Leakage of anastomoses remains a significant problem after colorectal surgery.
An oxygen‐producing suture material was produced that was shown to be safe in vitro and significantly improved several aspects of healing of colonic anastomoses in an animal model.
Oxygen‐producing suture material or stapler devices might help to reduce the risk of anastomotic leak of intestinal anastomoses under physiological and critical conditions such as hypoxia.
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Affiliation(s)
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Cited by Other Article(s) |
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1
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El Maleh Y, Fasquel C, Quesnel C, Garnier M. Updated meta-analysis on intraoperative inspired fraction of oxygen and the risk of surgical site infection in adults undergoing general and regional anesthesia. Sci Rep 2023; 13:2465. [PMID: 36774366 PMCID: PMC9922261 DOI: 10.1038/s41598-023-27588-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/04/2023] [Indexed: 02/13/2023] Open
Abstract
This updated meta-analysis aims at exploring whether the use of systematic high vs low intraoperative oxygen fraction (FiO2) may decrease the incidence of postoperative surgical site infection during general (GA) or regional anesthesia (RA). PubMed, Cochrane CENTRAL, ClinicalTrials.gov databases were searched from January 1st, 1999 and July, 1st 2022, for randomized and quasi-randomized controlled trials that included patients in a high and low FiO2 groups and reported the incidence of SSI. The meta-analysis was conducted with a DerSimonian and Laird random-effects model. Thirty studies (24 for GA and 6 for RA) totaling 18,055 patients (15,871 for GA and 2184 for RA) were included. We have low-to-moderate-quality evidence that high FiO2 (mainly 80%) was not associated with a reduction of SSI incidence compared to low FiO2 (mainly 30%) in all patients (RR 0.90, 95%CI 0.79-1.03). Moderate inconsistency existed between studies (I2 = 38%). Subgroup analyses showed a moderate protective effect in patients undergoing GA (RR 0.86, 95%CI 0.75-0.99) (low level of evidence), while high FiO2 was not associated with a reduction of SSI in patients undergoing RA (RR 1.17, 95%CI 0.90-1.52) (moderate level of evidence). Sensitivity analyses restricted to patients ventilated without nitrous oxide (n = 20 studies), to patients operated from abdominal surgeries (n = 21 studies), and to patients suffering from deep SSI (n = 13 studies), all showed the absence of any significant effect of high FiO2. As a conclusion there is no compelling evidence that high FiO2 can improve postoperative patient's outcome on its own when good SSI prevention practices are properly applied. Recent well-designed and adequately powered randomized controlled trials add further weight to these results.
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Affiliation(s)
- Yoann El Maleh
- Sorbonne University, GRC29, Assistance Publique-Hôpitaux de Paris (APHP), DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon University Hospital, 4 rue de la Chine, 75020, Paris, France
| | - Charlotte Fasquel
- Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200, Brest, France
| | - Christophe Quesnel
- Sorbonne University, GRC29, Assistance Publique-Hôpitaux de Paris (APHP), DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon University Hospital, 4 rue de la Chine, 75020, Paris, France
| | - Marc Garnier
- Sorbonne University, GRC29, Assistance Publique-Hôpitaux de Paris (APHP), DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon University Hospital, 4 rue de la Chine, 75020, Paris, France.
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2
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Nato CG, Tabacco L, Bilotta F. Fraud and retraction in perioperative medicine publications: what we learned and what can be implemented to prevent future recurrence. JOURNAL OF MEDICAL ETHICS 2022; 48:479-484. [PMID: 33990431 DOI: 10.1136/medethics-2021-107252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Fraud in medical publications is an increasing concern. In particular, disciplines related to perioperative medicine-including anaesthesia and critical care-currently hold the highest rankings in terms of retracted papers for research misconduct. The dominance of this dubious achievement is attributable to a limited number of researchers who have repeatedly committed scientific fraud. In the last three decades, six researchers have authored 421 of the 475 papers retracted in perioperative medicine. This narrative review reports on six cases of fabricated publication in perioperative medicine that resulted in the paper's retraction. The process that led to the unveiling of the fraud, the impact on clinical practice, and changes in regulatory mechanisms of scientific companies and governmental agencies' policies are also presented. Fraud in medical publications is a growing concern that affects perioperative medicine requiring a substantial number of papers to be retracted. The continuous control elicited by readers, by local institutional review boards, scientific journal reviewers, scientific societies and government agencies can play an important role in preserving the 'pact of trust' between authors, professionals and ultimately the relationship between doctors and patients.
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Affiliation(s)
- Consolato Gianluca Nato
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico di Roma, Roma, Lazio, Italy
| | - Leonardo Tabacco
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico di Roma, Roma, Lazio, Italy
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico di Roma, Roma, Lazio, Italy
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3
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Fasquel C, Huet O, Ozier Y, Quesnel C, Garnier M. Effects of intraoperative high versus low inspiratory oxygen fraction (FiO 2) on patient's outcome: A systematic review of evidence from the last 20 years. Anaesth Crit Care Pain Med 2020; 39:847-858. [PMID: 33038560 DOI: 10.1016/j.accpm.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
Abstract
Despite numerous studies, controversies about the best intraoperative FiO2 remain. In 2016, the World Health Organization (WHO) recommended that adult patients undergoing general anaesthesia should be ventilated intraoperatively with an 80% FiO2 to reduce surgical site infection (SSI). However, several data suggest that hyperoxia could have adverse effects. In order to determine the potential effect of FiO2 on SSI, we included in this systematic review 23 studies (among which 21 randomised controlled trials [RCT]) published between 1999 and 2020, comparing intraoperative high versus low FiO2. Results were heterogeneous but most recent studies on one hand, and the largest RCTs on the other hand, reported no difference on the incidence of SSI regarding intraoperative FiO2 during general anaesthesia. There was also no difference in the incidence of SSI depending of intraoperative FiO2 in patients receiving regional anaesthesia. The review on secondary endpoints (respiratory and cardiovascular adverse events, postoperative nausea and vomiting, postoperative length-of-stay and mortality) also failed to support the use of high FiO2. On the opposite, some data from follow-up analyses and registry studies suggested a possible negative effect of high intraoperative FiO2 on long-term outcomes. In conclusion, the systematic administration of a high intraoperative FiO2 in order to decrease SSI or improve other perioperative outcomes seems unjustified in the light of the evidence currently available in the literature.
