Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 222
Filtrar
1.
J Surg Res ; 257: 69-78, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818786

RESUMO

BACKGROUND: Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT. METHODS: The (2012-2015) National Readmission Database was queried for all adult (age ≥18 y) trauma patients with penetrating injuries who underwent exploratory laparotomy and were readmitted within 6 mo of index hospitalization discharge. Patients were stratified by firearm injuries (FIs) and stab injuries (SIs). Primary outcomes were rates of MAC: intra-abdominal abscesses (IAAs), superficial surgical site infection (SSI), and fascial dehiscence within 6 mo after discharge. Secondary outcomes were both nonabdominal complications and mortality, postdischarge, and 6-mo readmission. Regression analysis was performed. RESULTS: A total of 4473 patients (FI, 2326; SI, 2147) were included in the study; the mean age was 32 ± 14 y, the Injury Severity Score was 19 (15-25), and 23% underwent damage control laparotomy (DCL). The rate of MAC within 6 mo was 22% (IAA 19%, SSI 7%, and fascial dehiscence 4%). Patients with FIs had a higher rate of IAA (27% versus 10%; P < 0.01), SSI (11% versus 3%; P < 0.01), fascial dehiscence (5% versus 3%; P = 0.03), nonabdominal complications (54% versus 24%; P < 0.01), and postdischarge mortality (8% versus 6%; P < 0.01) compared with patients with SIs . On regression analysis, DCL (P < 0.01), large bowel perforation (P < 0.01), biliary-pancreatic injury (P < 0.01), hepatic injury (P < 0.01), and blood transfusion (P = 0.02) were predictors of MAC. CONCLUSIONS: MAC developed in one in five patients after PAT. FIs have a higher potential for hollow viscus injury and peritoneal contamination, and are more predictive of MAC and nonabdominal complications, especially after DCL. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Laparotomia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Ferimentos Penetrantes/cirurgia , Abscesso Abdominal/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/cirurgia , Adulto Jovem
2.
Lancet Gastroenterol Hepatol ; 5(9): 819-828, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32553149

RESUMO

BACKGROUND: Although treatment of Crohn's disease has improved with development of tumour necrosis factor antagonists, fewer than 50% of patients have sustained benefit. Durable maintenance therapy with orally administered alternative treatments remains an unmet need. We aimed to evaluate the effects of ozanimod, an oral agent selectively targeting sphingosine-1-phosphate receptor subtypes 1 and 5, on endoscopic disease activity in Crohn's disease. METHODS: STEPSTONE was a phase 2, uncontrolled, multicentre trial in adults with moderately to severely active Crohn's disease recruited at 28 hospital and community research centres in Canada, the USA, Hungary, Poland, and Ukraine. All patients began treatment with a 7-day dose escalation (4 days on ozanimod 0·25 mg daily followed by 3 days at 0·5 mg daily). Patients then received ozanimod 1·0 mg oral capsule daily for a further 11 weeks, for a 12-week induction period, followed by a 100-week extension. The primary endpoint was change in Simple Endoscopic Score for Crohn's Disease (SES-CD) from baseline to week 12, as determined by a blinded central reader. Data are reported for the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02531113 and EudraCT, number 2015-002025-19, and is completed. FINDINGS: 69 patients were enrolled between Nov 17, 2015, and Aug 18, 2016. At week 12, the mean change from baseline in SES-CD was -2·2 (SD 6·0); 16 (23·2%, 95% CI 13·9-34·9) patients experienced endoscopic response. A reduction from baseline in Crohn's Disease Activity Index (CDAI) score also was observed (mean change -130·4 [SD 103·9]). Clinical remission (CDAI <150 points) was shown in 27 (39·1%, 95% CI 27·6-51·6) patients and response (CDAI decrease from baseline ≥100) in 39 (56·5%, 95% CI 44·0-68·4) of patients. The mean change from baseline in two-item patient-reported outcome (PRO2, stool frequency, abdominal pain scores) score was -66·1 (SD 65·4). Mean change from baseline in Geboes Histology Activity Score (GHAS) was -5·9 (SD 11·0) and in Robart's Histopathology Index (RHI) -10·6 (25·1). Adverse events were most frequently those attributed to Crohn's disease, most commonly Crohn's disease (flare) in 18 (26%) patients. The most commonly reported serious treatment-related adverse events were Crohn's disease (six [9%]) and abdominal abscess (two [3%]). INTERPRETATION: Endoscopic, histological, and clinical improvements were seen within 12 weeks of initiating ozanimod therapy in patients with moderately to severely active Crohn's disease. Phase 3 placebo-controlled trials have been initiated. FUNDING: Celgene Corporation.


