BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine lea...BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.展开更多
To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hyp...To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.展开更多
BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear.AIM To systematically evaluate the effects of electrical stimulation on gastro...BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear.AIM To systematically evaluate the effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery.METHODS The Cochrane Library,Web of Science,PubMed,ProQuest,and the Chinese bio-medical literature databases Wanfang,Weipu,and CNKI were used to search for relevant studies on controlled trials of electrical stimulation in gynecological abdominal surgery patients from self-established databases to May 2024.The RevMan software(version 5.3)was used to analyze the included literature and explore the heterogeneity of each study.RESULTS Seven controlled trials,involving 520 patients,were included.The results of meta-analysis showed that electrical stimulation could shorten the recovery time of intestinal sound after gynecological abdominal surgery[odds ratio(OR):-5.11,95%CI:-5.84 to-4.38,P<0.00001]and improve the time of first anal exhaust(OR:-1.19,95%CI:-1.38 to-0.99,P<0.00001),improved the time of first anal defecation(OR:-0.98,95%CI:-1.19 to-0.78,P<0.00001),The difference is significant.According to the funnel plot,if the scatter is symmetrical,it indicates that the funnel plot is unbiased.CONCLUSION Electrical stimulation can shorten this reduces the length of time it takes for the patient to recover from bowel sounds and also affects the time to first anal voiding and defecation to some extent,thereby promoting gas-trointestinal function recovery after gynecological abdominal surgery.The quality of the studies included in this review was poor,which may have affected the final results.It is necessary to conduct a randomized controlled study with higher quality and more samples to further confirm the promoting effect of electrical stimulation on gastrointestinal function recovery to guide clinical treatment.展开更多
Background: Oxygen saturation refers to the quantity of oxygenated hemoglobin in the blood, that is to say the level of oxygen measurable in the red blood cells when they have passed through the lungs. The aim of this...Background: Oxygen saturation refers to the quantity of oxygenated hemoglobin in the blood, that is to say the level of oxygen measurable in the red blood cells when they have passed through the lungs. The aim of this study was to describe the management of early postoperative hypoxemia after abdominal surgery at the Yaounde General Hospital (YGH). Method: This is a quantitative, observational study, with a descriptive aim, which took place in the anesthesiology department of the YGH, over a period of 2 months from August 1st to October 1st, 2023. The study included all the patients ≥18 years, of both sexes who had abdominal surgery under general anesthesia and were willing to participate during the time of data collection. The variables studied were the sociodemographic and clinical characteristics, risk factors for oxygen desaturation, postoperative variations in SPO2 and therapeutic tools. Results: We collected 30 patients among whom 11 presented with early postoperative hypoxemia i.e. a frequency of 36.7%. The age of the patients ranged from 18 to 63 years and the mean was 42.47 ± 13.5 years on average. The sex ratio was 0.5. Hysterectomy was the most commonly performed surgery (23.3%). The most common comorbidity was high blood pressure (30%). Half of the patients had midline incision. Supra-umbilical surgery predominated (56.7%), intraoperative blood loss ≥500 ml in 46.7% of cases. Upper abdominal surgery with, subcostal incision and blood loss ≥500 ml are statistically significant risk factors for the occurrence of early postoperative hypoxemia (P Conclusion: Hypoxemia is the result of impaired respiratory function favored by the conditions encountered during the early postoperative period.展开更多
AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition (PN) in patients undergoing abdominal surgery. METHODS: A meta-analysis of all the relevant randomized co...AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition (PN) in patients undergoing abdominal surgery. METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases: the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002), decreasing postoperative infectious morbidity (OR = 0.24, 95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P < 0.00001). No serious adverse effects were found. CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.展开更多
With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanc...With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.展开更多
