Radiographs assessment of changes in the psoas muscle at L4-L5 level after single-level lateral lumbar interbody fusion in patients with postoperative motor weakness.

The purposes of this study were (1) to investigate postoperative changes in cross-sectional area (CSA) and signal intensity (SI) of the psoas muscle (PS) using magnetic resonance imaging (MRI) and (2) to compare the CSA and SI of the PS between patients with and without motor weakness after single-level lateral lumbar interbody fusion (LLIF) at level L4-L5. Sixty patients were divided into two groups-those with postoperative motor weakness and those without-and the two groups were compared. Baseline demographics and clinical characteristics, such as operation time and blood loss, length of hospital stay, and postoperative complications, were recorded. The CSA and SI of the PS were obtained from the MRI regions of interest defined by manual tracing. Patients who developed motor weakness after surgery were significantly older (p = 0.040). The operation time (p = 0.868), LLIF operative time (p = 0.476), and estimated bleeding loss (p = 0.168) did not differ significantly between groups. In both groups, the CSA and SI of the left and right PS increased after surgery. The change in the CSA of the left PS was significantly higher in patients with weakness (247.6 ± 155.2 mm2) than without weakness (152.2 ± 133.1 mm2) (p = 0.036). The change in SI of the left PS did not differ between the two groups (p = 0.530). To prevent postoperative motor weakness regardless of the operation time, surgeons should be aware of the potential for surgical invasive of the PS during LLIF in older people.

Performance assessment of the risk index category for surgical site infection after colorectal surgery.

BACKGROUND: The traditional National Healthcare Safety Network (previously National Nosocomial Infections Surveillance) risk index is used to predict the risk of surgical site infection across many operative procedures. However, this index may be too simple to predict risk in the various procedures performed in colorectal surgery. The aim of this study was to evaluate the usefulness of the risk index by analyzing the impact of the risk index factors on surgical site infection after abdominal colorectal surgery. METHODS: Using our surgical site infection surveillance database, we analyzed retrospectively 538 consecutive patients who underwent abdominal colorectal surgery between 2005 and 2010. Correlations between surgical site infection and the following risk index factors were analyzed: length of operation, American Society of Anesthesiologists score, wound classification, and use of laparoscopy. The 75th percentile for length of operation was determined separately for open and laparoscopic surgery in the study model. RESULTS: Univariate analyses showed that surgical site infection was more strongly associated with a >75th percentile length of operation in the study model (odds ratio [OR], 2.07) than in the traditional risk index model (OR, 1.64). Multivariable analysis found that surgical site infection was independently associated with a >75th percentile length of operation in the study model (OR, 2.75; 95% confidence interval [CI], 1.66-4.55), American Society of Anesthesiologists score ≥3 (OR, 2.22; 95% CI, 1.10-4.34), wound classification ≥III (OR, 5.29; 95% CI, 2.62-10.69), and open surgery (OR, 2.21; 95% CI, 1.07-5.17). Performance of the risk index category was improved in the study model compared with the traditional model. CONCLUSIONS: The risk index category is sufficiently useful for predicting the risk of surgical site infection after abdominal colorectal surgery. However, the 75th percentile length of operation should be set separately for open and laparoscopic surgery.

Quantitative assessment for stimulated saliva flow rate and buffering capacity in relation to different ages.

OBJECTIVES: To evaluate salivary flow rate and buffering capacity using a quantitative pH measurement among three broad age groups. METHODS: The population consisting of 117 patients was classified into three age groups: young, middle-aged, and elderly group. The volume of stimulated saliva after chewing gum was measured. Saliva samples were titrated with 0.1N HCl to evaluate the buffering capacity. Saliva pH change was measured directly using a hand-held pH meter. At the point of 50 microL of titrated HCl, individual salivary buffering capacities were ranked into one of the following three categories; high buffering capacity (above pH 5.5), medium buffering capacity (from pH 5.5 to 4.5), and low buffering capacity (below pH 4.5). RESULTS: Chi(2)-test showed that the proportional distribution of individuals in the three buffering capacity groups was not statistically different among the age groups (p>0.05). One-way ANOVA and Tukey's HSD test showed the flow rate of stimulated whole saliva in the young group was significantly greater than that of the middle-aged and elderly groups (p<0.05). Two-way ANOVA showed there was no significant interaction between the independent variables buffering capacity and age group (F=0.419, p=0.7950). One-way ANOVA and Tukey's HSD test indicated the flow rate showed significant differences among the three age and buffering capacity groups. CONCLUSIONS: Although a limited number of subjects were investigated in this study, the quantitative saliva assessment is useful as a screening method for different ages to identify patients with a low saliva flow rate and/or buffering capacity.