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1.
Surg Endosc ; 36(6): 4290-4298, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1838333

ABSTRACT

BACKGROUND: Ileal Crohn's disease (CD) complicated by intraabdominal abscess, phlegmon, fistula, and/or microperforation is commonly treated with antibiotics, bowel rest, and percutaneous drainage followed by interval ileocolic resection (ICR). This "cool off" strategy is intended to facilitate the safe completion of a one-stage resection using a minimally invasive approach and minimize perioperative complications. There is limited data evaluating the benefits of delayed versus early resection. METHODS: A retrospective review of a prospectively maintained inflammatory bowel disease (IBD) database at a tertiary center was queried from 2013-2020 to identify patients who underwent ICR for complicated ileal CD confirmed on preoperative imaging. ICR cohorts were classified as early (≤ 7 days) vs delayed (> 7 days) based on the interval from diagnostic imaging to surgery. Operative approach and 30-day postoperative morbidity were analyzed. RESULTS: Out of 474 patients who underwent ICR over the 7-year period, 112 patients had complicated ileal CD including 99 patients (88%) with intraabdominal abscess. Early ICR was performed in 52 patients (46%) at a median of 3 days (IQR 2, 5) from diagnostic imaging. Delayed ICR was performed in 60 patients (54%) following a median "cool off" period of 23 days of non-operative treatment (IQR 14, 44), including preoperative percutaneous abscess drainage in 17 patients (28%). A higher proportion of patients with intraabdominal abscess underwent delayed vs early ICR (57% vs 43%, p = 0.19). Overall, there were no significant differences in the rate of laparoscopy (96% vs 90%), conversion to open surgery (12% vs 17%), rates of extended bowel resection (8% vs 13%), additional concurrent procedures (44% vs 52%), or fecal diversion (10% vs 2%) in the early vs delayed ICR groups. The median postoperative length of stay was 5 days in both groups with an overall 25% vs 17% (p = 0.39) 30-day postoperative complication rate and a 6% vs 5% 30-day readmission rate in early vs delayed ICR groups, respectively. Overall median follow-up time was 14.3 months (IQR 1.2, 24.1) with no difference in the rate of subsequent CD-related intestinal resection (4% vs 5%) between the two groups. CONCLUSIONS: In this contemporary series, at a high-volume tertiary referral center, a "cool off" delayed resectional approach was not found to reduce perioperative complications in patients undergoing ICR for complicated ileal Crohn's disease. Laparoscopic ICR can be performed within one week of diagnosis with low rates of conversion and postoperative complications.


Subject(s)
Abdominal Abscess , Crohn Disease , Laparoscopy , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Abscess/etiology , Abscess/surgery , Anastomosis, Surgical/adverse effects , Colectomy/adverse effects , Crohn Disease/complications , Crohn Disease/surgery , Humans , Laparoscopy/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Treatment Outcome
2.
Nutrients ; 14(7)2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1834856

ABSTRACT

INTRODUCTION: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. METHODS: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. RESULTS: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37-4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37-5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). CONCLUSIONS: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.


Subject(s)
Colorectal Neoplasms , Malnutrition , Aged , Colorectal Neoplasms/complications , Colorectal Neoplasms/surgery , Female , Hand Strength , Humans , Male , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/epidemiology , Middle Aged , Physical Functional Performance , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies
3.
In Vivo ; 36(3): 1337-1341, 2022.
Article in English | MEDLINE | ID: covidwho-1818961

ABSTRACT

BACKGROUND/AIM: The COVID-19 pandemic has significantly influenced the management of oncogynecologic patients in regard to time of diagnosis, to delay of treatment, therapeutic strategy and postoperative complications. The aim of the study was to investigate the impact of preoperative SARS-Cov2 infection on the postoperative outcome after debulking surgery for ovarian cancer. PATIENTS AND METHODS: Between June 2021 and September 2021, 12 patients with antecedents of COVID-19 infection and ovarian cancer were submitted to surgery at "Dr. I. Cantacuzino" Hospital, Bucharest, Romania. Their outcomes were compared to those reported in a similar group of patients submitted to surgery during the same period in the absence of COVID-19 infection. RESULTS: Although preoperative data showed no statistically significant differences between the two groups, intraoperative length and estimated blood loss were higher in the COVID-19 group and so were the postoperative complications, the most commonly encountered ones being reported by wound infection, postoperative hemoperitoneum and pneumonia. However, the differences did not reach statistical significance. CONCLUSION: Preoperative COVID-19 infection seems to slightly increase the risk of postoperative complications after debulking surgery for ovarian cancer.