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Affiliation(s)
- Charlotte Fasquel
- APHP Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, 75020 Paris, France; Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France
| | - Olivier Huet
- Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France; Faculté de médecine et de sciences de la santé de Brest, 29238 Brest, France
| | - Yves Ozier
- Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France; Faculté de médecine et de sciences de la santé de Brest, 29238 Brest, France
| | - Christophe Quesnel
- APHP Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, 75020 Paris, France; Faculté de médecine Sorbonne Université, 75013 Paris, France
| | - Marc Garnier
- APHP Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, 75020 Paris, France; Faculté de médecine Sorbonne Université, 75013 Paris, France.
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4
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Makanyengo SO, Carroll GM, Goggins BJ, Smith SR, Pockney PG, Keely S. Systematic Review on the Influence of Tissue Oxygenation on Gut Microbiota and Anastomotic Healing. J Surg Res 2020; 249:186-196. [PMID: 31986361 DOI: 10.1016/j.jss.2019.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/04/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anastomotic leak rates have not improved over several decades despite improvements in surgical techniques and patient care. The gut microbiome has been implicated in the development of leaks. The exact mechanisms by which tissue oxygenation affects gut microbial composition and anastomotic healing physiology are unclear. Also, commonly used carbon dioxide (CO2) is a known vasodilator that improves tissue oxygen tension. We performed a systematic review to determine the influence of hyperoxia, hypoxia, and hypercapnia on the gut microbiome and anastomotic healing. METHODS A literature search was performed in MEDLINE, EMBASE, and COCHRANE to identify studies investigating the effects of hyperoxia, hypoxia, and hypercapnia on anastomotic healing and gut microbiota published between 1998 and 2018. Two reviewers screened the articles for eligibility and quality. Fifty-three articles underwent full text review, and a narrative synthesis was undertaken. RESULTS Hyperoxia is associated with better anastomotic healing, increased gastrointestinal oxygen tension, and may reduce gut anaerobes. Hypoxia is associated with poor healing and increased gut anaerobes. However, it is unclear if hypoxia is the most important predictor of anastomotic leaks. Low pressure CO2 pneumoperitoneum and mild systemic hypercapnia are both associated with increased gastrointestinal oxygen tension and may improve anastomotic healing. We found no studies which investigated the effect of hypercapnia on gut microbiota in the context of anastomotic healing. CONCLUSIONS Tissue oxygenation influences gut anastomotic healing, but little evidence exists to demonstrate the influence on the gut microbiome in the context of healing. Further studies are needed to determine if anastomotic microbiome changes with altered tissue oxygenation and if this affects healing and leak rates. If confirmed, altering tissue oxygenation through hyperoxia or hypercapnia could be feasible means of altering the microbiome such that anastomotic leak rates reduce.
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Affiliation(s)
- Samwel O Makanyengo
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Georgia M Carroll
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridie J Goggins
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Stephen R Smith
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter G Pockney
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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5
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Inglin RA, Brügger LE, Candinas D, Harrison BS, Eberli D. Effect of oxygen-producing suture material on hypoxic colonic anastomoses in an experimental model. BJS Open 2019; 3:872-881. [PMID: 31832595 PMCID: PMC6887904 DOI: 10.1002/bjs5.50220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open
Abstract
Background Anastomotic leak remains a significant cause of morbidity and mortality after colorectal surgery. Among multiple risk factors considered, hypoxia–ischaemia is considered to be a primary cause of intestinal anastomotic leakage. The aim of this experimental study was to assess safety, usability for surgical tasks, and efficacy of a newly developed oxygen‐producing suture material in the healing of colonic anastomoses under critical conditions. Methods An oxygen‐producing suture material was produced that is capable of releasing oxygen directly into the surrounding tissue. Off‐the‐shelf sutures loaded with calcium peroxide nano‐crystals and covered with poly(d,l‐lactide‐co‐glycolide) were assessed in vitro and in a rat model of hypoxic colonic anastomosis. Results In vitro assessment showed that these sutures can increase oxygen levels in a hypoxic environment. Potential oxygen byproducts did not seem to have a negative impact on the viability of intestinal cells. The use of oxygen‐producing sutures in vivo resulted in increased tissue oxygen saturation, measured by visible light spectroscopy, and increased mechanical stability of the anastomosis. Conclusion Oxygen‐producing suture material increased tissue oxygen saturation and mechanical stability of colonic anastomosis in a rat model. |
Surgical relevance
- R. A. Inglin
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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- L. E. Brügger
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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- D. Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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- B. S. Harrison
- Wake Forest Institute for Regenerative MedicineWake Forest University, Medical Center BoulevardWinston‐SalemNorth CarolinaUSA
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- D. Eberli
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
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Espinel-Rupérez J, Martín-Ríos MD, Salazar V, Baquero-Artigao MR, Ortiz-Díez G. Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact.
Vet Rec Open 2019;
6:e000233. [PMID:
31673370 PMCID:
PMC6802975 DOI:
10.1136/vetreco-2017-000233]
[Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 06/28/2019] [Accepted: 08/27/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives
To determine (1) the incidence of surgical site infection (SSI) in patients undergoing soft tissue surgery at a veterinary teaching hospital and to study (2) and describe the main risk factors associated with SSI and (3) assess the economic impact of SSI.
Design
Prospective cohort study.
Setting
Veterinary teaching hospital.
Participants
184 dogs undergoing soft tissue surgery during a 12-month period (October 2013 to September 2014).
Primary outcome measure
Surgical site infection.
