Negative Pressure Wound Therapy After Intestinal Anastomosis: A Risk Factor Analysis for Dehiscence.

INTRODUCTION: Negative pressure wound therapy (NPWT) is part of the temporary abdominal closure in the treatment of patients with traumatic, inflammatory, or vascular disease. However, the use of NPWT when performing an intestinal anastomosis has been controversial. This study aimed to describe the patients managed with NPWT therapy and identify the risk factors for anastomotic dehiscence when intestinal anastomosis was performed. METHODS: A single-center cohort study with prospectively collected databases was performed. Patients who required NPWT therapy from January 2014 to December 2018 were included. Patients were stratified according to the performance of intestinal anastomosis and according to the presence of dehiscence. Bivariate and multivariate analyses were performed for anastomotic dehiscence and mortality. RESULTS: A total of 97 patients were included. Median age was 52 y old [interquartile range 24.5-70]. Male patients corresponded to 75.6% (n = 34) of the population. Delayed fascial closure was performed in 80% (n = 36). The risk of anastomotic dehiscence was higher in females (odds ratio (OR) 11.52 [confidence interval (CI) 1.29-97.85], P = 0.030), delayed fascial closure (OR 18.18 [CI 2.02-163.5], P = 0.010) and use of vasopressors (OR 12.04 [CI 1.22-118.47], P = 0.033). NPWT pressures >110 mmHg were evidenced in the dehiscence group with statistically significant value (OR 1.2 [0.99-2.26] p 0.04) CONCLUSIONS: There is still controversy in the use of NPWT when performing intestinal anastomosis. According to our data, the risk of dehiscence is higher in females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 MMHG.

Correlación de los marcadores inflamatorios (proteina C reactiva, neutrofilia y leucocitosis) en las diferentes fases de la apendicitis aguda / Correlation of the inflammatory markers (C reactive protein, neutrophilia and leukocytosis) in the different phases of acute appendicites

Objetivo. Determinar si existe correlación entre la elevación de marcadores inflamatorios como la proteína C reactiva (PCR), leucocitosis y neutrofilia, con las diferentes etapas de la apendicitis aguda. Materiales y métodos. Se llevó a cabo un estudio prospectivo entre enero y mayo de 2011. Se evaluaron 100 pacientes con diagnóstico clínico de apendicitis aguda que fueron sometidos a cirugía con un cuadro clínico de máximo 24 horas de evolución y que a cuyo ingreso se realizó medición de hemograma y PCR. Se hizo una correlación diagnóstica entre los marcadores proinflamatorios y los hallazgos operatorios y patológicos. El análisis estadístico se hizo con el programa EpiInfo y las variables se analizaron con la prueba de ji al cuadrado. Resultados. De 100 pacientes seleccionados para el estudio, 74 cumplieron los criterios de inclusión. Se evaluó la relación entre el estadio de la enfermedad y los niveles de PCR, leucocitosis y neutrofilia. Hubo un gran incremento de los niveles de PCR en los pacientes con apendicitis complicada (gangrenosa y perforada), con una curva ROC (Receiver Operating Curve) de 11,7 mg/dl (rango, 8,7 a 14,85 mg/dl). La sensibilidad diagnóstica global de esta prueba fue de 75,6 %, con una elevación al 93,1 % en las fases complicadas (p=0,01). Conclusiones. La PCR y la neutrofilia son marcadores inflamatorios con una gran sensibilidad para el diagnóstico de apendicitis aguda. En los pacientes con una alta sospecha clínica hay una correlación directa y proporcional con los niveles de los marcadores inflamatorios, y nuestros resultados ayudan a decidir la conducta terapéutica, anotando que los valores de PCR superiores a 11,7 mg/dl y de neutrófilos superiores a 82 % se correlacionan con estadios avanzados de apendicitis.

Objective: To determine if there is a correlation between the elevation of inflammatory markers such as C reactive protein (PCR), leukocytosis and neutrophilia with the different stages of acute appendicitis. Materials and Methods: Prospective study carried out between January and May 2011 to evaluate 100 patients with a clinical diagnosis of acute appendicitis that were brought to surgery with clinical evolution of maximum 24 hours and that on admission hemogram and PCR measurement were done, in order to establish the diagnostic correlation between pro-inflammatory markers and the surgical and pathological findings. The statistical analysis was done with the program epi info and variables were analyzed using chi square test. Results: 100 patients were collected, 74 met inclusion criteria. We evaluated the relationship between the stage of the disease and the levels of CRP, leukocytosis and neutrophilia. There was a great increase in the levels of CRP in patients with complicated appendicitis (gangrenous and perforated) with an ROC value of 1.7 mg/dl (range 8.7 - 14.85 mg/dl). Global diagnostic sensitivity diagnose of this test was 75.6 %, with a lift to the 93.1 % in complicated phases (p = 0.01). Conclusions: PCR levels and the neutrophilia are inflammatory markers with high sensitivity in the diagnosis of acute appendicitis. There is a direct and proportional correlation with the levels of inflammatory markers in patients with a high clinical suspicion. Our results will help to define the therapeutic conduct, observing that PCR scoring values superior to 11.7 PCR mg/dl and neutrophils higher than 82 % correlate with advanced stages of acute appendicitis.