AIM: To assess the effectiveness and safety of perioperative growth hormone (GH) in patients undergoing abdominal surgery.METHODS: We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Controll...AIM: To assess the effectiveness and safety of perioperative growth hormone (GH) in patients undergoing abdominal surgery.METHODS: We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in February 2003. No language restrictions were applied. Randomized controlled trials (RCT) comparing GH with placebo in patients undergoing abdominal surgery were extracted and evaluated.Methodological quality was evaluated using the Jadad scale.RESULTS: Eighteen trials involving 646 patients were included. The combined results showed that GH had a positive effect on improving postoperative nitrogen balance (standardized mean difference [SMD] = 3.37, 95%CI [2.46, 4.27], P＜0.00001), and decreasing the length of hospital stay (weighted mean difference [WMD] = -2.07,95%CI [-3.03, -1.11], P = 0.00002), and reducing the duration of postoperative fatigue syndrome (SMD = -1.83,95%CI [-2.37, -1.30], P＜0.00001), but it could increase blood glucose levels (WMD = 0.91, 95%CI [0.56, 1.25],P＜0.00001).CONCLUSION: GH for patients undergoing abdominal surgery is effective and safe, if blood glucose can be controlled well. Further trials are required with a sufficient size to account for clinical heterogeneity and to measure other important outcomes such as infection, morbidity,mortality, fluid retention, immunomodulatory effects, and tumor recurrence.展开更多
The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled ...The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled in the study. Blood samples were collected prior to operation and 2, 24, 48 h after surgery for bacterial culture, microbial DNA extraction, plasma D-lactate and endotoxin measurement. PCR analysis was performed after DNA extraction, with β-lactosidase gene of E. coli and 16S rRNA gene as target genes. All patients were observed for a period of 30 days for infectious complications. Our results showed that no bacterial DNA was detected before surgery, but after operation it was found in 12 patients （19.0%）. Bacterial DNA was detected in 41.7% （10/24） of SIRS patients and 5.1% （2/39） of non-SIRS patients （P〈0.01）. About 83.3% of PCR-positive patients developed systemic inflammatory response syndrome （SIRS）, but only 27.5% of PCR-negative patients did so （P〈0.01）. Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did （P〈0.01）. The blood culture was positive only in 3 patients （4.8%）, who were all PCR-positive. E. coli DNA was found in 66.7% of the PCR-positive patients. The plasma levels of D-lactate and endotoxin were elevated significantly 2, 24 and 48 h after operation in PCR-positive patients, with a significant positive correlation found between them （r=0.91, P〈0.01）. It is concluded that increased intestinal permeability was closely related with bacterial translocation. Intestinal bacterial translocation （most commonly E. coli） might occur at early stage （2 h） after abdominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.展开更多
AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms "...AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms "colorectal", "colectomy", "PAOS", "previous surgery" and "PAOS". Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294(16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis(meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates.展开更多
This article provides a review of the causes of respiratory tract infection after abdominal surgery. These causes include general anesthesia, intubation factors, factors inherent to the patient, surgical factors, the ...This article provides a review of the causes of respiratory tract infection after abdominal surgery. These causes include general anesthesia, intubation factors, factors inherent to the patient, surgical factors, the injudicious use of antimicrobial agents, and the environmental factors of the ward. The perioperative management of the respiratory tract should be strengthened. Health education, respiratory function training, oral nursing intervention,atomization inhalation, and personalized expectoration methods should receive more attention to decrease the complications and promote the early rehabilitation of patients after abdominal surgery.展开更多
<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous...<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.展开更多
TO THE EDITORI read with a great interest the paper by Gonzalez-Roldan et al. The authors reported on the pattern expression of TREM-1 during sepsis and major abdominal surgery as compared to healthy controls and conc...TO THE EDITORI read with a great interest the paper by Gonzalez-Roldan et al. The authors reported on the pattern expression of TREM-1 during sepsis and major abdominal surgery as compared to healthy controls and concluded that TREM-1 expression increased on the surface of monocytes after surgery. Several points deserve consideration. First, no data related to TREM-1 expression on neutrophils is provided.展开更多
BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challengin...BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.展开更多