Results
Out of the 184 patients analysed, SSI was diagnosed in 16 (8.7 per cent) patients, 13 (81.3 per cent) were classified as superficial incisional infection, 2 (12.5 per cent) as deep incisional infection and 1 (6.3 per cent) as organ/space infection. The administration of steroidal anti-inflammatory drugs (P=0.028), preoperative hyperglycaemia (P=0.015), surgical times longer than 60 minutes (P=0.013), urinary catheterisation (P=0.037) and wrong use of the Elizabethan collar (P=0.025) were identified as risk factors. Total costs increased 74.4 per cent, with an increase in postsurgical costs of 142.2 per cent.
Conclusions
The incidence of SSI was higher than the incidence reported in other published studies, although they were within expected ranges when a surveillance system was implemented. This incidence correlated with an increase in costs. Additionally new important risk factors for its development were detected.
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Affiliation(s)
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- Veronica Salazar
- Department of Anaesthesia, Universidad Alfonso X El Sabio, Madrid, Spain
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- Gustavo Ortiz-Díez
- Small Animal Surgery Service, Universidad Alfonso X El Sabio, Madrid, Spain
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Alvandipour M, Mokhtari-Esbuie F, Baradari AG, Firouzian A, Rezaie M. Effect of Hyperoxygenation During Surgery on Surgical Site Infection in Colorectal Surgery.
Ann Coloproctol 2019;
35:9-14. [PMID:
30879279 PMCID:
PMC6425249 DOI:
10.3393/ac.2018.01.16]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/16/2018] [Indexed: 12/24/2022] Open
Abstract
Purpose
Despite the use of different surgical methods, surgical site infection is still an important cause of mortality and morbidity in patients and imposes a considerable cost on the healthcare system. Administration of supplemental oxygen during surgery has been reported to reduce surgical site infection (SSI); however, that result is still controversial. This study was performed to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of wound infection.
Methods
This study was a prospective double-blind case-control study. The main aim of the study was to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of SSI. Also, secondary outcomes, such as atelectasis, pneumonia, respiratory failure, length of hospital stay, and required hospitalization in the intensive care unit were evaluated.
Results
SSI was recorded in 2 patients (2 of 40, 5%) in the hyperoxygenation group (FiO2 80%) and 6 patients (6 of 40, 15%) in the control group (FiO2 30%) (P < 0.05). Time of hospitalization was 6 ± 6.4 days in the hyperoxygenation group and 9.2 ± 2.4 days in the control group (P < 0.05).
Conclusion
This study showed a positive effect of hyperoxygenation in reducing SSI in colorectal surgery, especially surgery in an emergency setting. When the low risk, low cost, and effectiveness of this method in patients undergoing a laparotomy are considered, it is recommended for all patients undergoing colorectal surgery.
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Affiliation(s)
- Mina Alvandipour
- Department of Colorectal Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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- Farzad Mokhtari-Esbuie
- Department of General Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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- Afshin Gholipour Baradari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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- Abolfazl Firouzian
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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- Mehdi Rezaie
- Department of General Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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8
de Jonge S, Egger M, Latif A, Loke YK, Berenholtz S, Boermeester M, Allegranzi B, Solomkin J. Effectiveness of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: an updated systematic review and meta-analysis.
Br J Anaesth 2019;
122:325-334. [PMID:
30770050 DOI:
10.1016/j.bja.2018.11.024]
[Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND
In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based.
METHODS
We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30-35%) FiO2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression.
RESULTS
Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73-1.07]. There was evidence that high FiO2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64-0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91-1.58); test of interaction; P=0.048].
CONCLUSIONS
The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO2, overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.
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Affiliation(s)
- Stijn de Jonge
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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- Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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- Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
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- Yoon Kong Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
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- Sean Berenholtz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
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- Marja Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, World Health Organization, Geneva, Switzerland.
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- Joseph Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bootsma BT, Huisman DE, Plat VD, Schoonmade LJ, Stens J, Hubens G, van der Peet DL, Daams F. Towards optimal intraoperative conditions in esophageal surgery: A review of literature for the prevention of esophageal anastomotic leakage.
Int J Surg 2018;
54:113-123. [PMID:
29723676 DOI:
10.1016/j.ijsu.2018.04.045]
[Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/02/2018] [Accepted: 04/25/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND
Esophageal anastomotic leakage (EAL) is a severe complication following gastric and esophageal surgery for cancer. Several non-modifiable, patient or surgery related risk factors for EAL have been identified, however, the contribution of modifiable intraoperative parameters remains undetermined. This review provides an overview of current literature on potentially modifiable intraoperative risk factors for EAL.
MATERIALS AND METHODS
The PubMed, EMBASE and Cochrane databases were searched by two researchers independently. Clinical studies published in English between 1970 and January 2017 that evaluated the effect of intraoperative parameters on the development of EAL were included. Levels of evidence as defined by the Centre of Evidence Based Medicine (CEBM) were assigned to the studies.
RESULTS
A total of 25 articles were included in the final analysis. These articles show evidence that anemia, increased amount of blood loss, low pH and high pCO2 values, prolonged duration of procedure and lack of surgical experience independently increase the risk of EAL. Supplemental oxygen therapy, epidural analgesia and selective digestive decontamination seem to have a beneficial effect. Potential risk factors include blood pressure, requirement of blood products, vasopressor use and glucocorticoid administration, however the results are ambiguous.
CONCLUSION
Apart from fixed surgical and patient related factors, several intraoperative factors that can be modified in clinical practice can influence the risk of developing EAL. More prospective, observational studies are necessary focusing on modifiable intraoperative parameters to assess more evidence and to elucidate optimal values of these factors.
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Affiliation(s)
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- Victor Dirk Plat
- Department of Surgery, VU Medical Center Amsterdam, The Netherlands
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- Jurre Stens
- Department of Anesthesiology, VU Medical Center Amsterdam, The Netherlands
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- Guy Hubens
- Department of Surgery, UZA Antwerpen, Belgium
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- Freek Daams
- Department of Surgery, VU Medical Center Amsterdam, The Netherlands
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10
Schietroma M, Colozzi S, Pessia B, Carlei F, Di Furia M, Amicucci G. Laparoscopic Nissen fundoplication: The effects of high-concentration supplemental perioperative oxygen on the inflammatory and immune response: A randomised controlled trial.
