ABSTRACT
Breast reconstruction (BR) is a unique surgical procedure that provides patients undergoing mastectomy with significant psychosocial and aesthetic benefits and has also become a crucial part of the treatment pathway for women with breast cancer. Due to methodological inadequacies and the absence of substantial risk factor analysis, no conclusion can be drawn about the correlation between risk variables and post-surgical complications in BR surgery. We aim to identify the potential risk factors associated with postoperative complications. Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to March 2022, for published randomized controlled trials and observational studies that assessed complications post-reconstruction procedure in breast cancer patients following mastectomy or evaluated at least one of the following outcomes of major or reoperative complications. The results from the studies were presented as odds ratios with 95% confidence intervals and were pooled using a random-effects model. Results: Our pooled analysis demonstrated a significant correlation with BR postoperative complications and risk factors such as diabetes, hypertension, and obesity. Diabetes and the development of seroma were found to have a significant relationship. Risk variables such as age, radiotherapy, COPD, and smoking had no significant connection with 0-to-30-day readmission and 30-to-90-day readmission. Conclusion: This meta-analysis shows that risk factors like age, smoking history, high blood pressure, and body mass index (BMI) have a big effect on complications after BR, and patients with risk factors have a high rate of developing infection.
ABSTRACT
INTRODUCTION: Acute kidney injury (AKI) is a term used to describe when the kidney loses its function rapidly. And it's associated with an increase in the level of serum creatinine by 0.5 to 1mg/dL. It can be diagnosed by a plethora of criteria such as the Kidney Disease Improving Global Outcomes (KDIGO) and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Cardiac surgery-associated AKI (CSA-AKI) is the most prevalent complication in patients following cardiac surgery and is also linked to increased mortality and morbidity rates. In addition, exogenous and endogenous toxins, ischemia and reperfusion, inflammation, oxidative stress, metabolic factors, and neurohormonal activation may all play a role in the development of CSA-AKI. All these factors may be active at varying time intervals and with different degrees of intensity, or may function simultaneously. Methods: In late 2019, a retrospective study was conducted by reviewing the health data of patients who underwent coronary artery bypass graft (CABG), valvular repairs, and other open cardiac surgeries at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between November 2014 and June 2019. Information was obtained from the Hospital information system, Jeddah, Saudi Arabia. Of the 159 patients who underwent open-heart surgery at KAUH, 126 (79.2%) were male and 33 (20.8%) were female. Patients below 15 years of age and those with poor renal function prior to open cardiac surgery were excluded. The KDIGO criteria were used to diagnose AKI for our patients. RESULTS: In this study, 34% of the patients experienced AKI after open cardiac surgery, and the most frequent risk factor encountered was diabetes mellitus (DM), which was present in 97 (61%) patients, followed by angina pectoris in 93 (58.5%) patients. Hypertension was identified in 85 (53.5%) and acute myocardial infarction in 82 (51.6%) patients. There were only two (1.3%) patients with known cases of chronic obstructive lung disease (COPD). Of the surgeries, 131 (82.4%) were classified as elective and 28 (17.6%) were urgent. CONCLUSION: The most common risk factor associated with AKI following open-heart surgery is DM, followed by angina pectoris. However, further studies are required to investigate all the cardiac procedures.
ABSTRACT
Objectives This study aimed to measure the incidence and record the relations between risk factors of postoperative pneumonia (POP) among patients who underwent open heart surgery in a single hospital in Saudi Arabia. Methods This retrospective cohort study was conducted in June 2019 at King Abdulaziz University hospital in Saudi Arabia. Data including general information, comorbidities, lab investigations, preoperative risk factors, intraoperative considerations, and postoperative elements were collected and analyzed. Results A total of 255 cardiac surgeries were performed from November 2014 to June 2019. Two hundred of the 255 cardiac surgeries were analyzed as open-heart surgeries. Only five patients were diagnosed with POP after open heart surgery with an incidence of 2.5%. The mean age of these patients was 47±18 years, more than half of them were smokers, three were hypertensive, four were classified as ASA 4, and three underwent the operation electively. The mean bypass time was 100.3 ± 24.5 min, the mean duration of operation was 199 ± 86.2 min, the mean postoperative intensive care unit (ICU) stay was 97.4 ± 83.4 hours, and the mean overall hospital stay was 10.4 ± 7.2 days. We observed significant differences in only the following correlations: amount of blood transfusion with ICU stay and with the overall hospital stay. Conclusion The incidence of developing postoperative pneumonia in patients undergoing open heart surgery in the King Abdulaziz University hospital from November 2014 to June 2019 was 2.5%, indicating a high-quality level of surgical technique and proper infection control.
ABSTRACT
BACKGROUND: Recent studies suggest a higher risk of adverse cardiovascular outcome and mortality in patients co-prescribed clopidogrel with proton pump inhibitors (PPI). OBJECTIVE: Investigate the impact of concomitant prescription of clopidogrel and PPI on 30-day unplanned readmission and one-year all-cause mortality. DESIGN: Retrospective longitudinal cohort study. SETTING: Single academic tertiary center. PATIENTS AND METHODS: The study included patients admitted with a diagnosis of ischemic or hemorrhagic stroke between 2010 and 2014. Demographic and outcome data were collected and compared for patients on clopidogrel plus PPI vs those on clopidogrel plus H2blockers and those not on clopidogrel. MAIN OUTCOME MEASURES: One-year mortality and 30-day unplanned readmissions were compared among different patient groups using multivariable logistic regression modeling. SAMPLE SIZE: 464 patients. RESULTS: Out of 464 patients, 175 (37.7%) were discharged on clopidogrel. The concomitant prescription of clopidogrel and PPI was noted in 107 (24.4%) and clopidogrel and H2 blockers in 36 patients (7.8%). The one-year all-cause mortality in the entire cohort was 22.2%. Patients on clopidogrel plus PPI did not have a higher risk of one-year mortality compared to the non-PPI cohort (6.2% vs. 4.8%, p 0.7). There was a non-significant suggestion of lower one-year mortality in patients on clopidogrel plus PPI vs those not on clopidogrel (6.2% vs. 10.1%, p 0.23). In multivariable logistic regression, the use of clopidogrel plus PPI did not predict higher one-year mortality (odds ratio 0.6, P=0.6). The risk of unplanned 30-day readmission was lower in those with clop-idogrel plus PPI (odds ratio 0.6, P=.03). CONCLUSION: The use of clopidogrel plus PPI resulted in lower readmission rates and was not associated with higher mortality compared with the non-PPI cohorts. LIMITATIONS: Single center study, not generalizable. Given the retrospective nature of this study, we did not collect data on duration of treatments or patient compliance. CONFLICT OF INTEREST: None.
