Clinical Study on Assessment of Post-Surgical Complications According to Clavien–Dindo Classification after Major Abdominal Surgery

Aims and Objectives: Surgical complications occur in every surgical department. The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome. This study aimed to define a simple and reproducible classification of complications following abdominal surgery based on a therapy-oriented severity grading system and to validate the Clavien–Dindo grades and categorize complications in elective major abdominal surgeries. Materials and Methods: This is a prospective study of 80 patients, who were diagnosed and admitted for major elective abdominal surgery in KIMS hospital, Hubli, from December 2012 to May 2014. Patients underwent definitive treatment. Data related to the objectives of the study were collected and post-operative complications were classified according to Clavien–Dindo grades and managed. Results: Ages between 30 and 39 years were the most common in our present study; there were 46 male patients and 34 female patients. Of 80 cases, 24 cases were cholelithiasis cases (predominate group) among which 17 were free of complications and 7 developed complications, 21.25% developed wound complications in the form of superficial surgical site infection followed by basal atelectasis (18.75%). 46 cases (57.5%) had complications in their post-operative course, among which Grade 1 constitutes 25 cases (31.25%), Grade 2 constitutes 12 cases (15%), Grade 3 A constitutes 2 cases (2.5%), Grade 3 B constitutes 2 cases (2.5%), Grade 4 A constitutes 1 case (1.25%), Grade 4 B constitutes 1 case (1.25%), and Grade 5 constitutes 3 cases (3.75%), and rest of 34 cases (42.5%) were free of complications and had normal post-operative course. In our study, Grade 1 complications were the most common complications. Conclusion: We conclude that the Clavien–Dindo classification is based on the therapeutic consequences of complications constitutes a simple, objective, and reproducible approach for comprehensive surgical outcome assessment. In this study, Clavien–Dindo Grade 1 complication is the most common complication.

Comparative Study on Prediction of Clinical Outcome of the Patients Presenting with Upper Gastrointestinal Bleeding Using Glasgow-Blatchford Score and Full Rockall Score Systems in Tertiary Care Center

Introduction and Objectives: Upper gastrointestinal bleeding (UGIB) is a potential life-threatening bleeding condition requiring accurate, prompt, and appropriate patient evaluation management. Early resuscitation and surgical intervention play a vital role in deciding the mortality and morbidity. Considerable advances have been made in endoscopic, surgical, and pharmacological therapy. The present study is aimed at the prediction of clinical outcome of the patients presenting to with UGIB using full Rockall score (RS) and the Glasgow-Blatchford score (GBS) systems. Materials and Methods: This was a prospective study where 118 patients who presented to the casualty with UGIB were studied. The data regarding the clinical profile, comorbidities, and course in the hospital were recorded. The GBS and full RS systems were calculated for every patient. The clinical course and outcome of each patient during the hospital stay were recorded. The patients were followed up for 1 month post-discharge for the complications such as rebleeding and mortality. Results: Follow-up was not done in 27 patients due to poor compliance. 11 patients had rebleeding (rebleeding rate - 12%) and 15 patients succumbed to the illness (mortality rate -16.5%) during 1-month follow-up period. During our study, it was found that GBS was more accurate in terms of detecting transfusion need, rebleeding rate, intensive care unit admission rate, and endoscopic intervention rate. Our study concluded that full RS was better than GBS in the prediction of 1-month mortality rate. Conclusion: The present study found that full RS system is better for the prediction of 1-month mortality, while GBS system is better for the prediction of other outcomes. Familiarity with the above scoring system can be a tool in the approach of the patient with UGIB.

Burkholderia pseudomallei septicaemia - A case report.

Burkholderia pseudomallei, a natural saprophyte widely distributed in soil, stagnant waters of endemic areas, is said to infect humans through breaks in the skin or through inhalation causing protean clinical manifestations including fatal septicaemia. A case of septicaemia in a elderly female diabetic due to B. pseudomallei following a history of fall is being reported with complete details.