J Minim Access Surg 2018;
14:221-229. [PMID:
29582795 PMCID:
PMC6001299 DOI:
10.4103/jmas.jmas_120_16]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background
A number of studies have been reported on the effects of high-concentration oxygen (HCO) on cytokine synthesis, with controversial results. We assessed the effect of administration of perioperative HCO on systemic inflammatory and immune response in patients undergoing laparoscopic Nissen fundoplication (LNF).
Materials and Methods
Patients (n = 117) were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 58) or 80% (n = 59). Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. White blood cells, peripheral lymphocytes subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-1 and IL-6 and C-reactive protein (CRP) were investigated.
Results
A significantly higher concentration of neutrophil elastase, IL-1, IL-6 and CRP was detected post-operatively in the 30% FiO2group patients in comparison with the 80% FiO2group (P < 0.05). A statistically significant change in HLA-DR expression was recorded post-operatively at 24 h, as a reduction of this antigen expressed on monocyte surface in patients from 30% FiO2group; no changes were noted in 80% FiO2group (P < 0.05).
Conclusions
This study demonstrated that perioperative HCO (80%), during LNF, can lead to a reduction in post-operative inflammatory response, and possibly, avoid post-operative immunosuppression.
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Affiliation(s)
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- Sara Colozzi
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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- Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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- Marino Di Furia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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11
Abstract
Surgical site infections (SSIs) lead to adverse patient outcomes, including prolonged hospitalization and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventative measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
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Affiliation(s)
- Bronwen H Garner
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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- Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
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12
O'Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings.
Thorax 2017;
72:ii1-ii90. [DOI:
10.1136/thoraxjnl-2016-209729]
[Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
13
The Effects of High-Concentration Oxygen on Inflammatory Markers in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.
Surg Laparosc Endosc Percutan Tech 2017;
27:83-89. [DOI:
10.1097/sle.0000000000000326]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
14
van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, Slooter GD. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together.
Int J Surg 2016;
36:183-200. [PMID:
27756644 DOI:
10.1016/j.ijsu.2016.09.098]
[Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND
Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation.
METHODS
Two independent literature searches were performed using EMBASE, Pubmed and Cochrane databases. Both clinical and experimental studies published in English from 1985 to August 2015 were included. The main outcome measure was the risk of anastomotic leakage and other postoperative complications during colorectal surgery. Determined risk factors of CAL were stated as strong evidence (level I and II high quality studies), and potential risk factors as either moderate evidence (experimental studies level III), or weak evidence (level IV or V studies).
RESULTS
The final analysis included 117 articles. Independent factors of CAL are diabetes mellitus, hyperglycemia and a high HbA1c, anemia, blood loss, blood transfusions, prolonged operating time, intraoperative events and contamination and a lack of antibiotics. Unequivocal are data on blood pressure, the use of inotropes/vasopressors, oxygen suppletion, type of analgesia and goal directed fluid therapy. No studies could be found identifying the impact of body core temperature or mean arterial pressure on CAL. Subjective factors such as the surgeons' own assessment of local perfusion and visibility of the operating field have not been the subject of relevant studies for occurrence in patients with CAL.
CONCLUSION
Both surgery related and non-surgery related risk factors that can be modified must be identified to improve colorectal care. Surgeons and anesthesiologists should cooperate on these items in their continuous effort to reduce the number of CAL. A registration study determining individual intraoperative risk factors of CAL is currently performed as a multicenter cohort study in the Netherlands.
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Affiliation(s)
- S J van Rooijen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands.
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- D Huisman
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
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- M Stuijvenberg
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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- J Stens
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
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- R M H Roumen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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- F Daams
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
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- G D Slooter
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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15
Yang W, Liu Y, Zhang Y, Zhao QH, He SF. Effect of intra-operative high inspired oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials.
J Hosp Infect 2016;
93:329-38. [DOI:
10.1016/j.jhin.2016.03.015]
[Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/03/2016] [Indexed: 02/01/2023]
16
Rasmussen LS, Meyhoff CS, Jørgensen LN, Wetterslev J. Effect of intraoperative high oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials.
J Hosp Infect 2016;
94:207-8. [PMID:
27480018 DOI:
10.1016/j.jhin.2016.05.023]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- L S Rasmussen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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- C S Meyhoff
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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- L N Jørgensen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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- J Wetterslev
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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17
Effect of intraoperative high oxygen concentrations on surgical site infection.
J Hosp Infect 2016;
94:206-7. [PMID:
27480017 DOI:
10.1016/j.jhin.2016.06.023]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 11/23/2022]
18
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update.
Infect Control Hosp Epidemiol 2016;
35 Suppl 2:S66-88. [DOI:
10.1017/s0899823x00193869]
[Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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19
Supplemental Peri-Operative Oxygen and Incision Site Infection after Surgery for Perforated Peptic Ulcer: A Randomized, Double-Blind Monocentric Trial.
Surg Infect (Larchmt) 2016;
17:106-13. [DOI:
10.1089/sur.2013.132]
[Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
20
Boersema GSA, Wu Z, Kroese LF, Vennix S, Bastiaansen-Jenniskens YM, van Neck JW, Lam KH, Kleinrensink GJ, Jeekel J, Lange JF. Hyperbaric oxygen therapy improves colorectal anastomotic healing.
Int J Colorectal Dis 2016;
31:1031-1038. [PMID:
27041554 PMCID:
PMC4834105 DOI:
10.1007/s00384-016-2573-y]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE
Hyperbaric oxygen treatment (HBOT) has been found to improve the healing of poorly oxygenated tissues. This study aimed to investigate the influence of HBOT on the healing in ischemic colorectal anastomosis.
METHODS
Forty Wistar rats were randomly divided into a treatment group that received HBOT for 10 consecutive days (7 days before and 3 days after surgery), or in a control group, which did not receive the therapy. Colectomy with an ischemic anastomosis was performed in all rats. In each group, the rats were followed for 3 or 7 days after surgery to determine the influence of HBOT on anastomotic healing.
