Multiple factors affecting perioperative antibiotherapy in minimally invasive lung surgery: a retrospective case-control study.

Background: During the perioperative period, empiric antibiotic escalation therapy is not uncommon, leading to longer postoperative hospital stay and higher medical expenses. However, few systematic studies have investigated this issue. In this case-control study, we explored the factors affecting empiric antibiotic escalation therapy after minimally invasive lung surgery during hospitalization, with the aim to enhance recovery after surgery and rational use of antibiotics. Methods: The data of patients who underwent minimally invasive lung surgery at our center from January 2019 to December 2020 were collected from the hospital information system (HIS). A total of 1,360 cases were identified based on the inclusion and exclusion criteria. These patients were divided into 2 groups: group A (n=825), in which patients did not receive antibiotic escalation therapy after surgery; and group B (n=535), in which patients received empiric antibiotic escalation therapy after surgery. A logistic regression model was used to analyze the influencing factors of empiric antibiotherapy escalation during postoperative hospitalization. Results: Compared with group A, group B had significantly longer postoperative hospital stay (5.05±2.78 vs. 4.49±2.24 days, P<0.001) and slightly higher average total hospitalization costs (74,080.85±23,796.51 vs. 71,798.09±21,307.26 yuan, P=0.067). Multivariate analysis showed that the statistically significant factors included history of secondary lung surgery [odds ratio (OR): 3.267; 95% confidence interval (CI): 1.305-8.178; P=0.011], preoperative hemoglobin A1c (HbA1c) ≥6.5% (OR: 1.603; 95% CI: 1.143-2.249; P=0.006), postoperative fever of unknown origin [temperature (T) >38 ℃; OR: 2.494; 95% CI: 1.321-4.708; P=0.005], postoperative hypoalbuminemia (intravenous albumin administration for ≥2 days; OR: 14.125; 95% CI: 1.777-112.282; P=0.012). Conclusions: Multivariate analysis showed that history of secondary lung surgery, preoperative HbA1c ≥6.5%, postoperative fever of unknown origin (T >38 ℃), and postoperative hypoalbuminemia (<35 g/L and intravenous albumin administration ≥2 days) were the independent risk factors for empiric antibiotic escalation therapy after minimally invasive lung surgery. For preoperative risk factors, further cohort studies should be conducted to explore better intervention indicators or measures. For postoperative risk factors, perioperative dynamic monitoring of procalcitonin can guide the rational use of antibiotics, reduce the risk of drug resistance and hospitalization cost.

Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior?

BACKGROUND: Surgical site infection (SSI) in thoracic surgery remains a significant cause of morbidity and prolonged hospitalization. Minimally invasive surgery (MIS) has significantly reduced the risk of SSI. We intended to compare whether there was difference between video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) in SSI and highlight possible factors influencing SSI in lobectomy. METHODS: This retrospective study analyzed patients who underwent minimally invasive lobectomy from January 2018 to December 2019. All patients' clinical characteristics and surgery-related information which may be related to the likelihood of SSI were recorded. RESULTS: A total of 1231 patients' records were reviewed with 806 VATS and 425 RATS. SSI was classified as deep or superficial SSI. Eighty-six (7.0%) patients were found to develop an SSI with 62 patients having deep infections and 24 had superficial infection. No statistical difference in the incidence rate and category of SSI was observed between patients undergoing VATS and RATS. CONCLUSIONS: There was no difference in the incidence of SSI between VATS and RATS lobectomy. Male gender, heavy smoking, uncontrolled diabetes mellitus, body mass index (BMI) > 27.9, more blood loss, and the higher National Healthcare Safety Network (NHSN) risk index score (1 or 2) were the independent risk factors of SSI following minimally invasive lobectomy, while male gender, uncontrolled diabetes mellitus, BMI > 27.9, more blood loss and the higher NHSN risk index score (1 or 2) were the main predictors of deep SSI.

Anisodamine Ameliorates Hyperkalemia during Crush Syndrome through Estradiol-Induced Enhancement of Insulin Sensitivity.

Hyperkalemia is a major cause of on-site death in crush syndrome (CS), which is more severe and common in male victims. Anisodamine is a belladonna alkaloid and widely used in China for treatment of shock through activation of α7 nicotinic acetylcholine receptor (α7nAChR). The present work was designed to study the protective effect of anisodamine in CS and the possible role of estradiol involved. Male and ovariectomized female CS mice exhibited lower serum estradiol and insulin sensitivity, and higher potassium compared to the relative female controls at 6 h after decompression. There was no gender difference in on-site mortality in CS mice within 24 h after decompression. Serum estradiol increased with similar values in CS mice of both gender compared to that in normal mice. Anisodamine decreased serum potassium and increased serum estradiol and insulin sensitivity in CS mice, and methyllycaconitine, selective antagonist of α7nAChR, counteracted such effects of anisodamine. Treatment with anisodamine or estradiol increased serum estradiol and insulin sensitivity, decreased serum potassium and on-site mortality, and eliminated the difference in these parameters between CS mice received ovariectomy or its sham operation. Anisodamine could also increase blood pressure in CS rats within 3.5 h after decompression, which could also be attenuated by methyllycaconitine, without influences on heart rate. These results suggest that activation of α7nAChR with anisodamine could decrease serum potassium and on-site mortality in CS through estradiol-induced enhancement of insulin sensitivity.