<strong>Backgrounds:</strong><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Post-operative complications in pediatr...<strong>Backgrounds:</strong><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Post-operative complications in pediatric surgery are important issues, especially that after major abdominal surgery for preterm infants: complications sometimes lead to mortality/morbidity even though the surgical procedures were successful. We here attempted to demonstrate and record post-operative complications in preterm infants after major abdominal surgery. This is a secondary analysis of our cohort (n = 594) previously reported regarding pediatric postoperative complications (not confined to preterm infants). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Of 594 patients, 25 preterm (born <37 weeks of gestation) infants underwent major abdominal surgery. We identified their characteristics, especially the postoperative complications. The Ethics Committee approved this study. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean weight was 2.43 ± 0.75 kg. Of 25, nine suffered postoperative complications: postoperative respiratory failure (n = 4), pulmonary sepsis (n = 2), and the followings were observed in one patient: intra-operative cardiac arrest, wound sepsis, septicemia, and multi-organ sepsis. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> In preterm infants undergoing major abdominal surgery, the most common postoperative complication was respiratory;respiratory failure and pulmonary sepsis. This data is roughly the same as that observed in the previous studies, which made us reconfirm the importance of the vigilance on respiratory complications in this population.</span></span></span></span></span>展开更多
Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver transplantation.LC is an important risk factor itself for surgery,due to the higher than average associate...Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver transplantation.LC is an important risk factor itself for surgery,due to the higher than average associated morbidity and mortality.This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors,such as coagulopathy,poor nutritional status,adaptive immune dysfunction,cirrhotic cardiomyopathy,and renal and pulmonary dysfunction,which all lead to poor outcomes.Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery.In the emergency setting,with the presence of decompensated LC,alcoholic hepatitis,severe/advanced LC,and significant extrahepatic organ dysfunction conservative management is preferred.A multidisciplinary,individualized,and specialized approach can improve outcomes;preoperative optimization after risk stratification and careful management are mandatory before surgery.Laparoscopic techniques can also improve outcomes.We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before,during,and after surgery.展开更多
BACKGROUND In China,as the population grows older,the number of elderly people who have died from respiratory problems has increased.AIM To investigate whether enhanced recovery after surgery(ERAS)-based respiratory f...BACKGROUND In China,as the population grows older,the number of elderly people who have died from respiratory problems has increased.AIM To investigate whether enhanced recovery after surgery(ERAS)-based respiratory function training may help older patients who had abdominal surgery suffer fewer pulmonary problems,shorter hospital stays,and improved lung function.METHODS The data of 231 elderly individuals having abdominal surgery was retrospectively analyzed.Based on whether ERAS-based respiratory function training was provided,patients were divided into ERAS group(n=112)and control group(n=119).Deep vein thrombosis(DVT),pulmonary embolism(PE),and respiratory tract infection(RTI)were the primary outcome variables.Secondary outcome variables included the Borg score Scale,FEV1/FVC and postoperative hospital stay.RESULTS The percentage of 18.75%of ERAS group participants and 34.45%of control group participants,respectively,had respiratory infections(P=0.007).None of the individuals experienced PE or DVT.The ERAS group’s median postoperative hospital stay was 9.5 d(3-21 d)whereas the control groups was 11 d(4-18 d)(P=0.028).The Borg score decreased on the 4th d following surgery in the ERAS group compared to the 2nd d prior(P=0.003).The incidence of RTIs was greater in the control group than in the ERAS group among patients who spent more than 2 d in the hospital before surgery(P=0.029).CONCLUSION ERAS-based respiratory function training may reduce the risk of pulmonary complications in older individuals undergoing abdominal surgery.展开更多
BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical i...BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.展开更多
Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate st...Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.展开更多