RESULTS
Five rats from each group died during follow-up. No anastomotic dehiscence was seen in the HBOT group, compared to 37.5 % and 28.6 % dehiscence in the control group on postoperative day (POD) 3 and 7, respectively. The HBOT group had a significantly higher bursting pressure (130.9 ± 17.0 mmHg) than the control group (88.4 ± 46.7 mmHg; p = 0.03) on POD 3. On POD 3 and POD 7, the adhesion severity was significantly higher in the control groups than in the HBOT groups (p < 0.005). Kidney function (creatinine level) of the HBOT group was significantly better than of the control group on POD 7 (p = 0.001). Interestingly, a significantly higher number of CD206+ cells (marker for type 2 macrophages) was observed in the HBOT group at the anastomotic area on POD 3.
CONCLUSION
Hyperbaric oxygen enhanced the healing of ischemic anastomoses in rats and improved the postoperative kidney function.
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Affiliation(s)
- G S A Boersema
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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- Z Wu
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
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- L F Kroese
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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- S Vennix
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
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- J W van Neck
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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- K H Lam
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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- G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
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- J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
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- J F Lange
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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21
Wetterslev J, Meyhoff CS, Jørgensen LN, Gluud C, Lindschou J, Rasmussen LS. The effects of high perioperative inspiratory oxygen fraction for adult surgical patients.
Cochrane Database Syst Rev 2015;
2015:CD008884. [PMID:
26110757 PMCID:
PMC6457590 DOI:
10.1002/14651858.cd008884.pub2]
[Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND
Available evidence on the effects of a high fraction of inspired oxygen (FIO2) of 60% to 90% compared with a routine fraction of inspired oxygen of 30% to 40%, during anaesthesia and surgery, on mortality and surgical site infection has been inconclusive. Previous trials and meta-analyses have led to different conclusions on whether a high fraction of supplemental inspired oxygen during anaesthesia may decrease or increase mortality and surgical site infections in surgical patients.
OBJECTIVES
To assess the benefits and harms of an FIO2 equal to or greater than 60% compared with a control FIO2 at or below 40% in the perioperative setting in terms of mortality, surgical site infection, respiratory insufficiency, serious adverse events and length of stay during the index admission for adult surgical patients.We looked at various outcomes, conducted subgroup and sensitivity analyses, examined the role of bias and applied trial sequential analysis (TSA) to examine the level of evidence supporting or refuting a high FIO2 during surgery, anaesthesia and recovery.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, BIOSIS, International Web of Science, the Latin American and Caribbean Health Science Information Database (LILACS), advanced Google and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) up to February 2014. We checked the references of included trials and reviews for unidentified relevant trials and reran the searches in March 2015. We will consider two studies of interest when we update the review.
SELECTION CRITERIA
We included randomized clinical trials that compared a high fraction of inspired oxygen with a routine fraction of inspired oxygen during anaesthesia, surgery and recovery in individuals 18 years of age or older.
DATA COLLECTION AND ANALYSIS
Two review authors extracted data independently. We conducted random-effects and fixed-effect meta-analyses, and for dichotomous outcomes, we calculated risk ratios (RRs). We used published data and data obtained by contacting trial authors.To minimize the risk of systematic error, we assessed the risk of bias of the included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied trial sequential analyses. We used Grades of Recommendation, Assessment, Development and Evaluation (GRADE) to assess the quality of the evidence.
MAIN RESULTS
We included 28 randomized clinical trials (9330 participants); in the 21 trials reporting relevant outcomes for this review, 7597 participants were randomly assigned to a high fraction of inspired oxygen versus a routine fraction of inspired oxygen.In trials with an overall low risk of bias, a high fraction of inspired oxygen compared with a routine fraction of inspired oxygen was not associated with all-cause mortality (random-effects model: RR 1.12, 95% confidence interval (CI) 0.93 to 1.36; GRADE: low quality) within the longest follow-up and within 30 days of follow-up (Peto odds ratio (OR) 0.99, 95% CI 0.61 to 1.60; GRADE: low quality). In a trial sequential analysis, the required information size was not reached and the analysis could not refute a 20% increase in mortality. Similarly, when all trials were included, a high fraction of inspired oxygen was not associated with all-cause mortality to the longest follow-up (RR 1.07, 95% CI 0.87 to 1.33) or within 30 days of follow-up (Peto OR 0.83, 95% CI 0.54 to 1.29), both of very low quality according to GRADE. Neither was a high fraction of inspired oxygen associated with the risk of surgical site infection in trials with low risk of bias (RR 0.86, 95% CI 0.63 to 1.17; GRADE: low quality) or in all trials (RR 0.87, 95% CI 0.71 to 1.07; GRADE: low quality). A high fraction of inspired oxygen was not associated with respiratory insufficiency (RR 1.25, 95% CI 0.79 to 1.99), serious adverse events (RR 0.96, 95% CI 0.65 to 1.43) or length of stay (mean difference -0.06 days, 95% CI -0.44 to 0.32 days).In subgroup analyses of nine trials using preoperative antibiotics, a high fraction of inspired oxygen was associated with a decrease in surgical site infections (RR 0.76, 95% CI 0.60 to 0.97; GRADE: very low quality); a similar effect was noted in the five trials adequately blinded for the outcome assessment (RR 0.79, 95% CI 0.66 to 0.96; GRADE: very low quality). We did not observe an effect of a high fraction of inspired oxygen on surgical site infections in any other subgroup analyses.
AUTHORS' CONCLUSIONS
As the risk of adverse events, including mortality, may be increased by a fraction of inspired oxygen of 60% or higher, and as robust evidence is lacking for a beneficial effect of a fraction of inspired oxygen of 60% or higher on surgical site infection, our overall results suggest that evidence is insufficient to support the routine use of a high fraction of inspired oxygen during anaesthesia and surgery. Given the risk of attrition and outcome reporting bias, as well as other weaknesses in the available evidence, further randomized clinical trials with low risk of bias in all bias domains, including a large sample size and long-term follow-up, are warranted.