Assuntos
Doença de Crohn/tratamento farmacológico , Indanos/uso terapêutico , Quimioterapia de Indução/métodos , Oxidiazóis/uso terapêutico , Moduladores do Receptor de Esfingosina 1 Fosfato/uso terapêutico , Abscesso Abdominal/induzido quimicamente , Abscesso Abdominal/epidemiologia , Administração Oral , Adulto , Idoso , Canadá/epidemiologia , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Humanos , Hungria/epidemiologia , Indanos/administração & dosagem , Indanos/efeitos adversos , Análise de Intenção de Tratamento/métodos , Masculino , Pessoa de Meia-Idade , Oxidiazóis/administração & dosagem , Oxidiazóis/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Polônia/epidemiologia , Estudos Prospectivos , Indução de Remissão , Moduladores do Receptor de Esfingosina 1 Fosfato/administração & dosagem , Moduladores do Receptor de Esfingosina 1 Fosfato/efeitos adversos , Ucrânia/epidemiologia , Estados Unidos/epidemiologia
3.
Surgery ; 168(2): 322-327, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32461001

RESUMO

BACKGROUND: The number of geriatric patients is expected to grow 3-fold over the next 30 years, and as many as 50% of the surgeries done in the United States may occur in geriatric patients. Geriatric patients often have increased comorbidities and more often present in a delayed manner for acute appendicitis. The aim of this study was to evaluate outcomes between geriatric patients and younger patients undergoing appendectomy, hypothesizing that geriatric patients will have a higher risk of abscess and/or perforation, conversion to open surgery, postoperative intra-abdominal abscess, and 30-day readmission. METHODS: The 2016 to 2017 American College of Surgeons National Surgical Quality Improvement Program Procedure Targeted Appendectomy database was queried for patients with preoperative image findings consistent with acute appendicitis. Geriatric patients (age ≥65 years old) were compared with younger patients (age <65 years old). A multivariable logistic regression model was used for analysis. RESULTS: From 21,586 patients undergoing appendectomy, 2,060 (9.5%) were geriatric patients. Compared with the younger cohort, geriatric patients were less likely to have leukocytosis (59.0% vs 65.8%, P < .001) and more likely to have a tumor and/or malignancy involving the appendix on final pathology (2.0% vs 0.8%, P < .001), an unplanned laparoscopic conversion to open surgery (4.2% vs 1.5%, P < .001), and 30-day readmission (7.0% vs 3.3%, P < .001). Geriatric patients had a longer median length of stay (2 vs 1 days, P < .001) and higher mortality rate (0.5% vs <0.1%, P < .001). After adjusting for covariates, there was an increased associated risk of intraoperative abscess and/or perforation (odds ratio 2.23, 2.01-2.48, P < .001) and postoperative intra-abdominal abscess (odds ratio 1.43, 1.12-1.83, P = .005) but no difference in associated risk for mortality (odds ratio 2.56, 0.79-8.25, P = .116), compared with the younger cohort. CONCLUSION: Nearly 10% of laparoscopic appendectomies are done on geriatric patients with geriatric patients having a higher rate of conversion to open surgery and tumor and/or malignancy on final pathology. Geriatric patients have an associated increased risk of intraoperative perforation and/or abscess and postoperative intra-abdominal abscess but have similar risk for mortality compared with nongeriatric patients undergoing laparoscopic appendectomy.


Assuntos
Abscesso Abdominal/epidemiologia , Apendicectomia , Apendicite/cirurgia , Idoso , Apendicectomia/efeitos adversos , Neoplasias do Apêndice/epidemiologia , Apendicite/mortalidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Surg Today ; 50(11): 1434-1442, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32451713

RESUMO

PURPOSE: Aging societies comprise an increasing number of elderly gastric cancer (GC) patients. We herein attempted to determine whether D2 lymphadenectomy is beneficial for older GC patients. METHODS: We retrospectively analyzed a multi-institutional dataset including 3484 patients who received surgical resection for GC. For the analysis, we selected patients aged ≥ 80 years who were clinically diagnosed with T1N + or T2-4 GC. To balance the essential variables including the type of gastrectomy and the stage of progression, propensity score matching was conducted, and we compared the background clinical factors and postoperative outcomes of the patients allocated to the D2 (n = 87) and non-D2 (n = 87) dissection groups. RESULTS: The D2 group had significantly longer operative times, more blood loss, and more retrieved lymph nodes (median 32 vs 24, P < 0.001) than the non-D2 group. The D2 group had a greater incidence of intra-abdominal abscesses (grade ≥ II in the Clavien-Dindo classification) than the non-D2 group (3.5% vs 0%, P = 0.040). The overall disease-specific and relapse-free survival rates of the D2 group tended to be poorer than those of the non-D2 group (hazard ratios 1.49, 1.70 and 1.14, respectively). CONCLUSIONS: D2 lymphadenectomy for older patients with GC conferred little benefit regarding overall survival despite an occurrence of increased complication rates.