Objective:To investigate the effects of different doses of BDNF on postoperative cognitive function in aged rats undergoing abdominal surgery.Methods:72 aged healthy male SD rats of SPF grade were selected.According t...Objective:To investigate the effects of different doses of BDNF on postoperative cognitive function in aged rats undergoing abdominal surgery.Methods:72 aged healthy male SD rats of SPF grade were selected.According to the random number table method,the rats were randomly divided into the control group,model group,low dose BDNF injection group,and high dose BDNF injection group,with 18 rats in each group.The model group,low dose group,and high dose group underwent abdominal surgery after anesthesia,and 5μL/time of BDNF was intranasally administered to the rats in the low dose and high dose groups 6 hours after abdominal surgery,of which the dose of the low dose group was 0.1 g/L,while that of the high dose group was 0.2 g/L.The drug was administered alternately through both nostrils,with an interval of 2 minutes each time,for 5 times.The control group did not undergo surgery after anesthesia.The escape latency and swimming distance of the four groups of rats were compared before surgery,the first day,the third day,and the seventh day after surgery;similarly,the BDNF protein expression level in the hippocampus of the four groups of rats was compared on the first day,the third day,and the seventh day after surgery.Results:The escape latency and swimming distance of the control group were not statistically significant on the first day,the third day,and the seventh day after surgery,p>0.05;the escape latency and swimming distance of the model group,low dose group,and high dose group on the first day,the third day,and the seventh day after surgery were statistically significant,p<0.05.Before surgery,the escape latency and swimming distance of the four groups were not statistically significant,p>0.05;on the first day,the third day,and the seventh day after surgery,the escape latency and swimming distance of the model group>low dose group>high dose group>control group,p<0.05.The BDNF protein expression level in the hippocampus of the control group on the first day,the third day,and the seventh day after surgery showed no statistical significance p>0.05;the expression level of BDNF protein in the hippocampus of the model group,low dose group,and high dose group on the first day,the third day,and the seventh day after surgery was statistically significant,p<0.05.On the first day,the third day,and the seventh day after surgery,the expression level of BDNF protein in the hippocampus of the model group<low dose group<high dose group<control group,p<0.05.Conclusion:Compared with 0.1 g/L of BDNF,0.2 g/L of BDNF can improve the postoperative cognitive function of aged rats undergoing abdominal surgery.展开更多
基金Supported by the Shanghai Municipal Health Commission Project,No.20214Y0284.
文摘BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.
基金supported by grants from the National Key Research&Development Program of China(Nos.2023YFC2506900 and 2018YFC2001800)the National High Level Hospital Clinical Research Funding(Nos.2022CR74 and 2022CR78 of Peking University First Hos pital)Braun Anesthesia Scientific Research Fund(No.BBDF-2019-004).
文摘To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.
文摘BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear.AIM To systematically evaluate the effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery.METHODS The Cochrane Library,Web of Science,PubMed,ProQuest,and the Chinese bio-medical literature databases Wanfang,Weipu,and CNKI were used to search for relevant studies on controlled trials of electrical stimulation in gynecological abdominal surgery patients from self-established databases to May 2024.The RevMan software(version 5.3)was used to analyze the included literature and explore the heterogeneity of each study.RESULTS Seven controlled trials,involving 520 patients,were included.The results of meta-analysis showed that electrical stimulation could shorten the recovery time of intestinal sound after gynecological abdominal surgery[odds ratio(OR):-5.11,95%CI:-5.84 to-4.38,P<0.00001]and improve the time of first anal exhaust(OR:-1.19,95%CI:-1.38 to-0.99,P<0.00001),improved the time of first anal defecation(OR:-0.98,95%CI:-1.19 to-0.78,P<0.00001),The difference is significant.According to the funnel plot,if the scatter is symmetrical,it indicates that the funnel plot is unbiased.CONCLUSION Electrical stimulation can shorten this reduces the length of time it takes for the patient to recover from bowel sounds and also affects the time to first anal voiding and defecation to some extent,thereby promoting gas-trointestinal function recovery after gynecological abdominal surgery.The quality of the studies included in this review was poor,which may have affected the final results.It is necessary to conduct a randomized controlled study with higher quality and more samples to further confirm the promoting effect of electrical stimulation on gastrointestinal function recovery to guide clinical treatment.