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Affiliation(s)
- Jørn Wetterslev
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
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- Christian S Meyhoff
- Bispebjerg Hospital, University of CopenhagenDepartment of AnaesthesiologyCopenhagen NVDenmark
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- Lars N Jørgensen
- Bispebjerg Hospital, University of CopenhagenDepartment of Surgery KBispebjerg Bakke 23CopenhagenDenmark2400 NV
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- Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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- Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
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- Lars S Rasmussen
- Rigshospitalet, University of CopenhagenDepartment of Anaesthesia, Centre of Head and OrthopaedicsDpt. 4231Blegdamsvej 9CopenhagenDenmarkDK‐2100 Ø
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22
Eker T, Genc V, Sevim Y, Cumaogullari O, Ozcelik M, Kocaay AF, Ensari CÖ, Pasaoglu OT. The effects of ventilation with high density oxygen on the strength of gastrointestinal anastomosis.
Ann Surg Treat Res 2015;
89:17-22. [PMID:
26131440 PMCID:
PMC4481027 DOI:
10.4174/astr.2015.89.1.17]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/08/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose
The aim of our study is to evaluate the effects of administration of perioperative supplemental oxygen on anastomoses.
Methods
Forty male Wistar albino rats were used in the study and randomized into 4 groups. Ischemia-reperfusion models were built in groups 3 and 4. Jejunojejunostomy was performed in all rats and assigned to an oxygen/nitrous oxide mixture with a fraction of inspired oxygen of 30% in groups 1 and 3 and 80% in groups 2 and 4. The measurements of perianastomotic tissue oxygen pressure, bursting pressure, level of hydroxyproline were evaluated and compared in all groups.
Results
The perianastomotic tissue oxygen pressures, bursting pressures and levels of hydroxyproline were identified as significantly high in groups 2 and 4, administered a fraction of inspired oxygen of 80%, compared to groups 1 and 3, administered a fraction of inspired oxygen of 30%.
Conclusion
Perioperative supplemental oxygen contributes positively to the anastomotic healing.
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Affiliation(s)
- Tevfik Eker
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
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- Volkan Genc
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
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- Yusuf Sevim
- Department of General Surgery, Ankara Penal Institution Campus State Hospital, Ankara, Turkey
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- Menekse Ozcelik
- Department of Anesthesiology and Reanimation, Ankara University Medical School, Ankara, Turkey
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- Akin Firat Kocaay
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
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- Cemal Özben Ensari
- Department of General Surgery, Antalya Education and Training Hospital, Antalya, Turkey
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- Ozge Tugce Pasaoglu
- Department of Medical Biochemistry, Gazi University Medical School, Ankara, Turkey
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23
Schietroma M, Piccione F, Cecilia EM, Carlei F, De Santis G, Sista F, Amicucci G. RETRACTED: How Does High-Concentration Supplemental Perioperative Oxygen Influence Surgical Outcomes after Thyroid Surgery? A Prospective, Randomized, Double-Blind, Controlled, Monocentric Trial.
J Am Coll Surg 2015;
220:921-33. [DOI:
10.1016/j.jamcollsurg.2015.01.046]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/13/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
24
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks.
Br J Surg 2015;
102:462-79. [PMID:
25703524 DOI:
10.1002/bjs.9697]
[Citation(s) in RCA: 579] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND
Anastomotic leak (AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs.
METHODS
A systematic review was performed to identify adjustable and non-adjustable preoperative, intraoperative and postoperative factors in the pathogenesis of AL. Additionally, a severity grading system was proposed to guide treatment.
RESULTS
Of 1707 papers screened, 451 fulfilled the criteria for inclusion in the review. Significant preoperative risk factors were: male sex, American Society of Anesthesiologists fitness grade above II, renal disease, co-morbidity and history of radiotherapy. Tumour-related factors were: distal site, size larger than 3 cm, advanced stage, emergency surgery and metastatic disease. Adjustable risk factors were: smoking, obesity, poor nutrition, alcohol excess, immunosuppressants and bevacizumab. Intraoperative risk factors were: blood loss/transfusion and duration of surgery more than 4 h. Stomas lessen the consequences but not the prevalence of AL. In the postoperative period, CT is the most commonly used imaging tool, with or without rectal contrast, and a C-reactive protein level exceeding 150 mg/l on day 3-5 is the most sensitive biochemical marker. A five-level classification system for AL severity and appropriate management is presented.
CONCLUSION
Specific risk factors and their potential correction or indications for stoma were identified. An AL severity score is proposed to aid clinical decision-making.
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Affiliation(s)
- F D McDermott
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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25
RETRACTED: High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: a prospective, randomized, double-blind, controlled, single-site trial.
Am J Surg 2014;
208:719-726. [DOI:
10.1016/j.amjsurg.2014.04.002]
[Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/30/2014] [Accepted: 04/18/2014] [Indexed: 11/17/2022]
26
Helito CP, Junqueira JJM, Gobbi RG, Angelini FJ, Rezende MU, Tírico LEP, Demange MK, Mota e Albuquerque RFD, Pécora JR, Camanho GL. Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty.
Clinics (Sao Paulo) 2014;
69:735-9. [PMID:
25518030 PMCID:
PMC4255075 DOI:
10.6061/clinics/2014(11)05]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/12/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES
Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter.
METHOD
A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection.
RESULTS
There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation.
CONCLUSION
Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.
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Affiliation(s)
- Camilo Partezani Helito
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Jader Joel Machado Junqueira
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Ricardo Gomes Gobbi
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Fábio Janson Angelini
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Marcia Uchoa Rezende
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Luis Eduardo Passarelli Tírico
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Marco Kawamura Demange
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- José Ricardo Pécora
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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- Gilberto Luis Camanho
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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27
Anderson DJ. Prevention of surgical site infection: beyond SCIP.
AORN J 2014;
99:315-9. [PMID:
24472594 DOI:
10.1016/j.aorn.2013.11.007]
[Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/11/2013] [Indexed: 01/07/2023]
28
van Vugt JLA, Reisinger KW, Derikx JPM, Boerma D, Stoot JHMB. Improving the outcomes in oncological colorectal surgery.
