. Most cases of fever immediately following surgery are self-limiting. The appearance of postoperative fever is not limited to specic types of surgery. Fever can occur immediately after surgery and seen to be related directly to the operation or may occur sometime after the surgery as a result of an infection at the surgical site or infections that involve organs distant from the surgery. Objectives: To study the common causes of post operative fever in general surgery patients. To study the correlation between the cause and the day of onset of fever. To study the risk factors associated with post operative fever. Material and Method: In this study Descriptive Research Design was used. The samples were 30 Post operative patients which fulls inclusion criteria. Setting of the study was surgical ICU, National cancer Institute, Dharampeth, Nagpur. RESULTS:-The result of this study shows that There 6 patients in the age group of 41yrs to 60 yrs having increase WBC count. Fisher exact test statistic value is 0.0449. The result is signicant at p < .05. so the post operative fever is signicantly associated with gender of the patient, Types of surgery and increase WBC count in Patient.

Vesical stone management by percutaneous cystolitholapexy versus open vesicolithotomy among children.

Objective: To compare outcomes, safety and complications of vesical stone management among children by open vesicolithotomy versus percutaneous cystolitholapaxy. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: July 2020 to December 2020. Material & Methods: Children with vesical stone, having age 1-12 years and fulfilling inclusion criteria were selected for this study. Total 50 cases were selected using non-probability consecutive sampling technique. Patients were divided into two groups Group-A and Group-B on the basis of given treatment each group containing 25 cases. Patients in Group-A were underwent open vesicolithotomy and those in group-B were underwent percutaneous cystolitholapexy. Procedure was done under general anesthesia. Alken metallic dilators were used for the dilatation of tract. Adult nephroscope with 24Fr sheath was used. Postoperative outcomes of both methods were compared with each other. Pneumatic fragmentation was used to break stones > 1.5cm in size. Results: Total 50 cases were studied, 25 cases in each group-A and group-B. Stone size was 1-3 cm in both groups. Age range of the patients was 1-12 years with mean age of 4.25 ± 1.4 years. Mean hospital stay was 2.6 days in group-A and 1.3 days in group-B. Mean requirement of analgesia (ketorolac) was 30.2mg in group-A and 14.8mg in group-B. Most common postoperative complication was fever observed in 28% cases in group-A and hematuria observed in 24% cases in group-B. Conclusion: Percutaneous cystolitholapexy is a minimal invasive procedure suitable among children with high success rate and minimum complications like postoperative fever, hematuria, urinary leakage and pain.

Cesarean Birth Morbidity among Women with SARS-CoV-2

Objective The objective of this study was to compare maternal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who underwent cesarean births. Study Design This was a matched cohort study of pregnant women who had a cesarean birth between March 15, 2020, and May 20, 2020. Cases included women who tested positive for SARS-CoV-2. For every case, two patients who tested negative for SARS-CoV-2 were matched by maternal age, gestational age, body mass index, primary or repeat cesarean birth, and whether the procedure was scheduled or unscheduled. We compared rates of adverse postcesarean complications (intraoperative bladder or bowel injury, estimated blood loss more than or equal to 1,000 mL, hemoglobin drop more than 3 g/dL, hematocrit drop more than 10%, need for blood transfusion, need for hysterectomy, maternal intensive care unit admission, postoperative fever, and development of surgical site infection), with the primary outcome being a composite of those outcomes. We also assessed duration of postoperative stay. Fisher's exact tests were performed to compare the primary outcome between both groups. Results Between March and May 2020, 202 women who subsequently underwent cesarean birth were tested for SARS-CoV-2. Of those 202, 43 (21.3%) patients were positive. They were matched to 86 patients who tested negative. There was no significant difference in the rate of composite adverse surgical outcomes between the groups (SARS-CoV-2 infected 27.9%, SARS-CoV-2 uninfected 25.6%; p = 0.833). There was a higher rate of postoperative fevers (20.9 vs. 5.8%; p = 0.015), but that did not result in a longer length of stay (p = 0.302). Conclusion Pregnant women with SARS-CoV-2 who underwent a cesarean birth did not have an increased risk of adverse surgical outcomes, other than fever, compared with pregnant women without SARS-CoV-2. Key Points

Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.

Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

Background To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy. Methods We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee. Results The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up. Conclusions The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

Low Body Mass Index as a Predictive Factor for Postoperative Infectious Complications after Ureterorenoscopic Lithotripsy

Background and Objectives: In this study, we aimed to evaluate predictive factors of postoperative fever (POF) after ureterorenoscopic lithotripsy (URSL). Materials and Methods: A total of 594 consecutive patients who underwent URSL for urinary stone disease at Gifu Municipal Hospital and Chuno Kosei Hospital between April 2016 and January 2021 were enrolled in this study. In all patients, antibiotics were routinely administered intraoperatively and the next day after surgery. We used rigid and/or flexible ureterorenoscopes depending on the stone location for URSL. Stones were fragmented using a holmium: YAG laser. The fragments of the stone were manually removed as much as possible using a stone basket catheter. A ureteral stent was placed at the end of the surgery in all cases. Results: The median age and body mass index (BMI) in all patients were 62 years and 23.8 kg/m2, respectively. The median operation duration was 52 min. The most common URSL-related complication was POF in 28 (4.7%) patients. In these patients, the rates of antibiotic administration and ureteral stent insertion before surgery were significantly higher than in those without POF. In multivariate analysis, BMI was associated with POF after URSL. There were no significant differences in predicting POF after surgery in patients who had bacteriuria or received antibiotics before surgery. Conclusions: A low BMI was significantly associated with POF after URS or URSL.

Modern Methods of Treatment for Proximal Ureterolithiasis

Urolithiasis is a disease characterized by the formation of stones in the urinary tract. According to statistics, SCC causes about 30% of hospitalizations in the urology department. Treatment of SCC is divided into conservative and operative. The choice of method depends on age, clinical course of the disease, general condition of the patient, anatomical and functional condition of the kidneys and the size of the localization of the calculus. Methods of treatment of SC have changed significantly in recent years. Due to the technical achievements of the method of open ureterolithotomy, which was once the standard method of treatment of so-called «complicated» concretions of the ureter, evolved into a laparoscopic ureterolithotomy, and with the advent of ultrasonic and laser lithotriptors – began the newest era of minimally invasive urology– extracorporeal shock-wave lithotripsy and endourology: antegrade percutaneous ureterolithotripsy, retrograde ureteroscopic lithotripsy and flexible retrograde uretherolithotripsy (FURS). The purpose of the work – on the basis of scientific literature to assess the effectiveness, safety and profitability of modern methods of surgical treatment for proximal ureterolithiasis. During the scientific research, attention was paid to the following parameters: stone free rate (SFR), postoperative pain level, need for painkillers, number of postoperative bed-days, presence of postoperative fever, hemoglobin level, need for blood transfusion, and on the economic component during the implementation of a technique. The principles of treatment of patients with large proximal ureterolithiasis are described in the clinical guidelines of the European and American Associations of Urologists. However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community. Percutaneous antegrade ureterolithotripsy is the preferred method of choice in patients with large proximal ureteral stones that cannot be removed by contact or extracorporeal ureterolithotripsy, characterized by a high level of absence of stones and minimal complications, optimal post operative and high indicators of economic attractiveness of this technique.