Risk factors for incisional complications after lumbar internal fixation via posterior midline approach: A case-control study of 455 consecutive cases.

To analyse the clinical data of patients who developed incisional complications and those who did not develop incisional complications after lumbar internal fixation, and investigate the risk factors for incisional complications in patients after lumbar internal fixation with posterior midline incision. A standardised data collection form was used to collect the clinical data of patients who were admitted and underwent lumbar internal fixation in our hospital from July 2018 to July 2021. Patients who experienced any one of the incisional complications, such as incision exudates, swelling, blisters, bruising, superficial/deep incisional infections, poor healing and scarring, after surgery were included in the incisional complication group, and patients who did not develop the above-mentioned incisional complications were included in the control group. Univariate logistic regression analysis was first performed to identify potential risk factors, significant factors from univariate analysis were then included in multivariable logistic regression analysis to identify independent risk factors for incisional complications after lumbar spine surgery. Among 455 patients included in the study, postoperative incision complications occurred in 82 patients, with an incidence rate of 18.02%. Multivariate regression analysis identified seven independent risk factors for incisional complications: age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time and local anaesthetic infiltration at the incision site after surgery. Our findings documented that age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time, and postoperative local anaesthetic infiltration at the incision site were risk factors for incisional complications after lumbar internal fixation with posterior median incision. Awareness of these risk factors can enable surgeons to develop a more appropriate perioperative management plan for patients undergoing lumbar internal fixation, thus helping them recover faster.

Prevention and Treatment of Postoperative Complications in Equines / Prevención y tratamiento de complicaciones postoperatorias en equinos / Prevenção e tratamento de complicações pós-operatórias em equinos

Abstract Colic surgery is one of the most expensive procedures in equine clinics throughout the world. Although costs of surgery and anesthesia can be standardized to some extent, the cost of aftercare is less predictable. It can be altered considerably by the development of complications, such as surgical site infection, postoperative ileus, and formation of post-operative hernias, among others. Colic surgery places enormous demands on personnel, time, and resources. Nevertheless, it is a life-saving procedure. Complications increase cost through prolonged nursing care, technician salaries, extended treatment with antibiotics and other drugs, repeated laboratory analysis, and high-volume fluid therapy. Additional surgery, such as repeat celiotomy or repair of incisional complications, increases the costs considerably. Because none of these can be anticipated in most cases, a critical part of case management is a complete evaluation of expected and probable unexpected costs for the owner.

Resumen La cirugía de cólicos es uno de los procedimientos más costosos en la clínica de equinos en todo el mundo. Aunque los costos de la cirugía y la anestesia se pueden estandarizar hasta cierta medida, el costo de cuidado posterior es menos predecible y se puede alterar considerablemente mediante el desarrollo de complicaciones, tales como infección del sitio quirúrgico, ileus postoperatorio y formación de hernias postoperatorias, entre otros. La cirugía de cólicos le trae exigencias enormes al personal y requiere tiempo y recursos. Sin embargo, es un procedimiento que salva vidas. Las complicaciones aumentan el costo debido a que el cuidado de enfermería se prolonga, hay que pagar salarios a los técnicos, se amplía el tratamiento con antibióticos y otros medicamentos, hay que repetir análisis de laboratorio y se requiere terapia de fluidos con altos volúmenes. La cirugía adicional, como una celiotomía repetida o reparación de las complicaciones incisionales, aumenta los costos considerablemente. Como ninguno en la mayoría de los casos no se puede prever ninguna de estas cosas, una parte crítica del manejo de casos es la evaluación completa de los costos esperados y los probables no-esperados que cubrirá el propietario.

Resumo A cirurgia de cólica é um dos mais custosos procedimentos clínicas equinas ao redor do mundo. No entanto, os custos de cirurgia e anestesia possam ser padronizados até certo ponto, o custo dos cuidados posteriores é menos previsível e pode se alterar consideravelmente a causa de complicações, tais como infecção do local cirúrgico, íleo pós-operatório e formação de hérnias pós-operatórias, entre outras. A cirurgia de cólica impõe uma enorme demanda de pessoal, tempo e recursos, toda vez que é um procedimento que salva vidas. As complicações aumentam o custo por meio de cuidados prolongados de enfermagem, salários dos técnicos, tratamento prolongado com antibióticos e outros medicamentos, análises laboratoriais repetidas e fluidoterapia de alto volume. Cirurgias adicionais, como repetição de celiotomia ou reparo de complicações incisionais, aumentam consideravelmente os custos. Como nada disso pode ser previsto na maioria dos casos, uma parte crítica do gerenciamento de casos é a avaliação completa dos custos esperados e prováveis inesperados para o proprietário.

Preliminary evaluation of a hydrogel liquid bandage in 30 dogs undergoing tibial plateau levelling osteotomy surgery.