World J Gastroenterol 2014;
20:12445-12457. [PMID:
25253944 PMCID:
PMC4168077 DOI:
10.3748/wjg.v20.i35.12445]
[Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 03/18/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.
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29
Øines MN, Krarup PM, Jorgensen LN, Ågren MS. Pharmacological interventions for improved colonic anastomotic healing: A meta-analysis.
World J Gastroenterol 2014;
20:12637-12648. [PMID:
25253969 PMCID:
PMC4168102 DOI:
10.3748/wjg.v20.i35.12637]
[Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/10/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify pharmaceuticals for the prophylaxis of anastomotic leakage (AL), we systematically reviewed studies on anastomosis repair after colorectal surgery.
METHODS: We searched PubMed and EMBASE for articles published between January 1975 and December 2012. We included studies in English with the primary purpose of promoting healing of anastomoses made in the colon or rectum under uncomplicated conditions. We excluded studies on adverse events from interventions, nutritional interventions or in situ physical supporting biomaterials. The primary outcome was biomechanical strength or AL. We performed meta-analyses on therapeutic agents investigated by three or more independent research groups using the same outcome. The DerSimonian-Laird method for random effects was applied with P < 0.05.
RESULTS: Of the 56 different therapeutic agents assessed, 7 met our inclusion criteria for the meta-analysis. The prostacyclin analog iloprost increased the weighted mean of the early bursting pressure of colonic anastomoses in male rats by 60 mmHg (95%CI: 30-89) vs the controls, and the immunosuppressant tacrolimus increased this value by 29 mmHg (95%CI: 4-53) vs the controls. Erythropoietin showed an enhancement of bursting pressure by 45 mmHg (95%CI: 14-76). The anabolic compound growth hormone augmented the anastomotic strength by 21 mmHg (95%CI: 7-35), possibly via the up-regulation of insulin-like growth factor-1, as this growth factor increased the bursting pressure by 61 mmHg (95%CI: 43-79) via increased collagen deposition. Hyperbaric oxygen therapy increased the bursting pressure by 24 mmHg (95%CI: 13-34). Broad-spectrum matrix metalloproteinase inhibitors increased the bursting pressure by 48 mmHg (95%CI: 31-66) on postoperative days 3-4. In the only human study, the AL incidence was not significantly reduced in the 103 colorectal patients treated with aprotinin (11.7%) compared with the 113 placebo-treated patients (9.7%).
CONCLUSION: This systematic review identified only one randomized clinical trial and seven therapeutic agents from pre-clinical models that could be explored further for the prophylaxis of AL after colorectal surgery.
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30
Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update.
Infect Control Hosp Epidemiol 2014;
35:605-27. [PMID:
24799638 PMCID:
PMC4267723 DOI:
10.1086/676022]
[Citation(s) in RCA: 581] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2
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Affiliation(s)
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- Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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- Linda Greene
- Highland Hospital and University of Rochester Medical Center, Rochester, New York
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- Ann-Christine Nyquist
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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- Lisa Saiman
- Columbia University Medical Center, New York, New York
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- Deborah S. Yokoe
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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- Keith S. Kaye
- Detroit Medical Center and Wayne State University, Detroit, Michigan
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31
Testini M, Franco IF, Ferraro V, Gurrado A, Lissidini G. Analysis of Surgical Risk Factors in Tailoring Digestive Anastomosis.
ENDOSCOPIC FOLLOW-UP OF DIGESTIVE ANASTOMOSIS 2014:3-10. [DOI:
10.1007/978-88-470-5370-0_1]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
32
Effect of intraoperative high inspired oxygen fraction on surgical site infection, postoperative nausea and vomiting, and pulmonary function: systematic review and meta-analysis of randomized controlled trials.
Anesthesiology 2013;
119:303-16. [PMID:
23719611 DOI:
10.1097/aln.0b013e31829aaff4]
[Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND
Intraoperative high inspired oxygen fraction (FIO2) is thought to reduce the incidence of surgical site infection (SSI) and postoperative nausea and vomiting, and to promote postoperative atelectasis.
METHODS
The authors searched for randomized trials (till September 2012) comparing intraoperative high with normal FIO2 in adults undergoing surgery with general anesthesia and reporting on SSI, nausea or vomiting, or pulmonary outcomes.
RESULTS
The authors included 22 trials (7,001 patients) published in 26 reports. High FIO2 ranged from 80 to 100% (median, 80%); normal FIO2 ranged from 30 to 40% (median, 30%). In nine trials (5,103 patients, most received prophylactic antibiotics), the incidence of SSI decreased from 14.1% with normal FIO2 to 11.4% with high FIO2; risk ratio, 0.77 (95% CI, 0.59-1.00). After colorectal surgery, the incidence of SSI decreased from 19.3 to 15.2%; risk ratio, 0.78 (95% CI, 0.60-1.02). In 11 trials (2,293 patients), the incidence of nausea decreased from 24.8% with normal FIO2 to 19.5% with high FIO2; risk ratio, 0.79 (95% CI, 0.66-0.93). In patients receiving inhalational anesthetics without prophylactic antiemetics, high FIO2 provided a significant protective effect against both nausea and vomiting. Nine trials (3,698 patients) reported on pulmonary outcomes. The risk of atelectasis was not increased with high FIO2.
CONCLUSIONS
Intraoperative high FIO2 further decreases the risk of SSI in surgical patients receiving prophylactic antibiotics, has a weak beneficial effect on nausea, and does not increase the risk of postoperative atelectasis.
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33
Sista F, Abruzzese V, Schietroma M, Cecilia EM, Mattei A, Amicucci G. New harmonic scalpel versus conventional hemostasis in right colon surgery: a prospective randomized controlled clinical trial.
Dig Surg 2013;
30:355-61. [PMID:
24080607 DOI:
10.1159/000354864]
[Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND
The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient.
METHODS
A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications.
RESULTS
Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time.