Subject(s)
COVID-19 , Ovarian Neoplasms , Carcinoma, Ovarian Epithelial , Female , Humans , Ovarian Neoplasms/complications , Ovarian Neoplasms/surgery , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Period , RNA, Viral , Retrospective Studies , SARS-CoV-2
4.
Comput Math Methods Med ; 2022: 4820835, 2022.
Article in English | MEDLINE | ID: covidwho-1807692

ABSTRACT

Objective: To analyze the effect of an intelligent medical management platform combined with perioperative detailed nursing on cognitive ability, postoperative complications, and quality of life (QOL) of patients undergoing hysterectomy. Methods: The clinical data of 76 patients undergoing hysterectomy in our hospital from December 2019 to December 2021 were selected for the retrospective analysis, and the patients were divided into the experimental group (EG, n = 38, intelligent medical management platform+perioperative detailed nursing) and the routine group (RG, n = 38, routine nursing) according to their admission order, and the cognition of disease and QOL after intervention of patients in the two groups were evaluated by the self-proposed questionnaire on cognition of disease of our hospital and the MOS 36-item short-form health survey (SF-36). Results: After intervention, the scores on cognitive ability, various nursing items, and QOL were significantly higher in EG than in RG (P < 0.001), and during the study, the total incidence rate of complications was significantly lower in EG than in RG (P < 0.05). Conclusion: Combining an intelligent medical management platform with perioperative detailed nursing is a reliable method to improve QOL and reduce postoperative complications for patients undergoing hysterectomy. Further research will be conducive to providing a reliable perioperative intervention scheme for such patients.


Subject(s)
Hysterectomy , Quality of Life , Cognition , Female , Humans , Hysterectomy/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Retrospective Studies
5.
Int J Colorectal Dis ; 37(5): 1087-1095, 2022 May.
Article in English | MEDLINE | ID: covidwho-1787809

ABSTRACT

PURPOSE: Current studies have demonstrated conflicting results regarding surgical care for acute appendicitis during the COVID-19 pandemic. This study aimed to assess trends in diagnosis as well as treatment of acute appendicitis in the Netherlands during the first and second COVID-19 infection wave. METHODS: All consecutive patients that had an appendectomy for acute appendicitis in nine hospitals from January 2019 to December 2020 were included. The primary outcome was the number of appendectomies for acute appendicitis. Secondary outcomes included time between onset of symptoms and hospital admission, proportion of complex appendicitis, postoperative length of stay and postoperative infectious complications. Outcomes were compared between the pre-COVID group and COVID group. RESULTS: A total of 4401 patients were included. The mean weekly rate of appendectomies during the COVID period was 44.0, compared to 40.9 in the pre-COVID period. The proportion of patients with complex appendicitis and mean postoperative length of stay in days were similar in the pre-COVID and COVID group (respectively 35.5% vs 36.8%, p = 0.36 and 2.0 ± 2.2 vs 2.0 ± 2.6, p = 0.93). There were no differences in postoperative infectious complications. A computed tomography scan was used more frequently as a diagnostic tool after the onset of COVID-19 compared to pre-COVID (13.8% vs 9.8%, p < 0.001, respectively). CONCLUSION: No differences were observed in number of appendectomies, proportion of complex appendicitis, postoperative length of stay or postoperative infectious complications before and during the COVID-19 pandemic. A CT scan was used more frequently during the COVID-19 pandemic.


Subject(s)
Appendicitis , COVID-19 , Acute Disease , Appendectomy/adverse effects , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , COVID-19/epidemiology , Cohort Studies , Humans , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies
7.
J Am Coll Surg ; 234(2): 115-120, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1713820

ABSTRACT

BACKGROUND: Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US. STUDY DESIGN: This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE. RESULTS: A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months). CONCLUSIONS: LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.


Subject(s)
Liver Transplantation/statistics & numerical data , Living Donors/statistics & numerical data , Tissue and Organ Procurement/methods , ABO Blood-Group System , Adolescent , Adult , Aged , Blood Group Incompatibility , COVID-19/mortality , Cause of Death , Female , Humans , Kidney , Living Donors/supply & distribution , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Tissue and Organ Procurement/statistics & numerical data , Transplant Recipients/statistics & numerical data , Young Adult
8.
Transplantation ; 105(7): 1405-1422, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1706459

ABSTRACT

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus responsible for the coronavirus disease 2019 (COVID-19) pandemic has raised concerns for programs overseeing donation and transplantation of cells, tissues, and organs (CTO) that this virus might be transmissible by transfusion or transplantation. Transplant recipients are considered particularly vulnerable to pathogens because of immunosuppression, and SARS-CoV-2 is likely to generate complications if contracted. Several signs and symptoms observed in COVID-19 positive patients reflect damage to multiple organs and tissues, raising the possibility of extrapulmonary SARS-CoV-2 infections and risk of transmission. At the beginning of the pandemic, a consensus has emerged not to consider COVID-19 positive patients as potential living or deceased donors, resulting in a global decrease in transplantation procedures. Medical decision-making at the time of organ allocation must consider safely alongside the survival advantages offered by transplantation. To address the risk of transmission by transplantation, this review summarizes the published cases of transplantation of cells or organs from donors infected with SARS-CoV-2 until January 2021 and assesses the current state of knowledge for the detection of this virus in different biologic specimens, cells, tissues, and organs. Evidence collected to date raises the possibility of SARS-CoV-2 infection and replication in some CTO, which makes it impossible to exclude transmission through transplantation. However, most studies focused on evaluating transmission under laboratory conditions with inconsistent findings, rendering the comparison of results difficult. Improved standardization of donors and CTO screening practices, along with a systematic follow-up of transplant recipients could facilitate the assessment of SARS-CoV-2 transmission risk by transplantation.