Assuntos
Conjuntos de Dados como Assunto , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Pontuação de Propensão , Medição de Risco , Neoplasias Gástricas/mortalidade , Abscesso Abdominal/epidemiologia , Fatores Etários , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
5.
Dis Colon Rectum ; 63(5): 629-638, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032204

RESUMO

BACKGROUND: Postoperative intra-abdominal septic complications of Crohn's disease substantially increase the healthcare expenditure and prolong hospitalization. OBJECTIVE: We aimed to develop and validate a prediction model for intra-abdominal septic complications after bowel resection and primary anastomosis for Crohn's disease. DESIGN: This was a retrospective cohort study. SETTINGS: This study was conducted in a tertiary center. PATIENTS: Data of 949 Crohn's disease-related primary bowel resections and anastomosis from January 2011 to December 2017 were collected. MAIN OUTCOME MEASURES: Primary outcomes were prevalence of intra-abdominal septic complications. RESULTS: Overall prevalence of intra-abdominal septic complications after Crohn's disease surgery was 11.6%. Predictors included preoperative C-reactive protein level ≥40 mg/L (OR = 3.545), preoperative glucocorticoids (OR = 1.829) and infliximab use (OR = 3.365), upper GI involvement (OR = 2.072), and hypoalbuminemia (albumin level <30 g/L, OR = 2.406). Preoperative exclusive enteral nutrition was a protector for postoperative septic complications (OR = 0.192) compared with partial enteral nutrition/parenteral nutrition/straight to surgery. A nomogram was computed to facilitate risk calculation; this had a predictive discrimination, measured as area under the receiver operating characteristic curve, of 0.823. LIMITATIONS: This model is generated from retrospective data. A major limitation of this model is the lack of external validation. CONCLUSIONS: A new model to predict postoperative intra-abdominal septic complications was developed, which may guide preoperative optimization and candidate selection for primary anastomosis after bowel resection for Crohn's disease. See Video Abstract at http://links.lww.com/DCR/B178. NOMOGRAMA PARA PREDECIR COMPLICACIONES SéPTICAS INTRAABDOMINALES POSTOPERATORIAS DESPUéS DE RESECCIóN INTESTINAL Y ANASTOMOSIS PRIMARIA EN ENFERMEDAD DE CROHN: Las complicaciones sépticas intraabdominales postoperatorias en la enfermedad de Crohn aumentan sustancialmente los costos de atención médica y prolongan la hospitalización.Nuestro objetivo fue desarrollar y validar un modelo de predicción para las complicaciones sépticas intraabdominales después de resección intestinal y anastomosis primaria en enfermedad de Crohn.Este fue un estudio de cohorte retrospectivo.Este estudio se realizó en un centro de tercer nivel.Se recopilaron datos de 949 resecciones intestinales primarias con anastomosis por enfermedad de Crohn de enero de 2011 a diciembre de 2017.El resultado primario fue la prevalencia de complicaciones sépticas intraabdominales.La prevalencia general de complicaciones sépticas intraabdominales después de cirugía por enfermedad de Crohn fue 11.6%. Los predictores incluyeron un nivel preoperatorio de proteína C reactiva ≥ 40 mg / L (odds ratio = 3.545), glucocorticoides preoperatorios (odds ratio = 1.829) y uso de infliximab (odds ratio = 3.365), compromiso gastrointestinal superior (odds ratio = 2.072) e hipoalbuminemia (albúmina <30g / L, odds ratio = 2.406). La nutrición enteral exclusiva preoperatoria fue un protector para las complicaciones sépticas postoperatorias (odds ratio = 0.192, en comparación con la nutrición enteral parcial / nutrición parenteral / envío directo a cirugía. Se calculó un nomograma para facilitar el cálculo del riesgo; esto tuvo una discriminación predictiva, medida como área bajo la curva de la característica de operación del receptor, de 0.823.Este modelo se generó a partir de datos retrospectivos. Una limitación importante de este modelo es la falta de validación externa.Se desarrolló un nuevo modelo para predecir complicaciones sépticas intraabdominales postoperatorias, que puede guiar la optimización preoperatoria y la selección de candidatos para anastomosis primaria después de resección intestinal en enfermedad de Crohn. Consulte Video Resumen en http://links.lww.com/DCR/B178. (Traducción-Dr. Jorge Silva Velazco).


Assuntos
Abscesso Abdominal/epidemiologia , Colectomia/efeitos adversos , Doença de Crohn/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sepse/epidemiologia , Abscesso Abdominal/diagnóstico , Adulto , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Complicações Pós-Operatórias/diagnóstico , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Sepse/diagnóstico , Adulto Jovem
6.
Australas Emerg Care ; 23(1): 6-10, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926960

RESUMO

BACKGROUND: The mortality of undrained abdominal abscesses may be as high as 35 %. In this study, we analyzed the clinical spectrum of intra-abdominal abscess (IAA) patients in the ED and attempted to identify factors that can predict the severity of IAA. METHOD: This study was a retrospective review of adults (≥ 18 years) with IAA admitted to a single ED. IAA were diagnosed by abdominal computed tomography. The differences in clinical variables between patients receiving and not receiving inotropic drugs were analyzed. Multiple logistic regression was performed for assessing predictor variables. RESULTS: 128 patients presented with IAA. The most common complaint was abdominal pain (60.2 %) and the liver was most common location (39.8 %). Patients who required inotropic drugs had lower serum leukocyte, lymphocyte, and platelet counts and higher serum BUN and CRP levels. The independent factors associated with need for inotropic drugs were serum leukocyte, CRP, and BUN level. The optimal cutoff CRP value for predicting inotropic drug use was 12.06mg/dL, BUN value was 21mg/dL. CONCLUSIONS: Elevated CRP and BUN levels could predict a higher association with requirement of inotrope. Therefore, emergency physicians should consider CRP and BUN levels and aiming for early aggressive treatment.