文摘Background: Oxygen saturation refers to the quantity of oxygenated hemoglobin in the blood, that is to say the level of oxygen measurable in the red blood cells when they have passed through the lungs. The aim of this study was to describe the management of early postoperative hypoxemia after abdominal surgery at the Yaounde General Hospital (YGH). Method: This is a quantitative, observational study, with a descriptive aim, which took place in the anesthesiology department of the YGH, over a period of 2 months from August 1st to October 1st, 2023. The study included all the patients ≥18 years, of both sexes who had abdominal surgery under general anesthesia and were willing to participate during the time of data collection. The variables studied were the sociodemographic and clinical characteristics, risk factors for oxygen desaturation, postoperative variations in SPO2 and therapeutic tools. Results: We collected 30 patients among whom 11 presented with early postoperative hypoxemia i.e. a frequency of 36.7%. The age of the patients ranged from 18 to 63 years and the mean was 42.47 ± 13.5 years on average. The sex ratio was 0.5. Hysterectomy was the most commonly performed surgery (23.3%). The most common comorbidity was high blood pressure (30%). Half of the patients had midline incision. Supra-umbilical surgery predominated (56.7%), intraoperative blood loss ≥500 ml in 46.7% of cases. Upper abdominal surgery with, subcostal incision and blood loss ≥500 ml are statistically significant risk factors for the occurrence of early postoperative hypoxemia (P Conclusion: Hypoxemia is the result of impaired respiratory function favored by the conditions encountered during the early postoperative period.
文摘AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition (PN) in patients undergoing abdominal surgery. METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases: the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002), decreasing postoperative infectious morbidity (OR = 0.24, 95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P < 0.00001). No serious adverse effects were found. CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.
文摘With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.
基金Supported by the China Medical Board of New York No. 98-680
文摘AIM: To assess the effectiveness and safety of perioperative growth hormone (GH) in patients undergoing abdominal surgery.METHODS: We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in February 2003. No language restrictions were applied. Randomized controlled trials (RCT) comparing GH with placebo in patients undergoing abdominal surgery were extracted and evaluated.Methodological quality was evaluated using the Jadad scale.RESULTS: Eighteen trials involving 646 patients were included. The combined results showed that GH had a positive effect on improving postoperative nitrogen balance (standardized mean difference [SMD] = 3.37, 95%CI [2.46, 4.27], P＜0.00001), and decreasing the length of hospital stay (weighted mean difference [WMD] = -2.07,95%CI [-3.03, -1.11], P = 0.00002), and reducing the duration of postoperative fatigue syndrome (SMD = -1.83,95%CI [-2.37, -1.30], P＜0.00001), but it could increase blood glucose levels (WMD = 0.91, 95%CI [0.56, 1.25],P＜0.00001).CONCLUSION: GH for patients undergoing abdominal surgery is effective and safe, if blood glucose can be controlled well. Further trials are required with a sufficient size to account for clinical heterogeneity and to measure other important outcomes such as infection, morbidity,mortality, fluid retention, immunomodulatory effects, and tumor recurrence.
文摘The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled in the study. Blood samples were collected prior to operation and 2, 24, 48 h after surgery for bacterial culture, microbial DNA extraction, plasma D-lactate and endotoxin measurement. PCR analysis was performed after DNA extraction, with β-lactosidase gene of E. coli and 16S rRNA gene as target genes. All patients were observed for a period of 30 days for infectious complications. Our results showed that no bacterial DNA was detected before surgery, but after operation it was found in 12 patients （19.0%）. Bacterial DNA was detected in 41.7% （10/24） of SIRS patients and 5.1% （2/39） of non-SIRS patients （P〈0.01）. About 83.3% of PCR-positive patients developed systemic inflammatory response syndrome （SIRS）, but only 27.5% of PCR-negative patients did so （P〈0.01）. Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did （P〈0.01）. The blood culture was positive only in 3 patients （4.8%）, who were all PCR-positive. E. coli DNA was found in 66.7% of the PCR-positive patients. The plasma levels of D-lactate and endotoxin were elevated significantly 2, 24 and 48 h after operation in PCR-positive patients, with a significant positive correlation found between them （r=0.91, P〈0.01）. It is concluded that increased intestinal permeability was closely related with bacterial translocation. Intestinal bacterial translocation （most commonly E. coli） might occur at early stage （2 h） after abdominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.