Subject(s)
COVID-19/transmission , Donor Selection/methods , Hematopoietic Stem Cell Transplantation/adverse effects , Organ Transplantation/adverse effects , Postoperative Complications/etiology , SARS-CoV-2/isolation & purification , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/virology , Humans , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Risk
9.
Obes Surg ; 32(5): 1451-1458, 2022 05.
Article in English | MEDLINE | ID: covidwho-1681711

ABSTRACT

PURPOSE: To compare sleeve gastrectomy (SG) to SG associated with Rossetti fundoplication (SG + RF) in terms of de novo gastro-esophageal reflux disease (GERD) after surgery, weight loss, and postoperative complications. MATERIALS AND METHODS: Patients affected by morbid obesity, without symptoms of GERD, who were never in therapy with proton pump inhibitors (PPIs), were randomized into two groups. One group underwent SG and the other SG + RF. The study was stopped on February 2020 due to the COVID pandemic. RESULTS: A total of 278 patients of the programmed number of 404 patients were enrolled (68.8%). De novo esophagitis was considered in those patients who had both pre- and postoperative gastroscopy (97/278, 34.9%). Two hundred fifty-one patients (90.3%) had completed clinical follow-up at 12 months. SG + RF resulted in an adequate weight loss, similar to classic SG at 12-month follow-up (%TWL = 35. 4 ± 7.2%) with a significantly better outcome in terms of GERD development. One year after surgery, PPIs were necessary in 4.3% SG + RF patients compared to 17.1% SG patients (p = 0.001). Esophagitis was present in 2.0% of SG + RF patients versus 23.4% SG patients (p = 0.002). The main complication after SG + RF was wrap perforation (4.3%), which improved with the surgeon's learning curve. CONCLUSION: SG + RF seemed to be an effective alternative to classic SG in preventing de novo GERD. More studies are needed to establish that an adequate learning curve decreases the higher percentage of short-term complications in the SG + RF group.


Subject(s)
COVID-19 , Esophagitis , Gastroesophageal Reflux , Laparoscopy , Obesity, Morbid , Esophagitis/etiology , Fundoplication/adverse effects , Gastrectomy/adverse effects , Gastrectomy/methods , Gastroesophageal Reflux/diagnosis , Humans , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/etiology , Proton Pump Inhibitors/therapeutic use , Retrospective Studies , Treatment Outcome , Weight Loss
10.
BMC Musculoskelet Disord ; 23(1): 64, 2022 Jan 18.
Article in English | MEDLINE | ID: covidwho-1635553

ABSTRACT

BACKGROUND: A higher mortality and morbidity rate has been reported in COVID-19 patients undergoing surgery. To reduce the morbidity and mortality rate in COVID-19 patients undergoing orthopedic procedures, we aimed to increase the threshold for surgical planning. METHODS: In a prospective cohort study, COVID-19 patients who underwent elective or emergent orthopedic surgery in three orthopedic surgery centers from February 2020 to September 2020 were included. In this period, 6751 patients were scheduled for orthopedic surgery. To increase surgical threshold planning, all patients with grade 5 of the American Society of Anesthesiologists (ASA) classification and patients with COVID-19 related moderate to severe pulmonary involvement were identified as high-risk patients and were excluded. RESULTS: 35 deaths occurred during the study. The frequency of deaths was significantly higher in patients with COVID-19, 6 (9.4%) than patients without COVID-19, 29 (0. 43%). The average hospitalization stay was 12.8 ± 12.1 days. The odds ratio (OR) for death was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 8.13, Confidence interval 95% (CI95%) (5.02-11.25), P: 0.001]. Four (6.3%) COVID-19-associated complications were recorded in this series that all were respiratory failure requiring unexpected postoperative ventilation. Twenty surgical complications (31.3%) were recorded. The odds ratio for ICU admission was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 5.46, CI 95% (2.68-8.68), P: 0.001]. CONCLUSIONS: An increased threshold for orthopedic surgery is suggested for COVID-19 patients with a mortality rate of 9.3%, which is less than the mortality rate in other studies. Level of evidence III.


Subject(s)
COVID-19 , Orthopedic Procedures , Humans , Orthopedic Procedures/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2
11.
Exp Clin Transplant ; 19(10): 1099-1102, 2021 10.
Article in English | MEDLINE | ID: covidwho-1534489

ABSTRACT

Kidney transplant is the best therapeutic option for patients with end-stage kidney disease. However, kidney transplant is not exempt from postoperative complications. One of the most frequent urological complications is lymphocele, which can appearin up to 20% of patients. Lymphocele most often appears during the first month after surgery. However, its appearance after the first yearis completely infrequent. Here, we report a case of a giant idiopathic lymphocele 18 years after kidney transplant and its resolution with lymphatic embolization.The patient, a 34-year-old man who received a deceased-donor kidney transplant in 2002, had presented with no complications until the lymphocele was diagnosed. The lymphocele presented as a voluminous organ-compressing mass. A percutaneous drainage was placed, and 3600 cm3 of lymphatic fluidwere drained.Afterthat, 800 cm3 continued to leak every day. An intranodal lymphography and lymphatic embolization with Lipiodol Ultra-Fluide (Guerbet Australia) were performed, owing to the high amount of leakage. At 50 days after embolization, an ultrasonograph showed no fluid collections, so the percutaneous catheter was removed. In most patients, the treatment ofthe lymphocele after kidney transplant is frequently conservative. However,for patients whose situation cannot be resolved spontaneously, there are few therapeutic choices. As described here, intranodal lymphatic embolization is a mini-invasive option, with a success rate of up to 80%, and should be offered as the first approach.