Assuntos
Abscesso Abdominal/classificação , Infecções Intra-Abdominais/classificação , Abscesso Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Cardiotônicos/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Infecções Intra-Abdominais/epidemiologia , Contagem de Leucócitos/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
J Surg Res ; 246: 395-402, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31629495

RESUMO

BACKGROUND: Laparoscopic appendectomy is a preferred approach in children with appendicitis. Patient characteristics associated with open appendectomy are poorly characterized, although such information can help optimize the care. MATERIAL AND METHODS: To characterize the factors associated with open appendectomy, we performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified surgically managed appendicitis using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged 18 or younger. Factors associated with open appendectomy, 30-d readmission rate, and hospitalization length were assessed using logistic regression, Cox proportional hazards regression, and Poisson regression, respectively. RESULTS: Of 46,147 children with surgically managed appendicitis, 85.2% had laparoscopic appendectomy. Low-volume hospitals (odds ratio, OR: 3.01 [95% confidence interval, CI: 1.81-5.01]), rural hospitals (OR: 2.36 [95%CI: 1.63-3.40]), public insurance (OR: 1.19 [95%CI: 1.03-1.36]), lower-income neighborhood residence (OR: 1.40 [95%CI: 1.06-1.86]), younger age (OR: 5.00 [95%CI: 3.64-6.86] in <5 year-old), and abscess complicating appendicitis (OR: 1.91 [95%CI: 1.58-2.31]) were associated with open appendectomy. Laparoscopic appendectomy was associated with shorter hospitalization (incidence rate ratio: 0.77 [95%CI: 0.69-0.87]) and less readmission with wound infection, but not with 30-d readmission, or readmission with intraabdominal abscess. CONCLUSIONS: Along with clinical factors, non-clinical factors including appendicitis volume and rural/teaching status of the treating hospitals play a role in the choice of surgical approach. Awareness of the patient- and hospital-level factors associated with open appendectomy may allow for future resource distribution or improvement in access to care, resulting in population-level impact.


Assuntos
Abscesso Abdominal/epidemiologia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Adolescente , Fatores Etários , Apendicectomia/métodos , Apendicite/complicações , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
8.
Dig Surg ; 37(2): 101-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31163433

RESUMO

Postoperative antibiotics are recommended after appendectomy for complex appendicitis to reduce infectious complications. The duration of this treatment varies considerably between and even within institutions. The aim of this review was to critically appraise studies on duration of antibiotic treatment following appendectomy for complex appendicitis. A systematic literature search according to the PRISMA guidelines was performed. Comparative studies evaluating different durations of postoperative antibiotic therapy. Primary endpoint was intra-abdominal abscess (IAA) after appendectomy. Secondary endpoints were surgical site infection, readmission and length of hospital stay. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Pooled event rates were calculated using a random-effects model. Nine studies reporting 2006 patients with complex appendicitis were included. The methodological quality of the included articles was poor. IAA was seen in 138 patients (8,6%). Meta-analysis revealed a statistically significant difference in IAA incidence between antibiotic treatment of ≤5 vs. >5 days (risk ratio (OR) 0.36 [95% CI 0.23-0.57] (p < 0.0001)) but not between ≤3 vs. >3 days (OR 0.81 [95% CI 0.38-1.74] (p = 0.59)). Descriptive statistics were used for secondary endpoints. The duration of postoperative antibiotic treatment is not associated with IAA following appendectomy for complex appendicitis.


Assuntos
Abscesso Abdominal/prevenção & controle , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Apendicite/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Abscesso Abdominal/epidemiologia , Antibacterianos/uso terapêutico , Esquema de Medicação , Humanos , Período Pós-Operatório , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
9.
J Microbiol Immunol Infect ; 53(2): 283-291, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30150137

