Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation.

It has been shown that pressure ulcer formation in critically ill paediatric patients increases morbidity and mortality. We sought to identify factors associated with pressure ulcer formation in paediatric patients on extracorporeal membrane oxygenation (ECMO). From December 2014 to 2015, we identified patients at our institution who developed a pressure ulcer to create two cohorts: ulcer and no ulcer. Variables of interest included: type of ECMO, ECMO indication, hours on ECMO, location of cannulas, volume of crystalloid and blood products received during the first 7 days or during the length of the ECMO run, albumin and lactate levels on the day of cannulation, and presence of vasopressor support or steroid therapy. Of 43 patients studied, 11 (25.5%) developed a pressure ulcer. Patients that developed ulcers were older (P = 0.001) and weighed more (P = 0.006). Femoral cannulation was more frequent in the ulcer group (36.4% vs 6.3%, P = 0.029), and duration of ECMO was longer (P = 0.007). Age, weight, duration of ECMO, and femoral cannulation may contribute to the development of pressure ulcers in children who require ECMO support. Further analysis is imperative to identify specific techniques and protocols that will prevent pressure ulcers in this critically ill population.

End-stage renal disease increases the risk of mortality after appendectomy.

INTRODUCTION: With each passing year, the number of patients with end-stage renal disease (ESRD) is increasing steadily, but there are limited data on the postoperative outcomes of these patients after appendectomy. METHODS: Using the Nationwide Inpatient Sample, we identified all patients who underwent appendectomy in the United States between 1998 and 2010. We used International Classification of Diseases, 9th Revision, Clinical Modification codes to identify patients with ESRD and to track postoperative complications during hospital admission. Statistical models were controlled for age, sex, race, insurance type, number of Elixhauser comorbidities, year of admission, perforation of the appendix, and operative approach. RESULTS: The study population included 5,712 patients with ESRD, with the remaining 3,615,391 patients serving as reference controls. Patients with ESRD had risk of death that was nearly 5 times greater than controls (odds ratio [OR] 5.68; 95% confidence interval [95% CI] 3.96-8.15; P < .001); this risk was similar for nonperforated (OR 4.97; P < .001) and perforated (5.96; P = .004) appendicitis. The risk of death, however, was greater for open appendectomy (OR 6.65; P < .001) compared with laparoscopic appendectomy (OR 2.50; P = .060). Patients with ESRD also were at an increased risk of mechanical wound complication (OR 1.58; P = .040) and had a mean duration of stay that was 34% greater compared with controls (P < .001). CONCLUSION: Patients with ESRD undergoing appendectomy were at an increased risk of death. These patients also had an increased risk of mechanical wound complications and had a greater duration of hospital stay. Future studies should investigate the specific causes of death among patients with ESRD after appendectomy and optimal management strategies in this subset of patients.

How sick are dialysis patients undergoing cholecystectomy? Analysis of 92,672 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

BACKGROUND: Although cholecystectomy is one of the most common surgical procedures performed in the United States, there is an absence of data on the risks of cholecystectomy in dialysis patients. Our objective was to analyze the outcomes of cholecystectomy in dialysis patients. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we selected all patients who underwent cholecystectomy from 2005 to 2010. Univariate analysis was performed and logistic and linear regression models were used to obtain risk-adjusted outcomes. The main outcomes were morbidity, mortality, and length of stay. RESULTS: Dialysis was associated with a higher risk of 30-day postoperative morbidity (16.1% vs 3.8%, adjusted odds ratio 1.91, 95% confidence interval 1.18 to 3.10), but not mortality. The average length of stay following any cholecystectomy was 4.1 days longer for dialysis patients (5.5 vs 1.4 days, P < .0001). CONCLUSION: Patients on dialysis who undergo cholecystectomy are at a higher risk for postoperative morbidity, but not mortality.