Multicenter cross-sectional study of surgical site infection after emergency surgery in China / 中国实用外科杂志

OBJECTIVE: To understand the current status of surgical site infection(SSI)after emergency abdominal surgery(EAS) in China,and to discuss the risk factors.METHODS: The study included 293 adult patients who underwent EAS in 26 hospitals in China in May 2018. The basic information, perioperative data, and microbial culture results of infected incisions were collected prospectively. The primary outcome measure was the incidence of surgical site infection within 30 days after surgery. Secondary outcome variables were postoperative hospital stay,ICU occupancy,ICU stay,treatment costs,and postoperative30-day mortality.RESULTS: Twenty-two(7.5%) patients developed SSI after surgery.The main pathogen of SSI is Escherichia coli [culture positive rate was 36.4%(8/22)]. Patients with SSI had a significantly longer overall hospital stay and ICUstay,and ICU occupancy and treatment were significantly higher. Multivariate logistic regression analysis showed thatmales(P=0.030) and operative time(P=0.007) were risk factors for SSI. Laparoscopic surgery(P=0.022)was aprotective factor for SSI.CONCLUSION: The incidence of SSI after EAS in China is 7.5%,and SSI leads to a significantincrease in the medical burden of patients. Choosing laparoscopic surgery can reduce the incidence of SSI after EAS.Controlling preoperative blood glucose may have positive significance in preventing SSI after EAS.

Diagnostic value of combined modified Alvarado scores and computed tomography imaging in the pathological types of acute appendicitis in adults / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the diagnostic value of combined modified Alvarado scores (MAS) and computed tomography imaging in the pathological types of acute appendicitis in adults.</p><p><b>METHODS</b>Clinical data of a total of 396 adult patients with acute appendicitis confirmed by surgery and pathology were analyzed retrospectively from June 2007 to July 2010. Case-control study was used to investigate the MAS. CT signs were studied in 115 patients who underwent preoperative CT scan. Univariable analysis was performed using each indicator among different pathological types. Discriminant classification was formed by applying significant variables identified from univariable analysis and a Fisher discriminant function was created.</p><p><b>RESULTS</b>Twenty three variables were statistically significant among different pathological types after univariable analysis(P<0.05) and were selected for discriminant analysis. Six variables including temperature(X1), leucocyte count(X2), the proportion of neutrophil(X3), MAS points(X4), periappendiceal fat stranding(X5), and extraluminal air(X6) were enrolled. The discriminant function equation was Y1=0.012X1+0.041X2+0.069X3-0.039X4+2.653X5+1.418X6, Y2=0.327X1+0.041X2-0.034X3-0.140X4-1.114X5+2.982X6. The accuracy was 76.5%(88/115) in retrospective assessment and 77.8%(21/27) in prospective assessment.</p><p><b>CONCLUSION</b>The combined use of MAS and CT imaging signs is useful in identifying the pathological types of acute appendicitis in adults, so it is helpful in choosing reasonable therapeutic option for surgeons.</p>

Value of modified APACHE II score in predicting postoperative complications in patients with acute obstructing colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of modified acute physiologic and chronic health score (APACHE II score) in predicting postoperative complications in patients with acute obstructing colorectal carcinoma.</p><p><b>METHODS</b>Postoperative complications in 92 patients with acute obstructing colorectal carcinoma were evaluated by APACHE II score and modified APACHE II score (severe organ dysfunction and immune damage in chronic health indicators were replaced by the duration and degree of obstruction, which were considered as the severity of intestinal obstruction). The sensitivity, specificity, and Youden index were compared with regard to complication prediction. Receiver operating characteristic curves were plotted to calculate area under the curve(AUC).</p><p><b>RESULTS</b>Twenty-five patients developed postoperative complications including 3 deaths. The APACHE-II score(13.72±4.24), modified APACHE II score (19.28±4.92), intestinal obstruction severity score (5.56±2.20) were significantly higher in patients with complications than those in patients without complications (10.58±3.44, 14.69±3.73, 4.10±1.52, all P<0.01). The sensitivity, specificity, accuracy, Youden index, and AUC were 0.640, 0.940, 0.859, 0.580, and 0.839 for the modified APACHE-II score with 20 being the optimal cut-off point, respectively, and were 0.560, 0.896, 0.804, 0.456, and 0.784 for APACHE-II (14 was the optimal cut-off point), respectively.</p><p><b>CONCLUSION</b>The modified APACHE-II score system with the intestinal obstruction severity score is a better prediction method for the occurrence of postoperative complications in patients with acute obstructing colorectal carcinoma.</p>

Surgical treatment and prognostic factors for obstructing left colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the outcomes of surgical treatment and the prognostic factors of long-term survival for obstructing left colorectal cancer.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 93 patients with obstructing left colorectal cancer undergoing surgical treatment from January 2001 to December 2006 in the Affiliated Hospital of Medical College of Qingdao University were analyzed retrospectively.</p><p><b>RESULTS</b>There were 53 males and 40 females. The median age was 61 years old. Fifty-one patients had concurrent medical condition. Radical resection was performed in 67 patients, including one-stage resection (n=21), Hartmann procedure (n=35), and Miles procedure (n=11). Surgery was palliative in 26 patients, including diverting stoma (n=14), bypass surgery (n=7), and palliative resection (n=5). All the 93 patients were followed up. The 1-, 3-, and 5-year survival rates were 94%, 59%, and 38%, respectively. Univariate and multivariate analyses showed that radical resection, TNM staging, and preoperative level of carcinoembryonic antigen were independent prognostic factors (all P<0.05).</p><p><b>CONCLUSIONS</b>Radical resection, TNM stage, and preoperative CEA level are prognostic factors of obstructing left colorectal cancer. Early diagnosis, radical resection, and selection of appropriate surgical procedure are helpful to prolong survival time of patients with obstructing left colorectal cancer.</p>

Influence of obesity on short-term surgical outcome in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the influence of obesity on surgical procedure and short-term surgical outcome in patients with gastric carcinoma.</p><p><b>METHODS</b>A total of 426 patients with gastric carcinoma underwent laparotomy in our hospital during January 2006 and June 2008. All the patients were divided into obesity group and non-obesity group according to body mass index (BMI). The thickness of subcutaneous fat (SCF), abdominal anterior-posterior diameter (APD) and transverse diameter (TD) at the umbilicus level were measured by abdominal CT. Furthermore, the surgical data and postoperative conditions including short-term outcome were reviewed and compared between two groups.</p><p><b>RESULTS</b>The incidence of obesity was 29.8% in gastric carcinoma patients. Mean values of SCF thickness, APD and TD in obesity group and non-obesity group were (21.8+/-7.1) mm vs (14.4+/-7.5) mm, (223.2+/-24.6) mm vs (181.8+/-23.5) mm and (323.6+/-23.8) mm vs (285.8+/-24.4) mm (P=0.000). Longer operative time (P=0.007) and less amount of dissected lymph nodes were found in obesity group as compared to non-obesity group (P=0.000). Also, obesity group lasted a longer postoperative period of fever (P=0.000) and experienced more post-operative complications (P=0.005) than non-obesity group did.</p><p><b>CONCLUSIONS</b>Abdominal CT scan may display the abdominal shape of gastric carcinoma patients, hence, it is useful to evaluate the difficulty of surgical procedure. These patients may involve in complicated surgical procedure and worse short-term outcome due to obese abdominal shape. Therefore, perioperative management should be emphasized for these patients.</p>