RESUMO

BACKGROUND: To analyze clinical spectrum of intra-abdominal abscesses in children and find helpful clinical parameters could aid physicians in earlier detection and differential diagnosis. METHODS: From 2004 to 2011, we retrospectively analyzed 66 pediatric patients, aged 18 years or younger with intra-abdominal abscesses. The data were obtained and studied: demographics, clinical presentations, etiologies, laboratory tests, microbiology, imaging studies, treatment modalities, complications and long-term outcomes. RESULTS: There were 66 patients (mean age, 9.27 ± 4.16 years) diagnosed as intra-abdominal abscesses. The two most common presented symptoms were fever and abdominal pain (90.9%; 78.8%, respectively). Most patients presented with leukocytosis (81.8%) and elevated C-reactive protein (CRP) levels (95.5%). In patients with abscesses in solid organs, urine white blood cell counts, nitrate and leukocyte esterase were all significant parameters (all P < 0.05), and urine pH and specific gravity were both lower than those in non-solid organs (P = 0.026; P = 0.043, respectively). Escherichia coli (E. coli) was the most common organism cultured from renal abscess. Streptococcus viridans was the most common organism cultured from liver abscess. Moreover, the two most predominant bacteria in periappendical and intraperitoneal abscesses were E. coli and Bacteroides fragilis. CONCLUSIONS: We suggest that primary physicians should keep this disease in mind when children present with predisposing risk factors, fever, abdominal pain, leukocytosis and elevated CRP level. Besides, we recommend the urinary analysis or ultrasonography (US) is valuable in patients with fever and abdominal pain.


Assuntos
Abscesso Abdominal/microbiologia , Abscesso Abdominal/fisiopatologia , Serviço Hospitalar de Emergência , Hospitalização , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/epidemiologia , Dor Abdominal/epidemiologia , Adolescente , Bactérias , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Bacteroides fragilis , Proteína C-Reativa , Criança , Pré-Escolar , Escherichia coli , Infecções por Escherichia coli , Feminino , Febre/epidemiologia , Humanos , Leucocitose/epidemiologia , Abscesso Hepático , Masculino , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Estreptococos Viridans
10.
J Pediatr Surg ; 55(3): 414-417, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31672408

RESUMO

PURPOSE: To determine the optimal nonoperative management of periappendiceal abscess in a pediatric population, we compared the therapeutic efficacy and cost-effectiveness of antibiotics alone versus antibiotics plus percutaneous drainage (PD). METHODS: We conducted a 10-year retrospective chart review of pediatric patients less than 18 years of age who had acute perforated appendicitis complicated by periappendiceal abscess. Group 1 consisted of patients (N = 35) who received nonoperative management with antibiotics only. Group 2 consisted of patients (N = 11) who underwent PD and also received antibiotics. Group 1 was subdivided into groups 1A and 1B. Group 1A consisted of patients (N = 25) who responded to antibiotics treatment. Group 1B consisted of patients (N = 10) who were initially treated with antibiotics but subsequently required PD. Patients' demographics, initial clinical presentation, abscess size and location, length of hospital stay, outcome, and complications were compared among these groups. RESULTS: Median hospital stay of group 1A and group 2 was identical at 6 days. Group 1B had a significantly longer median hospital stay of 13 days. There were no deaths and no significant long-term complications in any group. One patient in group 1A returned to the emergency room (ER) for abdominal pain and was readmitted for observation. Four patients in group 1B returned to the ER shortly after discharge and required readmission. One of these 4 patients developed acute pancreatitis in addition to enlarging abscess and underwent surgical drainage. There were no documented failures or complications of treatment in group 2 prior to interval appendectomy with the exception of 1 patient lost to follow-up. The presence of small bowel obstruction at the time of admission was an independent predictor of increased length of stay. CONCLUSIONS: Antibiotic therapy alone can be effective in a majority of patients and is recommended as initial management. To prevent potential complications and increased cost, PD should not be delayed if clinical symptoms persist or the abscess remains unchanged. Reimaging 6 days after initiation of antibiotic therapy with ultrasound or MRI is recommended to identify patients who would progress on antibiotics alone or who need to receive drainage without delay. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos , Apendicite , Drenagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/cirurgia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Drenagem/efeitos adversos , Drenagem/métodos , Drenagem/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Estudos Retrospectivos
11.
Intensive Care Med ; 46(2): 163-172, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31701205

RESUMO

Postoperative abdominal infections are an important and heterogeneous health challenge in intensive care units (ICU) and encompass postoperative infectious processes developing within the abdominal cavity that may be caused by either bacterial or fungal pathogens. In this narrative review, we discuss postoperative bacterial and fungal abdominal infections, covering also multidrug-resistant (MDR) pathogens. We also cover clinically preeminent aspects such as the definition of postoperative abdominal infections, which still remains difficult owing to their heterogeneity in patient characteristics, clinical presentation, ecology and antimicrobial treatment. With regard to treatment, modifiable factors such as source control and antimicrobial therapy play a key role in influencing the prognosis of postoperative abdominal infections, but several conditions may hamper their correct application; thus efforts should necessarily be devoted towards improving their appropriateness and timing. Hot topics regarding the characteristics and management of postoperative abdominal infections are discussed in this narrative review.