AIMS: To compare the prevalence of minor incisional complications in canine patients undergoing tibial plateau levelling osteotomy (TPLO) surgery that had a hydrogel liquid bandage (HLB) applied to their incision, with patients that had a light adhesive bandage applied. METHODS: Thirty dogs undergoing TPLO surgery were randomly assigned to either application of a light adhesive bandage to the incision, with removal 18-24 hours later, or application of a clear-drying polyethylene glycol HLB to the incision. Erythema, swelling, discharge, and dehiscence were assessed 1 day (Day 1) and 10-14 days (Days 10-14) postoperatively. All persons completing the assessment were blinded to the treatment. Outcomes were compared for the two groups using Fisher's Exact Test. RESULTS: On both Day 1 and Days 10-14, the distribution of dogs with erthemyma or swelling did not differ between the two groups (p≥0.4). The prevalence of erythema was the same in the bandage and HLB groups at Day 1 (11/15; 73%) and was similar at Days 10-14 (3/11 (27%) and 2/11 (18%), respectively). Prevalence of swelling was also the same in the two groups on Day 1 (11/15; 73%) and was similar at Days 10-14 (3/11 (27%) and 6/11 (55%), respectively). On Day 1, 2/15 (13%) dogs in the HLB group and none of the dogs in the bandage group had incisional discharge (p=0.483). No dogs were observed with discharge on Days 10-14. No dehiscence, infection, or any other major incisional complication was observed in either group at any point in the study. CONCLUSIONS: Preliminary results suggest that prevalence of minor incisional complications after TPLO surgery treated with HLB or with a traditional adhesive bandage may be comparable. No major adverse effects were seen with the use of HLB. CLINICIAL RELEVANCE: Due to several disadvantages of traditional bandaging, which can require post-operative maintenance and removal, lasts only a short time, and be painful when removed, an alternative with fewer drawbacks is desirable. HLB may present such an alternative.

Lack of association between arterial oxygen tensions in horses during exploratory coeliotomy and post-operative incisional complications: A retrospective study.

The aim of this retrospective study was to determine if there was an association between the lowest arterial blood oxygen tensions (PaO2) measured during anaesthesia and post-operative incisional complications in horses. Clinical records of 278 horses undergoing ventral midline coeliotomy from 1 January 2010 to 31 December 2013 were examined. The frequency of incisional complications was 32.0% (n = 89). In a multivariable model, intra-operative arterial blood oxygen tensions (PaO2) were not significantly associated with development of an incisional complication (P = 0.351). Using hypertonic (7.2%) saline (P = 0.028, OR 3.167, 95% CI 1.132-8.861), increasing total plasma protein concentration (TP) (P = 0.002, OR 1.061 per g/L, 95% CI 1.021-1.102), an intestinal resection (P <0.001, OR 4.056, 95% CI 2.231-9.323), increasing body mass (P = 0.004, OR 1.004 per kg, 95% CI 1.001-1.006) and the use of penicillin alone compared with penicillin and gentamicin pre-operatively (P = 0.009, OR 4.145, 95% CI 1.568-10.958) increased the risk of incisional complications. The study was unable to demonstrate a link between low intra-operative PaO2 and increased risk of post-operative incisional complications.

Avaliação física e ultrassonográfica da cicatriz em 12 equinos submetidos à celiotomia mediana com fio de poliéster para tratamento de cólica / Physical and ultrasonographic assessment of scar from celiorrhaphy with polyester thread in horses undergoing treatment of acute abdominal colic / Evaluación física y ecografia de cicatriz en 12 equinos sometidos a celiotomia mediana con hilo de poliéster para tratamiento del cólico

Foi realizado um levantamento das complicações incisionais em 12 equinos submetidos à celiotomia mediana seguida de celiorrafia com fio de poliéster. Os animais foram submetidos a exame clínico e complementar. O exame clínico consistiu na inspeção e palpação da linha média. O método de exame complementar foi a ultrassonografia da linha media na área referente à cicatriz abdominal. Foram encontrados complicações incisionais em sete animais (58,3%). As complicações incisionais encontradas foram fibrose (41,6%), reação ao fio de sutura (41,6%), fístulas (16,6%), edema peri-incisional (25%), infecção incisional (16,6%), drenagem incisional (16,6%). No exame indireto foi observado edema pós-operatório, pequenas áreas focais de líquido ao redor do fio de sutura. Mesmo com as complicações incisionais encontradas e o número de animais examinados, o fio de poliéster mostrou-se resistente e seguro podendo ser utilizado na laparorrafia mediana em equinos.

A survey on the incisional complications in twelve horses submitted to median celiotomy followed with celiorrhaphy with polyester suture was performed. The animals were submitted to clinical and complementary examination. Inspection and palpation of the midline for clinical evaluation was performed. Ultrasonography of the abdominal scar of the midline area was used as an indirect test. Seven animals presented incisional complications (58.3%), such as fibrosis (41.6%), suture material reaction (41.6%), fistulas (16.6%), peri-incisional edema (25%), wound infection (16.6%), and incisional drainage (16.6%). In indirect evaluation, post-operative edema was observed, as well as small focal areas with fluid around the suture. Despite the incisional complications found and the small number of animals examined, it was concluded that polyester suture proved to be resilient and safe, and can be used in median celiorrhaphy in horses.

Una encuesta sobre las complicaciones incisionales en 12 equinos sujetados a una celiotomía mediana seguida de una celiorrafia con hilo de poliéster. Los animales fueron sometidos a exámenes clínicos y complementarios. El examen clínico incluyó la inspección y palpación de la línea mediana. Otro método evaluativo fue la ecografía de la línea media en la zona referente a la cicatriz abdominal. Complicaciones incisionales fueron encontradas en siete animales (58,3%). Las complicaciones incisionales encontradas fueron fibrosis (41,6%), reacción al hilo de sutura (41,6%), fístulas (16,6%), edema perincisional (25%), infecciones incisionales (16,6%) y drenaje incisional (16,6%). En el examen indirecto se ha observado edema postoperatorio, pequeñas áreas focales de líquido alrededor del hilo de sutura. A pesar de las complicaciones incisionales encontradas y el número de animales examinados, el hilo de poliéster demostró resistencia, seguridad y puede ser utilizado en celiorrafia mediana en equinos.