Subject(s)
Kidney Transplantation , Lymphocele , Adult , Drainage/adverse effects , Ethiodized Oil , Humans , Kidney Transplantation/adverse effects , Lymphocele/diagnostic imaging , Lymphocele/etiology , Lymphocele/therapy , Male , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome
12.
J Surg Oncol ; 125(4): 564-569, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1525470

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic, with high rate of asymptomatic infections and increased perioperative complications, prompted widespread adoption of screening methods. We analyzed the incidence of asymptomatic infection and perioperative outcomes in patients undergoing cancer surgery. We also studied the impact on subsequent cancer treatment in those with COVID-19. METHODS: All patients who underwent elective and emergency cancer surgery from April to September 2020 were included. After screening for symptoms, a preoperative test was performed from nasopharyngeal and oropharyngeal swabs before the procedure. Patients were followed up for 30 days postoperatively and complications were noted. RESULTS: 2108 asymptomatic patients were tested, of which 200 (9.5%) tested positive. Of those who tested positive, 140 (70%) underwent the planned surgery at a median of 30 days from testing positive, and 20 (14.3%) had ≥ Grade III complications. Forty (20%) patients did not receive the intended treatment; 110 patients were retested in the Postoperative period, and 41 (37.3%) tested positive and 9(22%) patients died of COVID-related complications. CONCLUSION: Routine preoperative testing for COVID-19 helps to segregate patients with asymptomatic infection. Higher complications occur in those who develop COVID-19 in postoperative period. Prolonged delay in surgery after COVID infection may influence planned treatment.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19 Testing , COVID-19/epidemiology , Neoplasms/surgery , Postoperative Complications/etiology , Preoperative Care , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Incidence , India/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Neoplasms/complications , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Young Adult
13.
Rev. latinoam. enferm. (Online) ; 29: e3496, 2021. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1511860

ABSTRACT

Objective: to analyze the evidence available in the literature about postoperative complications in adult patients undergoing surgical procedures with confirmed infection by SARS-CoV-2. Method: an integrative literature review conducted in the CINAHL, EMBASE, LILACS, PubMed, Scopus and Web of Science databases, as well as in the gray literature. The references identified were exported to the EndNote manager and, subsequently, to the Rayyan web application for study selection. The stages of sampling, categorization of studies, evaluation of the studies included, interpretation of the results and knowledge synthesis were performed by two reviewers independently and in a masked manner. The data were analyzed descriptively. Results: of the 247 articles identified, 15 were selected to comprise this review. The prevalent postoperative complications in patients infected with SARS-CoV-2 were the following: cough, dyspnea and hypoxia, need for invasive mechanical ventilation or not, admission to the intensive care unit and death. Conclusion: the most reported postoperative complications in the studies evaluated were respiratory-related, followed by cardiovascular complications. The importance of preoperative screening for COVID-19 is highlighted, as well as of the monitoring and tracking of confirmed cases in the postoperative period, as these actions exert an impact on reducing the occurrence of complications related to SARS-CoV-2.


Objetivo: analizar la evidencia disponible en la literatura sobre las complicaciones postoperatorias en pacientes adultos sometidos a procedimientos quirúrgicos con infección confirmada por SARS-CoV-2. Método: revisión integradora de la literatura realizada en las bases de datos CINAHL, EMBASE, LILACS, PubMed, Scopus, Web of Science y literatura gris. Las referencias identificadas se exportaron al administrador EndNote y luego a la aplicación web Rayyan para la selección de estudios. Las etapas de muestreo, categorización de los estudios, evaluación de los estudios incluidos, interpretación de los resultados y síntesis del conocimiento fueron realizadas por dos revisores de forma independiente y enmascarada. Los datos se analizaron de forma descriptiva. Resultados: de los 247 artículos identificados, se seleccionaron 15 para componer esta revisión. Las complicaciones postoperatorias prevalentes en pacientes infectados por SARS-CoV-2 fueron: tos, disnea e hipoxia, necesidad de ventilación mecánica invasiva o no, ingreso en la unidad de terapia intensiva y muerte. Conclusión: las complicaciones postoperatorias más reportadas en los estudios evaluados fueron las respiratorias seguidas de las cardiovasculares. Se destaca la importancia del cribado preoperatorio de COVID-19, así como también del monitoreo y seguimiento de los casos confirmados en el postoperatorio, ya que son acciones que reducen la aparición de complicaciones relacionadas con el SARS-CoV-2.