Assuntos
Abscesso Abdominal/etiologia , Complicações Pós-Operatórias/classificação , Abscesso Abdominal/epidemiologia , Anti-Infecciosos/uso terapêutico , Humanos , Unidades de Terapia Intensiva/organização & administração , Avaliação de Resultados em Cuidados de Saúde/métodos , Peritonite/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório
12.
J Surg Res ; 247: 508-513, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31812337

RESUMO

BACKGROUND: The need for extended postoperative antibiotics (Abx) for complicated (gangrenous or perforated) appendicitis (CA) remains unclear. We hypothesize that giving ≤24 h of Abx for CA is not inferior to a longer duration in preventing infectious complications after appendectomy. METHODS: In this post hoc analysis of a prospective multicenter study, only patients with intraoperative diagnosis of CA were included. ANOVA and Chi-squared tests were used to compare length of stay, 30-day readmission rates, surgical site infection (SSI), and intra-abdominal abscess (IAA) between patients receiving ≥96 h and ≤24 h of Abx. RESULTS: Of 751 patients with CA, 704 met inclusion criteria. Mean age was 48 (±17) y; 391 (56%) were male. A total of 185 (26%) received Abx for ≤24 h and 100 (14% of overall) received no Abx. 85 (12%) patients were lost to follow-up at 30 d postop. Twenty-seven (4%) patients developed an SSI (≤24 h = 5 (3%), ≥96 h = 22 (5%), P = 0.502) and 82 (13%) developed IAA (≤24 h = 11 (7%), ≥96 h = 71 (15%), P = 0.008) within 30d postop. Sixty-six (11%) patients underwent a secondary intervention for infection within 30 d postop. 41% of SSIs (11/27) and 60% (49/82) of IAA occurred during the index hospitalization. On the multivariate analysis, there was not any evidence of an association between the duration of Abx and an increased rate of SSI (P = 0.539), IAA (P = 0.274), emergency department visits (P = 0.509), readmission (P = 0.911), or secondary interventions (P = 0.523). CONCLUSIONS: No evidence of an association between the duration of Abx (≤24 h versus ≥ 96 h) for complicated appendicitis and an increased rate of SSI was observed and ≤24 h duration was associated with shorter length of stay. Because of possible selection bias, adequately powered randomized trials are required to definitely prove noninferiority of shorter course Abx duration.


Assuntos
Abscesso Abdominal/epidemiologia , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Apendicectomia/efeitos adversos , Apendicite/terapia , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Apendicite/complicações , Esquema de Medicação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do Tratamento
13.
Med Arch ; 73(5): 316-320, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31819304

RESUMO

Introduction: Colorectal Cancer (CRC) is the third most common malignant disease and the fourth most common cause of death associated with malignancy. Adenocarcinomas account for 95% of all cases of colon cancer. Treatment usually includes a surgical resection which is preceded or followed by chemotherapy and radiotherapy depending on the stage. There is constant interest in the microbiological ecosystem of the intestine, which is considered to be crucial for the onset and progression of the disease as well as the development of postoperative complications. Iatrogenic factors associated with the treatment of CRC may result in pronounced expression of virulence of the bacterial intestinal flora and fulminant inflammatory response of the host which ultimately leads to adverse treatment results. The modulation of intestinal microflora by probiotics seems to be an effective method of reducing complications in surgical patients. The question is whether ordering probiotics can lead to more favourable treatment outcomes for our patients who are operated due to colorectal adenocarcinoma, and whether this should become common practice. Aim: To demonstrate the clinical significance of probiotic administration in patients treated for colorectal adenocarcinoma and the results compared with relevant studies. Patients and Methods: In a randomized controlled prospective study conducted at the Clinic of General and Abdominal Surgery of the UCCS in the period of 01 January 2017 until 31 December 2017, there were a total of 78 patients with colorectal adenocarcinoma. Patients were divided into two groups: a group treated with oral probiotics (n = 39) according to the 2x1 scheme starting from the third postoperative day lasting for the next thirty days, followed by 1x1 lasting for two weeks in each subsequent month to one year, and the control group (n = 39) which was not routinely treated with probiotics. Results: A statistically significant difference in the benefit of using probiotics was found during postoperative hospitalization and the occurrence of fatal outcome in the first six months. All complications were more present in the group of patients untreated with probiotic, with statistical significance shown only in the case of ileus. Probiotic has a statistically significant reduction in postoperative complications in the localization of tumours on the rectum -33.3% and the ascending colon -16.7%. Conclusion: There is a significant benefit of administering probiotics in surgically treated patients for colorectal adenocarcinoma.


