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INTRODUCTION: Postoperative anastomotic leaks remain a common and serious complication of colorectal surgeries and are a major cause of mortality and morbidity of these procedures. Anastomotic leaks (AL) have been extensively studied; however, there has been no significant reduction in their prevalence over time. In addition, there is a significant economic burden from AL attributed to the need for repeat surgery, radiologic intervention and lengthened hospital stay. We conducted a comparative cost analysis of patients undergoing colorectal surgery with anastomosis, with the application of fibrin sealant (FS) to the sutured anastomosis versus not treating the sutured anastomosis with FS. METHODS: The deterministic decision-tree model was populated with clinical data including operating room time, hospitalization days, occurrence of AL, need for revision surgery, blood products and radiologic interventions to treat the AL in lower colorectal surgery. A systematic literature review was conducted to identify appropriate studies with these variables. RESULTS: The average cost per case treated lower colorectal surgery with fibrin sealant glue 10 mL Tisseel® and those not treated with a fibrin sealant after suturing the anastomoses was 3233 and 4130, respectively, for resource expenses paid by the healthcare system. This would suggest potential savings of 897 per surgery, achieved through the application of FS to the sutured anastomosis for preventing AL following colorectal surgery. CONCLUSION: Application of FS to the sutured anastomosis in lower colorectal surgery resulted in a decrease in post-operative AL, and cost savings based on a reduction in hospitalization days, a reduction needing: revision surgery, radiologic intervention and blood products to treat AL.
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OBJECTIVES: To quantify immunological dysfunction in surgical patients with presence/absence of sepsis using a droplet digital polymerase chain reaction (ddPCR) transcriptomic analysis. The study also aims to evaluate this approach for improving identification of sepsis in these patients. BACKGROUND: Immune dysregulation is a central event in sepsis. Quantification of the expression of immunological genes participating in the pathogenesis of sepsis could represent a new avenue to improve its diagnosis. METHODS: Expression of 6 neutrophil protease genes (MMP8, OLFM4, LCN2/NGAL, LTF, PRTN3, MPO) and also of 5 genes involved in the immunological synapse (HLA-DRA, CD40LG, CD3E, CD28, ICOS) was quantified in blood from 101 surgical patients with sepsis, 53 uninfected surgical patients, and 16 blood donors by using ddPCR. Areas under receiver operating characteristic curves (AUROC) and multivariate regression analysis were employed to test individual genes and gene ratios to identify sepsis, in comparison with procalcitonin. RESULTS: Sepsis-induced overexpression of neutrophil protease genes and depressed expression of immunological synapse genes. MMP8/HLA-DRA, LCN2/HLA-DRA outperformed procalcitonin in differentiating between patients with sepsis and surgical controls in the AUROC analysis: LCN2/HLA-DRA: 0.90 (0.85-0.96), MMP8/HLA-DRA: 0.89 (0.84-0.95), procalcitonin: 0.80 (0.73-0.88) (AUROC, confidence interval 95%), and also in the multivariate analysis: LCN2/HLA-DRA: 8.57 (2.25-32.62); MMP8/HLA-DRA: 8.03 (2.10-30.76), procalcitonin: 4.20 (1.15-15.43) [odds ratio (confidence interval 95%)]. Gene expression levels of HLA-DRA were an independent marker of hospital mortality. CONCLUSIONS: Quantifying the transcriptomic ratios MMP8/HLA-DRA, LCN2/HLA-DRA by ddPCR is a promising approach to improve sepsis diagnosis in surgical patients.
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Doenças do Sistema Imunitário/diagnóstico , Reação em Cadeia da Polimerase/métodos , Complicações Pós-Operatórias/diagnóstico , Sepse/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Marcadores Genéticos , Humanos , Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Análise de Regressão , Sepse/sangue , Sepse/etiologia , Sepse/imunologiaRESUMO
Amyand hernia is a rare entity that is generally an unexpected intraoperative finding. The decision to perform prophylactic appendectomy, must take into account individual factors that may increase morbidity in a short, medium or long term future.
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Apêndice/patologia , Hérnia Inguinal/diagnóstico , Idoso , Apendicectomia , Apêndice/cirurgia , Diagnóstico Diferencial , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Humanos , MasculinoRESUMO
Vascular trauma caused by bull horn injuries can be regarded as a subgroup of vascular traumatology, due to its particular etiology, mechanism of action, associated injuries and surgical management. In this paper, the authors report their experience in the management of 56 such injuries, for the last 20 years, analysing the annual frequency (more common in summer time), the nature of the injury, the most commonly affected vessels and the surgical reconstruction or revascularization methods employed. The quality of results are discussed according some variable, such as is the case of the precocity of the repair, the degree of contamination, the occurence of post operative infections and the nature of the reconstructive or revascularization method employed. Finnaly, a comparison with similar reports already published in the literature is made.