Objetivo: analisar as evidências disponíveis na literatura sobre as complicações pós-operatórias em pacientes adultos submetidos a procedimentos cirúrgicos com infecção confirmada por SARS-CoV-2. Método: revisão integrativa da literatura realizada nas bases de dados CINAHL, EMBASE, LILACS, PubMed, Scopus, Web of Science e na literatura cinzenta. As referências identificadas foram exportadas para o gerenciador EndNote e, em seguida, para o aplicativo web Rayyan para a seleção dos estudos. As etapas de amostragem, categorização dos estudos, avaliação dos estudos incluídos, interpretação dos resultados e síntese do conhecimento foram realizadas por dois revisores de forma independente e mascarada. Os dados foram analisados de forma descritiva. Resultados: dos 247 artigos identificados, 15 foram selecionados para compor a presente revisão. As complicações pós-operatórias prevalentes em pacientes infectados com SARS-CoV-2 foram: tosse, dispneia e hipóxia, necessidade de ventilação mecânica invasiva ou não, internação em unidade de terapia intensiva e óbito. Conclusão: destacaram-se, como complicações pós-operatórias mais relatadas nos estudos avaliados, as respiratórias seguidas das cardiovasculares. Ressalta-se a importância da triagem pré-operatória para COVID-19, bem como de acompanhamento e rastreamento de casos confirmados no pós-operatório, por serem ações que impactam na redução da ocorrência de complicações relacionadas ao SARS-CoV-2.


Subject(s)
Humans , Adult , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Respiration, Artificial , Perioperative Nursing , Coronavirus Infections , SARS-CoV-2
14.
PLoS One ; 16(10): e0258963, 2021.
Article in English | MEDLINE | ID: covidwho-1496521

ABSTRACT

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) provokes early injury response, represented in part by dynamic changes in the inflammatory markers. The association of self-expanding valves (SEVs) and balloon-expandable valves (BEVs) with the consequent inflammatory response remains uncertain. MATERIALS AND METHODS: Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVI: SEVs or BEVs, from January 2010 to December 2019 were enrolled. Whole white blood cells (WBC) and subpopulation dynamics as well the neutrophil to lymphocyte ratio (NLR) were evaluated. RESULTS: Three-hundred seventy consecutive patients (mean age 81.75 ± 6.8 years, 199 women's) were enrolled. In the entire population, significant kinetic changes in the WBC response (p <0.0001) between admission and first 24 hours post procedure, with a significant increase in total WBC (7.46 ± 2.26 to 10.08 ± 3.55) and absolute neutrophil count (4.97 ± 2.06 to 8.19 ± 3.43), NL ratio (3.72 ± 2.8 to 9.76 ± 7.29), and a meaningful decrease in absolute lymphocytes count (1.67 ± 1.1 to 1.1 ± 0.76). When compared between the types of valves, SEVs were associated with a more pronounced inflammatory response than BEVs, with total WBC (10.44 ± 3.86 vs. 9.45 ± 3.19) neutrophils (8.56 ± 3.75 vs. 7.55 ± 3.06) with p 0.016 and 0.012 respectively. CONCLUSION: This is the first description of a differential inflammatory response between the two leading delivery systems. SEV appears to trigger a more robust inflammatory response as compared to BEV. Clinical studies are warranted to assess the long term effect of our findings.


Subject(s)
Aortic Valve Stenosis/surgery , Heart Valve Prosthesis , Inflammation/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Aortic Valve Stenosis/blood , Female , Humans , Inflammation/blood , Lymphocytes , Male , Neutrophils , Postoperative Complications/blood , Postoperative Complications/etiology , Treatment Outcome
15.
J Int Med Res ; 49(9): 3000605211043245, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1486544

ABSTRACT

OBJECTIVE: Pulmonary complication is common in older patients after surgery. We analyzed risk factors of lower respiratory tract infection after general anesthesia among older patients. METHODS: In this retrospective investigation, we included older patients who underwent surgery with general anesthesia. Logistic regression analyses were performed to determine risk factors of lower respiratory tract infection. RESULTS: A total 418 postoperative patients with general anesthesia were included; the incidence of lower respiratory tract infection was 9.33%. Ten cases were caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2 cases by fungus. We found significant differences in age, smoking, diabetes, oral/nasal tracheal intubation, and surgery duration. Logistic regression analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence interval [CI] 1.115-3.646), smoking (OR 2.314, 95% CI 1.073-4.229), diabetes (OR 2.185, 95% CI 1.166-4.435), nasotracheal intubation (OR 3.528, 95% CI 1.104-5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI 1.015-1.923) were independent risk factors of lower respiratory tract infections. CONCLUSIONS: Older patients undergoing general anesthesia after tracheal intubation have a high risk of lower respiratory tract infections. Clinical interventions should be provided to prevent pulmonary infections in patients with relevant risk factors.


