A simple prediction score for postoperative mortality after decortication.

Background: Decortication of the lung, either by video-thoracoscopy or thoracotomy is potentially a morbid procedure and has significantly higher mortality compared with other major thoracic procedures. Much of this difference can be attributed to other significant comorbidities and to the non-elective nature of the surgery. Our primary goal was to recognize the preoperative unique characteristics of patients who had postoperative mortality within the first 30 days. Our secondary goal was to build a score system to calculate the odds of death after decortication. Methods: Patients who had undergone either partial or total pulmonary decortication were retrospectively identified from the 2015-2017 databases of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and were employed for this analysis. Multivariable regression models were used to evaluate the possible association of multiple risk factors with postoperative death. Factors that remained significant in the multivariable regression analysis were used to develop the Decortication Prognostic Score (DPS). Results: The final study population consisted of 2,315 patients. The overall observed mortality rate was 5.6%. The greatest independent risk factor for increased 30-day mortality in multivariable logistic regression analysis was disseminated cancer, followed by age ≥65 years, ventilator dependence, active hemodialysis, open wound or wound infection, partially or totally dependent preoperative functional status, preoperative systemic inflammatory response syndrome (SIRS), sepsis or septic shock, congestive heart failure (CHF), preoperative need for blood transfusion, dyspnea, and chronic obstructive pulmonary disease (COPD). Afterwards, we developed a prognostic score for calculating the odds of postoperative death. The total score was associated with a stepwise higher risk of postoperative death after decortication. Patients with a score of 1 had an associated mortality of 1.1% [odds ratio (OR): 2, 95% confidence interval (CI): 0.43-9.32, P=0.375], patients with scores 2-3 had an associated mortality of 6.6% (OR: 12.5, 95% CI: 3.04-51.36, P<0.001), and patients with scores ≥4 had an associated mortality of 27.1% (OR: 65.8, 95% CI: 15.86-273.2, P<0.001). Conclusions: Preoperative factors can predict postoperative mortality after decortication. DPS may help guide surgeons with bedside decision making and heighten awareness to patients most likely to be at risk for 30-day re-intubation, failure to wean from ventilator, surgical site infections, prolong length of stay and higher mortality after decortication.

Simple Prediction Score for Developing Surgical Site Infection after Clean Neck Operation.

Background: Clean neck operations (thyroidectomies, parathyroidectomies, and lymph node resection) are among the most common procedures performed in the United States. Surgical site infections (SSIs) after clean neck operations are rare, but the consequences are devastating and often life-threatening. The aim of this study was to develop a score that will identify patients at high risk for developing a SSI after a clean neck procedure. Materials and Methods: Patients with either thyroidectomies, parathyroidectomies, or lymph node resection of the neck were identified from the 2016 and 2017 databases of the American College of Surgeons National Surgical Quality Improvement Program and were used for this analysis. Our primary goal was to build a scoring system with which we will be able to identify patients at high risk for SSI after a clean neck operation. Results: Of a total of 99,877 patients, 72,719 patients had a thyroidectomy, 22,043 patients had parathyroidectomy, and 5,115 patients had lymph node resection of the neck. Multivariable logistic regression identified the following independent risk factors associated with post-operative SSI: male gender (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.03-1.51), diabetes mellitus (aOR, 1.34; 95% CI, 1.07-1.67), smoking (aOR, 1.66; 95% CI, 1.36-2.04), pre-operative steroid use (aOR, 1.75; 95% CI, 1.21-2.53), cancer diagnosis (aOR, 1.44; 95% CI, 1.17-1.77), radical lymphadenectomies (aOR, 2.94; 95% CI, 2.16-4), and total operative time ≥198 minutes (aOR, 2.25; 95% CI, 1.82-2.78). Afterward, we developed a prognostic score for calculating the odds of having post-operative SSI. One point was allotted for each of the aforementioned factors, except lymphadenectomies where two points were allotted, and operative time was excluded. Our score was associated with a stepwise higher risk of post-operative SSI after a clean neck operation. Conclusions: Pre-operative and intra-operative factors can predict which patients undergoing a clean neck surgery may develop SSI. Our prognostic score may help guide surgeons identify patients at high-risk for SSI after clean neck surgery and these patients might benefit from prophylactic use of antibiotic agents.

Occupational dermatoses by type of work in Greece.

BACKGROUND: To elucidate the relationship between seven occupational dermatoses (ODs) and 20 types of work in Greece. METHODS: This was a prevalence epidemiologic study of certain ODs among 4,000 workers employed in 20 types of enterprise, in 104 companies, in 2006-2012, using data from company medical records, questionnaires, occupational medical, and special examinations. The χ(2) test was applied to reveal statistically significant relationships between types of enterprises and occurrence of ODs. RESULTS: A high percentage (39.9%) of employees included in the study population suffered from ODs. The highest prevalence rates were noted among hairdressers (of contact dermatitis: 30%), cooks (of contact dermatitis: 29.5%), bitumen workers (of acne: 23.5%), car industry workers (of mechanical injury: 15%), construction workers (of contact urticaria: 29.5%), industrial cleaning workers (of chemical burns: 13%), and farmers (of malignant tumors: 5.5%). We observed several statistical significant correlations between ODs (acute and chronic contact dermatitis, urticaria, mechanical injury, acne, burns, skin cancer) and certain types of enterprises. There was no statistically significant correlation between gender and prevalence of ODs, except for dermatoses caused by mechanical injuries afflicting mainly men [χ(2) (1) = 13.40, p < 0.001] and for chronic contact dermatitis [χ(2) (1) = 5.53, p = 0.019] afflicting mainly women. CONCLUSION: Prevalence of ODs is high in Greece, contrary to all official reports by the Greek National Institute of Health. There is a need to introduce a nationwide voluntary surveillance system for reporting ODs and to enhance skin protection measures at work.