文摘AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms "colorectal", "colectomy", "PAOS", "previous surgery" and "PAOS". Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294(16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis(meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates.
文摘This article provides a review of the causes of respiratory tract infection after abdominal surgery. These causes include general anesthesia, intubation factors, factors inherent to the patient, surgical factors, the injudicious use of antimicrobial agents, and the environmental factors of the ward. The perioperative management of the respiratory tract should be strengthened. Health education, respiratory function training, oral nursing intervention,atomization inhalation, and personalized expectoration methods should receive more attention to decrease the complications and promote the early rehabilitation of patients after abdominal surgery.
文摘<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.
文摘TO THE EDITORI read with a great interest the paper by Gonzalez-Roldan et al. The authors reported on the pattern expression of TREM-1 during sepsis and major abdominal surgery as compared to healthy controls and concluded that TREM-1 expression increased on the surface of monocytes after surgery. Several points deserve consideration. First, no data related to TREM-1 expression on neutrophils is provided.
基金Supported by Key Research and Development Program of Shaanxi,No.2020GXLH-Y-019 and 2022KXJ-141Innovation Capability Support Program of Shaanxi,No.2019GHJD-14 and 2021TD-40+1 种基金Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital,No.2021LJ-052023 Natural Science Basic Research Foundation of Shaanxi Province,No.2023-JC-YB-739.
文摘BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.
文摘<strong>Backgrounds:</strong><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Post-operative complications in pediatric surgery are important issues, especially that after major abdominal surgery for preterm infants: complications sometimes lead to mortality/morbidity even though the surgical procedures were successful. We here attempted to demonstrate and record post-operative complications in preterm infants after major abdominal surgery. This is a secondary analysis of our cohort (n = 594) previously reported regarding pediatric postoperative complications (not confined to preterm infants). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Of 594 patients, 25 preterm (born <37 weeks of gestation) infants underwent major abdominal surgery. We identified their characteristics, especially the postoperative complications. The Ethics Committee approved this study. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean weight was 2.43 ± 0.75 kg. Of 25, nine suffered postoperative complications: postoperative respiratory failure (n = 4), pulmonary sepsis (n = 2), and the followings were observed in one patient: intra-operative cardiac arrest, wound sepsis, septicemia, and multi-organ sepsis. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> In preterm infants undergoing major abdominal surgery, the most common postoperative complication was respiratory;respiratory failure and pulmonary sepsis. This data is roughly the same as that observed in the previous studies, which made us reconfirm the importance of the vigilance on respiratory complications in this population.</span></span></span></span></span>
文摘Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver transplantation.LC is an important risk factor itself for surgery,due to the higher than average associated morbidity and mortality.This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors,such as coagulopathy,poor nutritional status,adaptive immune dysfunction,cirrhotic cardiomyopathy,and renal and pulmonary dysfunction,which all lead to poor outcomes.Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery.In the emergency setting,with the presence of decompensated LC,alcoholic hepatitis,severe/advanced LC,and significant extrahepatic organ dysfunction conservative management is preferred.A multidisciplinary,individualized,and specialized approach can improve outcomes;preoperative optimization after risk stratification and careful management are mandatory before surgery.Laparoscopic techniques can also improve outcomes.We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before,during,and after surgery.
基金Supported by Project for Scientific Research by the Hongkou District Health Committee,No.Hong Wei 2002-08.