Subject(s)
Anesthesia, General , Respiratory Tract Infections , Aged , Anesthesia, General/adverse effects , Humans , Intubation, Intratracheal , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/etiology , Retrospective Studies , Risk Factors
16.
Breast Cancer ; 29(2): 242-246, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1469776

ABSTRACT

PURPOSE: Elective operations including surgeries for breast cancer were significantly reduced during the height of the surge of COVID-19 cases in Massachusetts. The safety of performing breast reconstruction during the pandemic was unknown. This study aims to review the safety of performing mastectomy with immediate breast reconstruction during the first COVID-19 surge in Massachusetts. METHODS: A retrospective chart review of patients who underwent mastectomy with immediate breast reconstruction by Massachusetts General Hospital breast and plastic surgeons immediately preceding and during the COVID-19 pandemic was performed. RESULTS: Thirty patients (34 breasts) underwent mastectomies with immediate breast reconstruction during the COVID-19 restriction period in Massachusetts. Most reconstructions were unilateral. All reconstructions were performed with implants or expanders, and no autologous reconstructions were performed. Two patients (2 breasts) had operative complications. The complication rate during the pandemic was similar to the complication rate pre-pandemic. No patients or surgeons experienced symptoms or positive COVID-19 tests. Over 90% of patients were discharged the same day. CONCLUSION: Prosthetic breast reconstruction was able to be performed safely during the height of the COVID-19 pandemic surge in Massachusetts. Strict screening protocols, proper use of personal protective equipment, and same-day discharge when possible are essential for patient and surgeon safety during the pandemic.


Subject(s)
Breast Implants , Breast Neoplasms , COVID-19 , Mammaplasty , Breast Implants/adverse effects , Breast Neoplasms/complications , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Mammaplasty/adverse effects , Mammaplasty/methods , Mastectomy/adverse effects , Pandemics/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , SARS-CoV-2
17.
Sci Rep ; 10(1): 5189, 2020 03 23.
Article in English | MEDLINE | ID: covidwho-1454803

ABSTRACT

Stapled hemorrhoidopexy has a few advantages such as less postoperative pain and faster recovery compared with conventional hemorrhoidectomy. There are two major devices used for stapled hemorrhoidopexy, PPH stapler (Ethicon EndoSurgery) and DST stapler (Covidien). This study was conducted to investigate the postoperative outcomes among patients with grade III and IV hemorrhoids who underwent hemorrhoidopexy with either of these two devices. A total of 242 consecutive patients underwent stapled hemorrhoidopexy with either PPH stapler (110 patients) or DST stapler (132 patients) at a single center in 2017. We performed a retrospective case-control study to compare the short-term postoperative outcomes and the complications between these two groups. After matching the cases in terms of age, gender, and the grade of hemorrhoids, there were 100 patients in each group (PPH versus DST). There were no significant differences in the postoperative visual analog scale (VAS) score and analgesic usage. Among complications, the incidence of anorectal stricture was significantly higher in the DST group (p = 0.02). Evaluation of the mucosal specimen showed that the total surface area, the muscle/mucosa ratio and the surface area of the muscle were also significantly higher in the DST group (p = 0.03). Further analysis of the DST group demonstrated that patients with anorectal stricture after surgery are younger than patients without anorectal stricture, and higher muscle/mucosa ratio (p = 0.03) and a higher surface area of the muscle (p = 0.03) also measured in the surgical specimen. The two devices provide similar outcomes of postoperative recovery. Patients who underwent DST stapled hemorrhoidopexy had a higher incidence rate of stricture, larger area of muscle excision, and higher muscle/mucosa ratio in the surgical specimen. Further investigation is warranted for a better understanding of the correlation between muscle excision and anorectal stricture.


Subject(s)
Hemorrhoidectomy/instrumentation , Hemorrhoids/surgery , Surgical Staplers , Acetaminophen/therapeutic use , Anal Canal/pathology , Analgesics/therapeutic use , Anus Diseases/etiology , Constriction, Pathologic/etiology , Equipment Design , Female , Hemorrhage/etiology , Humans , Intestinal Mucosa/pathology , Isoxazoles/therapeutic use , Male , Middle Aged , Organ Size , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome , Urinary Retention/etiology
18.
J Minim Invasive Gynecol ; 27(6): 1256-1257, 2020.
Article in English | MEDLINE | ID: covidwho-1454310