CONCLUSION
NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.
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Affiliation(s)
- Federico Sista
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie, University of L'Aquila, L'Aquila, Italy
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34
Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K. Do we really know why colorectal anastomoses leak?
J Gastrointest Surg 2013;
17:1698-707. [PMID:
23690209 DOI:
10.1007/s11605-013-2227-0]
[Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 04/30/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION
Colorectal anastomotic leak, a feared complication, results in significantly increased patient morbidity, mortality, and hospital resource utilization. The overall incidence of colorectal anastomotic leak is approximately 11% with increasing rate the closer the anastomosis is to the anal verge. Because surgeons are unable to reliably predict which anastomosis would fail, most will construct a diverting ileostomy for low colorectal anastomosis to circumvent the devastating complications of anastomotic failure. Despite extensive investigations on technical considerations of anastomosis construction, anastomotic leaks continue to occur at an unacceptably high rate.
DISCUSSION
In this review, we examine the major known risk factors and technical considerations that have been implicated as factors in leakage. Although surgical technique has evolved over the past several decades with the advent of newer surgical staplers, laparoscopy, and robotics, we have not witnessed a decrease in the incidence of colorectal anastomotic leaks suggesting that the fundamental pathogenesis of anastomotic leak remains unknown. Among the factors contributing to anastomotic healing, intestinal bacteria remains largely overlooked even though compelling evidence exist that intraluminal microbes could play a major role in pathogenesis of anastomotic leak. Further investigation focusing on intestinal microbes could be one such avenue for uncovering the elusive cause of colorectal anastomotic leak.
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Affiliation(s)
- Benjamin D Shogan
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
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35
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Ferrando C, Carbonell JA, Gutierrez A, Hernandez J, Belda J. Mechanical ventilation in the operating room: Adjusting VT, PEEP, and FiO2.
TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI:
10.1016/j.tacc.2012.09.002]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
37
Adamina M, Gié O, Demartines N, Ris F. Contemporary perioperative care strategies.
Br J Surg 2012;
100:38-54. [DOI:
10.1002/bjs.8990]
[Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Historically, the preoperative and postoperative care of patients with gastrointestinal cancer was provided by surgeons. Contemporary perioperative care is a truly multidisciplinary endeavour with implications for cancer-specific outcomes.
Methods
A literature review was performed querying PubMed and the Cochrane Library for articles published between 1966 to 2012 on specific perioperative interventions with the potential to improve the outcomes of surgical oncology patients. Keywords used were: fast-track, enhanced recovery, accelerated rehabilitation, multimodal and perioperative care. Specific interventions included normothermia, hyperoxygenation, surgical-site infection, skin preparation, transfusion, non-steroidal anti-inflammatory drugs, thromboembolism and antibiotic prophylaxis, laparoscopy, radiotherapy, perioperative steroids and monoclonal antibodies. Included articles had to be randomized controlled trials, prospective or nationwide series, or systematic reviews/meta-analyses, published in English, French or German.
Results
Important elements of modern perioperative care that improve recovery of patients and outcomes in surgical oncology include accelerated recovery pathways, thromboembolism and antibiotic prophylaxis, hyperoxygenation, maintenance of normothermia, avoidance of blood transfusion and cautious use of non-steroidal anti-inflammatory drugs, promotion of laparoscopic surgery, chlorhexidine–alcohol skin preparation and multidisciplinary meetings to determine multimodal therapy.
Conclusion
Multidisciplinary management of perioperative patient care has improved outcomes.
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Affiliation(s)
- M Adamina
- Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
- Institute for Surgical Research and Hospital Management, University of Basel, Basel, Switzerland
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- O Gié
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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- N Demartines
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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- F Ris
- Division of Visceral and Transplantation Surgery, Geneva University Hospitals, Geneva, Switzerland
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38
Davis B, Rivadeneira DE. Complications of colorectal anastomoses: leaks, strictures, and bleeding.
Surg Clin North Am 2012. [PMID:
23177066 DOI:
10.1016/j.suc.2012.09.014]
[Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intestinal anastomosis is an essential part of surgical practice, and with it comes the inherent risk of complications including leaks, strictures, and bleeding, which result in significant morbidity and occasional mortality. Understanding the myriad of risk factors and the strength of the data helps guide a surgeon as to the safety of undertaking an operation in which a primary anastomosis is to be considered. This article reviews the risk factors, management, and outcomes associated with anastomotic complications.
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Affiliation(s)
- Bradley Davis
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA.
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39
Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Piccione F, Amicucci G. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration: a prospective randomized, double-blind, controlled, single-center trial.
Ann Surg Oncol 2012;
20:1584-90. [PMID:
23099730 DOI:
10.1245/s10434-012-2714-7]
[Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND
The role of supplemental oxygen therapy in the healing of esophagojejunal anastomosis is still very much in an experimental stage. The aim of the present prospective, randomized study was to assess the effect of administration of perioperative supplemental oxygen therapy on esophagojejunal anastomosis, where the risk of leakage is high.
METHODS
We enrolled 171 patients between January 2009 and April 2012 who underwent elective open esophagojejunal anastomosis for gastric cancer. Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30 % (n = 85) or 80 % (n = 86). Administration commenced after induction of anesthesia and was maintained for 6 h after surgery.
RESULTS
The overall anastomotic leak rate was 14.6 % (25 of 171): 17 patients (20 %) had an anastomotic dehiscence in the 30 % FiO2 group and 8 (9.3 %) in the 80 % FiO2 group (P < 0.05). The risk of anastomotic leak was 49 % lower in the 80 % FiO2 group (relative risk 0.61; 95 % confidence interval 0.40-0.95) versus 30 % FiO2.
CONCLUSIONS
Supplemental 80 % FiO2 provided during and for 6 h after major gastric cancer surgery to reduce postoperative anastomotic dehiscence should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.
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40
Lázár G. [Intestinal surgery].
Magy Seb 2012;
65:116-28. [PMID:
22717966 DOI:
10.1556/maseb.65.2012.3.6]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- György Lázár
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged
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