Assuntos
Abscesso Abdominal/epidemiologia , Adenocarcinoma/terapia , Fístula Anastomótica/epidemiologia , Colectomia , Neoplasias Colorretais/terapia , Íleus/epidemiologia , Probióticos/uso terapêutico , Infecção da Ferida Cirúrgica/epidemiologia , Adenocarcinoma/patologia , Bifidobacterium , Colo Ascendente/patologia , Neoplasias Colorretais/patologia , Humanos , Lactobacillus , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Streptococcus thermophilus
14.
United European Gastroenterol J ; 7(9): 1198-1214, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700633

RESUMO

Background: Anti-tumour necrosis factor alpha agents (anti-TNF-α) have been widely used in patients with inflammatory bowel disease (IBD). However, few published meta-analyses have focused on timing of the last infusion before surgery. We evaluated the relationship between preoperative anti-TNF-α timing and postoperative surgical site infection to provide additional evidence for surgeons to choose appropriate dates for surgery. Methods: We searched from inception until January 2019 for studies that documented postoperative complications of adults with IBD who underwent preoperative anti-TNF-α treatment. Primary outcomes of included studies were the odds ratios of preoperative anti-TNF-α time frames (4, 8 and 12 weeks). In addition, surgical site infection and its subtypes (anastomotic leakage, abscesses and wound infection) were analysed. Results: Twenty-seven publications were included. No significant difference between anti-TNF-α and control cohorts was observed for most postoperative surgical site infections (or its subtypes) when the preoperative anti-TNF-α infusion time window was within 4, 8 or 12 weeks. Additionally, no significant difference in postoperative complications was observed between preoperative anti-TNF-α windows of within four weeks and more than four weeks. Conclusions: In terms of surgical site infection and its subtypes, anti-TNF-α may be safe for ulcerative colitis and Crohn's disease patients who receive their last infusion of anti-TNF-α more than four weeks before surgery. We also found no evidence that anti-TNF-α was a risk factor when administered within four weeks, with the exception of subgroup results from a single study. Stratified by time window, use of anti-TNF-α until surgery has the potential to become a more considered strategy in clinical practice.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doenças Inflamatórias Intestinais/terapia , Infecção da Ferida Cirúrgica/epidemiologia , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Abscesso Abdominal/epidemiologia , Fístula Anastomótica/epidemiologia , Humanos , Cuidados Pré-Operatórios/métodos , Fatores de Risco , Fatores de Tempo
16.
J Laparoendosc Adv Surg Tech A ; 29(10): 1232-1238, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31524565

RESUMO

Background: Although previous studies have evaluated whether use of irrigation decreases postoperative intraabdominal abscess (PO-IAA) formation, these studies treated irrigation as a dichotomous variable and concluded that no irrigation resulted in a decreased incidence of PO-IAA formation. However, a recent study found decreased incidence with small aliquots to a total volume of 6 L. We hypothesized that higher volumes of irrigation would result in a lower incidence of PO-IAA. Materials and Methods: A postoperative template was developed as a quality improvement initiative and included descriptors for complex appendicitis and volume of irrigation. Data were prospectively collected from February 2016 to December 2018. Patients with complex appendicitis (fibropurulent exudate, extraluminal fecalith, well-formed abscess, visible hole in the appendix) were identified and analyzed by using standard statistical analysis. Volume of irrigation was categorized for analysis. Results: Two thousand three hundred six appendicitis patients were identified; 408 had complex appendicitis (17.7%). Three hundred eighty-four patients with complex appendicitis had documented irrigation volumes. The overall incidence of PO-IAA was 13.8%. Irrigation was commonly used (92.7%). The median amount of irrigation was 1000 mL (500 mL, 2500 mL), but it ranged from none to 9000 mL. There was no overall difference in the volume of irrigation used between those who developed a PO-IAA and those who did not (P = .34). No specific intraoperative finding was associated with the development of PO-IAA. Increasing volume of irrigation did not lower PO-IAA incidence (P = .24). Conclusions: The volume of irrigation did not appear to affect the rate of PO-IAA formation. The use of irrigation should be left to the discretion of the operating surgeon.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Adolescente , Apendicectomia/normas , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Estudos Retrospectivos , Irrigação Terapêutica/métodos , Irrigação Terapêutica/normas , Resultado do Tratamento
17.
Cir Cir ; 87(5): 540-544, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448803

RESUMO

Introduction: Acute appendicitis is the main cause of emergency surgical care. Post-operative patients with complicated acute appendicitis present complications, many of them expected. The use of drains is one of the measures to prevent these complications; however, recent meta-analyzes do not justify this therapeutic measure. This study evaluates the relationship between use and non-use of drains, post-operative complications in patients with complicated peritonitis secondary to acute appendicitis. Methods: A retrospective observational cohort study was conducted. The outcomes were analyzed by Chi-square test and Student's t-test; Fisher exact test was performed. Results: The average operating time was 1.46 h (1.0-2.5) and 1.66 (1-3) for patients without drains and with drains, respectively, the difference was significant (p = 0.001). Post-operative fever was more prevalent in group with a drains odds ratio (OR) 3.4 (confidence interval [CI] 95% 1.4-7.9). The mean time of hospitalization was 7.3 (3-20) and 8.8 days (3-35) for patients without drains and with drains, respectively. (p = 0.01). The Chi-square analysis was significant for evisceration Grade III and residual collection p = 0.036, OR not evaluable. Reoperation was not significant among both groups, p = 0.108 OR 6.3 (CI 95% 0.6-62.4). Conclusions: There is a relationship between the non-use of drains and collections and evisceration in post-operative patients with open appendectomy, by complicated acute appendicitis.