ABSTRACT

STUDY OBJECTIVE: To demonstrate a surgical video wherein a robot-assisted colostomy takedown was performed with anastomosis of the descending colon to the rectum after reduction of ventral hernias and extensive lysis of adhesions. DESIGN: Case report and a step-by-step video demonstration of a robot-assisted colostomy takedown and end-to-side anastomosis. SETTING: Tertiary referral center in New Haven, Connecticut. A 64-year-old female was diagnosed with stage IIIA endometrioid endometrial adenocarcinoma in 2015 when she underwent an optimal cytoreductive surgery. In addition, she required resection of the sigmoid colon and a descending end colostomy with Hartmann's pouch, mainly secondary to extensive diverticulitis. After adjuvant chemoradiation, she remained disease free and desired colostomy reversal. Body mass index at the time was 32 kg/m2. Computed tomography of her abdomen and pelvis did not show any evidence of recurrence but was notable for a large ventral hernia and a parastomal hernia. She then underwent a colonoscopy, which was negative for any pathologic condition, except for some narrowing of the distal rectum above the level of the levator ani. INTERVENTIONS: Enterolysis was extensive and took approximately 2 hours. The splenic flexure of the colon had to be mobilized to provide an adequate proximal limb to the anastomosis site. An anvil was then introduced into the distal descending colon through the colostomy site. A robotic stapler was used to seal the colostomy site and detach it from the anterior abdominal wall. Unfortunately, the 28-mm EEA sizer (Covidien, Dublin, Ireland) perforated through the distal rectum, caudal to the stricture site. A substantial length of the distal rectum had to be sacrificed secondary to the perforation, which mandated further mobilization of the splenic flexure. The rectum was then reapproximated with a 3-0 barbed suture in 2 layers. This provided us with approximately 6- to 8-cm distal rectum. An end-to-side anastomosis of the descending colon to the distal rectum was performed. Anastomotic integrity was confirmed using the bubble test. Because of the lower colorectal anastomosis, a protective diverting loop ileostomy was performed. The patient had an uneventful postoperative course. A hypaque enema performed 3 months after the colostomy takedown showed no evidence of anastomotic leak or stricture. The ileostomy was then reversed without any complications. CONCLUSION: Robot-assisted colostomy takedown and anastomosis of the descending colon to rectum were successfully performed. Although there is a paucity of literature examining this technique within gynecologic surgery, the literature on general surgery has supported laparoscopic Hartmann's reversal and has demonstrated improved rates of postoperative complications and incisional hernia and reduced duration of hospitalization [1]. Minimally invasive technique is a feasible alternative to laparotomy for gynecologic oncology patients who undergo colostomy, as long as the patients are recurrence free.


Subject(s)
Colostomy/adverse effects , Hernia, Ventral/etiology , Hernia, Ventral/surgery , Robotic Surgical Procedures/methods , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Abdominal Wall/surgery , Anastomosis, Surgical/methods , Anastomotic Leak/surgery , Colon, Sigmoid/pathology , Colon, Sigmoid/surgery , Colonic Pouches/adverse effects , Colostomy/methods , Female , Humans , Laparoscopy/methods , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/surgery , Reconstructive Surgical Procedures/methods , Reoperation/methods , Severity of Illness Index
19.
Colorectal Dis ; 23(10): 2501-2514, 2021 10.
Article in English | MEDLINE | ID: covidwho-1455531

ABSTRACT

AIM: The objective of this systematic review was to investigate the outcomes of ileorectal anastomosis (IRA) in Crohn's disease and to clarify whether there are any time-related trends in outcome measures. The primary outcomes are risk of anastomotic leakage, death, clinical recurrence and subsequent diverting or permanent stoma and/or proctectomy. Secondary end-points are quality of life and functional outcome. METHODS: Systematic searches were conducted using the Cochrane Library, Embase and MEDLINE. The complete search strategy is uploaded online at http://www.crd.york.ac.uk/prospero/. Human studies in English with over five subjects were included and no limit was set regarding the date of publication. All relevant studies were screened by two reviewers. The web-based software platform www.covidence.org was used for primary screening of the title, abstract, full-text review and data extraction. RESULTS: The search identified 2231 unique articles. After the screening process, 37 remained. Key results were an overall anastomotic leak rate of 6.4%; cumulative rates of clinical recurrence of 43% and 67% at 5 and 10 years, respectively; an overall rate of proctectomy of 18.9%; and subsequent ileostomy required in 18.8%. Only one study presented useful data on quality of life. Recurrence rates remained stable over time. A small decline in the anastomotic leak rate was found. CONCLUSIONS: Only minor improvements in the outcomes of IRA in patients with Crohn´s disease have occurred during the past 50 years regarding anastomotic leakage and recurrence, except for a slight increase in the rate of a functioning IRA. These results call for implementation guidelines in patient selection for IRA and postoperative medical treatment and follow-up.


Subject(s)
Crohn Disease , Anastomosis, Surgical/adverse effects , Colectomy , Crohn Disease/surgery , Humans , Ileum/surgery , Neoplasm Recurrence, Local , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Quality of Life , Rectum/surgery , Retrospective Studies
20.
Cochrane Database Syst Rev ; 4: CD000479, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1453523