文摘BACKGROUND In China,as the population grows older,the number of elderly people who have died from respiratory problems has increased.AIM To investigate whether enhanced recovery after surgery(ERAS)-based respiratory function training may help older patients who had abdominal surgery suffer fewer pulmonary problems,shorter hospital stays,and improved lung function.METHODS The data of 231 elderly individuals having abdominal surgery was retrospectively analyzed.Based on whether ERAS-based respiratory function training was provided,patients were divided into ERAS group(n=112)and control group(n=119).Deep vein thrombosis(DVT),pulmonary embolism(PE),and respiratory tract infection(RTI)were the primary outcome variables.Secondary outcome variables included the Borg score Scale,FEV1/FVC and postoperative hospital stay.RESULTS The percentage of 18.75%of ERAS group participants and 34.45%of control group participants,respectively,had respiratory infections(P=0.007).None of the individuals experienced PE or DVT.The ERAS group’s median postoperative hospital stay was 9.5 d(3-21 d)whereas the control groups was 11 d(4-18 d)(P=0.028).The Borg score decreased on the 4th d following surgery in the ERAS group compared to the 2nd d prior(P=0.003).The incidence of RTIs was greater in the control group than in the ERAS group among patients who spent more than 2 d in the hospital before surgery(P=0.029).CONCLUSION ERAS-based respiratory function training may reduce the risk of pulmonary complications in older individuals undergoing abdominal surgery.
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 21K10715 and No.JP 20K10404Northern Advancement Center for Science&Technology,No.T-2-2+9 种基金the Yasuda Medical Foundation,No.31010316the Okawa Foundation for Information and Telecommunications,No.41111042Taiju Life Social Welfare Foundation,No.50811490Japan Keirin Autorace Foundation,No.2023M-378Project Mirai Cancer Research Grants,No.31010269Takahashi Industrial and Economic Research Foundation,No.50411278Sapporo Doto Hospital,No.50311211Noguchi Hospital,No.40310551Doki-kai Tomakomai Hospital,No.40710739Tsuchida Hospital,No.50811478.
文摘BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.
文摘Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.
基金Key Research and Development Program of Shaanxi Province(2021SF-288)Natural Science Basic Research Program of Shaanxi Province(2020JQ-950,2022JM-570)+1 种基金Health Research Program of Shaanxi Province(2022D002)Incubation Fund of Shaanxi Provincial People’s Hospital(2018YXQ-07)。
文摘Objective:To investigate the effects of different doses of BDNF on postoperative cognitive function in aged rats undergoing abdominal surgery.Methods:72 aged healthy male SD rats of SPF grade were selected.According to the random number table method,the rats were randomly divided into the control group,model group,low dose BDNF injection group,and high dose BDNF injection group,with 18 rats in each group.The model group,low dose group,and high dose group underwent abdominal surgery after anesthesia,and 5μL/time of BDNF was intranasally administered to the rats in the low dose and high dose groups 6 hours after abdominal surgery,of which the dose of the low dose group was 0.1 g/L,while that of the high dose group was 0.2 g/L.The drug was administered alternately through both nostrils,with an interval of 2 minutes each time,for 5 times.The control group did not undergo surgery after anesthesia.The escape latency and swimming distance of the four groups of rats were compared before surgery,the first day,the third day,and the seventh day after surgery;similarly,the BDNF protein expression level in the hippocampus of the four groups of rats was compared on the first day,the third day,and the seventh day after surgery.Results:The escape latency and swimming distance of the control group were not statistically significant on the first day,the third day,and the seventh day after surgery,p>0.05;the escape latency and swimming distance of the model group,low dose group,and high dose group on the first day,the third day,and the seventh day after surgery were statistically significant,p<0.05.Before surgery,the escape latency and swimming distance of the four groups were not statistically significant,p>0.05;on the first day,the third day,and the seventh day after surgery,the escape latency and swimming distance of the model group>low dose group>high dose group>control group,p<0.05.The BDNF protein expression level in the hippocampus of the control group on the first day,the third day,and the seventh day after surgery showed no statistical significance p>0.05;the expression level of BDNF protein in the hippocampus of the model group,low dose group,and high dose group on the first day,the third day,and the seventh day after surgery was statistically significant,p<0.05.On the first day,the third day,and the seventh day after surgery,the expression level of BDNF protein in the hippocampus of the model group<low dose group<high dose group<control group,p<0.05.Conclusion:Compared with 0.1 g/L of BDNF,0.2 g/L of BDNF can improve the postoperative cognitive function of aged rats undergoing abdominal surgery.
