Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study.

BACKGROUND: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. METHODS: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. RESULTS: Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61-0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12-3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11-6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05-3.89). CONCLUSIONS: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Oscillatory flow suppression improves inflammation in chronic venous disease.

BACKGROUND: To assess if suppression of the oscillatory component of reflux may improve the inflammatory phenotype in chronic venous disease (CVD). MATERIALS AND METHODS: From 193 CVD patients, we selected 54 (13 males, 41 females, CEAP C2-4EpAsPr) for a blinded, case-control prospective investigation. All of them underwent echo-color-Doppler assessment of reflux parameters. In the same patients a blood systemic assessment of 19 inflammatory cytokines was obtained. Follow-up lasted 6 months. The control group (C) was constituted by 21 homogenous CVD patients, unselected and not operated. RESULTS: Thirty-one of 54 patients were excluded from post-operative evaluation in consequence of reported new other inflammatory episodes. Twenty-three (23) completed the follow up, showing the suppression of the oscillatory component of venous reflux; 4 of the 19 cytokines decreased significantly after the procedure: Tumor Necrosis Factor-α (TNFα), Granulocyte Colony Stimulating Factor (G-CSF), Interferon gamma-induced Protein 10 (IP-10), Interleukin-15 (IL-15). Particularly, TNFα and IP-10 even returned inside a physiological range: 5.3 ± 2.7 to 4.2 ± 2.2 pg/mL (P < 0.003) and from 303.7 ± 168.4 to 254.0 ± 151.6 pg/mL (P < 0.024), respectively. Both cytokines showed a weak but significant correlation with parameters of oscillatory flow correction. Finally, three cytokines implicated in repair and remodeling of tissue, Epidermal Growth Factor, Monocyte Chemoattractant Protein-1 and Platelet Derived Growth Factor-BB (PDGF-BB), significantly increased. Our findings are further reinforced by the significant changes of the same cytokines when compared to C group. CONCLUSIONS: The surgical suppression of the oscillatory component of reflux modulates the inflammatory phenotype, suggesting a pivotal role of flow among factors concurring to inflammation in CVD.