Assuntos
Apendicite/complicações , Drenagem , Peritonite/etiologia , Complicações Pós-Operatórias/etiologia , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Terapia Combinada , Drenagem/efeitos adversos , Feminino , Febre/epidemiologia , Febre/etiologia , Hospitais Públicos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , México/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Utilização de Procedimentos e Técnicas , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Desnecessários
18.
HPB (Oxford) ; 21(12): 1784-1789, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31164275

RESUMO

BACKGROUND: Perioperative fluid overload has been reported to increase complications after a variety of operative procedures. This study was conducted to investigate the incidence of fluid retention after pancreatic resection and its association with postoperative complications. METHODS: Data from 1174 patients undergoing pancreatoduodenectomy between 2010 and 2016 were collected from the Swedish National Pancreatic and Periampullary Cancer Registry. Early postoperative fluid retention was defined as a weight gain ≥2 kg on postoperative day 1. Outcome measures were overall complications, as well as procedure-specific complications. RESULTS: The weight change on postoperative day 1 ranged from -1 kg to +9 kg. A total of 782 patients (66.6%) were considered to have early fluid retention. Patients with fluid retention had significantly higher rates of total complications (p = 0.002), surgical complications (p = 0.001), pancreatic anastomotic leakage (p = 0.018) and wound infection (p = 0.023). Multivariable logistic regression confirmed early fluid retention as an independent risk factor for total complications (OR 1.46; p = 0.003), surgical complications (OR 1.49; p = 0.002), pancreatic anastomotic leakage (OR 1.48; p = 0.027) and wound infection (OR 1.84; p = 0.023). CONCLUSIONS: Fluid retention is common after elective pancreatic resection, and its associated with an increased rate of postoperative complications.


Assuntos
Líquidos Corporais , Pancreaticoduodenectomia , Complicações Pós-Operatórias/epidemiologia , Ganho de Peso , Abscesso Abdominal/epidemiologia , Idoso , Fístula Anastomótica/epidemiologia , Estudos de Coortes , Feminino , Esvaziamento Gástrico , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Suécia/epidemiologia
19.
Eur J Gastroenterol Hepatol ; 31(7): 786-791, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31150364

RESUMO

BACKGROUND: We aimed to determine the safety and effectiveness of laparoscopic-assisted surgery (LAS) in visceral obesity patients with colorectal cancer (CRC). PATIENTS AND METHODS: We retrospectively collected the clinical data of consecutive patients who underwent colorectal surgery for CRC between August 2014 and July 2018. The third lumbar vertebra visceral fat area was measured to diagnose visceral obesity. One-to-one propensity score matching was performed to compare the short-term outcomes between the open surgery (OS) and LAS in visceral obesity patients. Univariate and multivariate analyses were performed to evaluate the risk factors of postoperative complications. RESULTS: A total of 280 visceral obesity patients were included in this study with 140 patients for each group. Compared with the OS group, the LAS group had more lymph nodes harvested, longer surgical duration, and shorter postoperative hospital stay. The overall incidence of complications in OS was significantly higher than LAS (32.1 vs. 20.0%, P=0.021). Multivariate analysis revealed that age of at least 65 years (odds ratio: 1.950, 95% confidence interval: 1.118-3.403; P=0.019) was an independent risk factor for postoperative complications, whereas LAS (odds ratio: 0.523, 95% confidence interval: 0.302-0.908; P=0.021) was a protective factor. CONCLUSION: LAS in visceral obesity patients with CRC was a safer and less invasive alternative than open surgery, with fewer complications within the first 30 days postoperatively.


Assuntos
Colectomia/métodos , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Obesidade Abdominal/complicações , Complicações Pós-Operatórias/epidemiologia , Protectomia/métodos , Abscesso Abdominal/epidemiologia , Idoso , Fístula Anastomótica/epidemiologia , Neoplasias Colorretais/complicações , Conversão para Cirurgia Aberta , Feminino , Humanos , Laparotomia , Tempo de Internação/estatística & dados numéricos , Pneumopatias/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia
20.
BMC Surg ; 19(1): 55, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138190

RESUMO

BACKGROUND: Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient's life. DSF is related to high mortality (16-20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. METHODS: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. RESULTS: The 20 included articles covered an approximately 40 years-study period (1979-2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21-39 days, ranging from 1 to 1035 days. Healing time was 19-63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. CONCLUSIONS: DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.


Assuntos
Gastrectomia/métodos , Fístula Intestinal/etiologia , Neoplasias Gástricas/cirurgia , Abscesso Abdominal/epidemiologia , Duodenopatias/etiologia , Humanos , Peritonite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Cicatrização
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...