ABSTRACT

BACKGROUND: Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist, including surgical or radiological treatment, however the safest and most efficient treatment remains unclear.  OBJECTIVES: To evaluate the effectiveness and safety of surgical and radiological treatment of varicoceles on live birth rate, adverse events, pregnancy rate, varicocele recurrence, and quality of life amongst couples where the adult male has a varicocele, and the female partner of childbearing age has no fertility problems. SEARCH METHODS: We searched the following databases on 4 April 2020: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries and reference lists of articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) if they were relevant to the clinical question posed and compared different forms of surgical ligation, different forms of radiological treatments, surgical treatment compared to radiological treatment, or one of these aforementioned treatment forms compared to non-surgical methods, delayed treatment, or no treatment. We extracted data if the studies reported on live birth, adverse events, pregnancy, varicocele recurrence, and quality of life. DATA COLLECTION AND ANALYSIS: Screening of abstracts and full-text publications, alongside data extraction and 'Risk of bias' assessment, were done dually using the Covidence software. When we had sufficient data, we calculated random-effects (Mantel-Haenszel) meta-analyses; otherwise, we reported results narratively. We used the I2 statistic to analyse statistical heterogeneity. We planned to use funnel plots to assess publication bias in meta-analyses with at least 10 included studies. We dually rated the risk of bias of studies using the Cochrane 'Risk of bias' tool, and the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: We identified 1897 citations after de-duplicating the search results. We excluded 1773 during title and abstract screening. From the 113 new full texts assessed in addition to the 10 studies (11 references) included in the previous version of this review, we included 38 new studies, resulting in a total of 48 studies (59 references) in the review providing data for 5384 participants. Two studies (three references) are ongoing studies and two studies are awaiting classification. Treatment versus non-surgical, non-radiological, delayed, or no treatment Two studies comparing surgical or radiological treatment versus no treatment reported on live birth with differing directions of effect. As a result, we are uncertain whether surgical or radiological treatment improves live birth rates when compared to no treatment (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.19 to 26.93; 2 RCTs, N = 204; I2 = 74%, very low-certainty evidence). Treatment may improve pregnancy rates compared to delayed or no treatment (RR 1.55, 95% CI 1.06 to 2.26; 13 RCTs, N = 1193; I2 = 65%, low-certainty evidence). This suggests that couples with no or delayed treatment have a 21% chance of pregnancy, whilst the pregnancy rate after surgical or radiological treatment is between 22% and 48%. We identified no evidence on adverse events, varicocele recurrence, or quality of life for this comparison. Surgical versus radiological treatment We are uncertain about the effect of surgical versus radiological treatment on live birth and on the following adverse events: hydrocele formation, pain, epididymitis, haematoma, and suture granuloma. We are uncertain about the effect of surgical versus radiological treatment on pregnancy rate (RR 1.13, 95% CI 0.75 to 1.70; 5 RCTs, N = 456, low-certainty evidence) and varicocele recurrence (RR 1.31, 95% CI 0.82 to 2.08; 3 RCTs, N = 380, low-certainty evidence). We identified no evidence on quality of life for this comparison. Surgery versus other surgical treatment We identified 19 studies comparing microscopic subinguinal surgical treatment to any other surgical treatment. Microscopic subinguinal surgical treatment probably improves pregnancy rates slightly compared to other surgical treatments (RR 1.18, 95% CI 1.02 to 1.36; 12 RCTs, N = 1473, moderate-certainty evidence). This suggests that couples with microscopic subinguinal surgical treatment have a 10% to 14% chance of pregnancy after treatment, whilst the pregnancy rate in couples after other surgical treatments is 10%. This procedure also probably reduces the risk of varicocele recurrence (RR 0.48, 95% CI 0.29, 0.79; 14 RCTs, N = 1565, moderate-certainty evidence). This suggests that 0.4% to 1.1% of men undergoing microscopic subinguinal surgical treatment experience recurrent varicocele, whilst 1.4% of men undergoing other surgical treatments do. Results for the following adverse events were inconclusive: hydrocele formation, haematoma, abdominal distension, testicular atrophy, wound infection, scrotal pain, and oedema. We identified no evidence on live birth or quality of life for this comparison. Nine studies compared open inguinal surgical treatment to retroperitoneal surgical treatment. Due to small sample sizes and methodological limitations, we identified neither treatment type as superior or inferior to the other regarding adverse events, pregnancy rates, or varicocele recurrence. We identified no evidence on live birth or quality of life for this comparison. Radiological versus other radiological treatment One study compared two types of radiological treatment (sclerotherapy versus embolisation) and reported 13% varicocele recurrence in both groups. Due to the broad confidence interval, no valid conclusion could be drawn (RR 1.00, 95% CI 0.16 to 6.20; 1 RCT, N = 30, very low-certainty evidence). We identified no evidence on live birth, adverse events, pregnancy, or quality of life for this comparison. AUTHORS' CONCLUSIONS: Based on the limited evidence, it remains uncertain whether any treatment (surgical or radiological) compared to no treatment in subfertile men may be of benefit on live birth rates; however, treatment may improve the chances for pregnancy. The evidence was also insufficient to determine whether surgical treatment was superior to radiological treatment. However, microscopic subinguinal surgical treatment probably improves pregnancy rates and reduces the risk of varicocele recurrence compared to other surgical treatments. High-quality, head-to-head comparative RCTs focusing on live birth rate and also assessing adverse events and quality of life are warranted.


Subject(s)
Embolization, Therapeutic , Infertility, Male/therapy , Sclerotherapy/methods , Varicocele/therapy , Bias , Confidence Intervals , Embolization, Therapeutic/adverse effects , Female , Humans , Infertility, Male/etiology , Infertility, Male/surgery , Live Birth , Male , Outcome Assessment, Health Care , Postoperative Complications/etiology , Pregnancy , Pregnancy Rate , Randomized Controlled Trials as Topic , Recurrence , Sclerotherapy/adverse effects , Sperm Count , Testicular Hydrocele/etiology , Varicocele/complications , Varicocele/surgery
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