Purpose To evaluate the role of the nucleotide oligomerization domain 2 (NOD2) mutation status and other risk factors for the incidence of postoperative complications after ileocolic resection for Crohn’s disease (CD). Methods Data of 138 patients consecutively undergoing ileocolic resection for CD at a tertiary academic referral center were retrospectively analyzed including single nucleotide polymorphism (SNP) data of the NOD2 gene. Uni- and multivariate regression analysis was performed to identify factors associated with increased risk of severe postoperative complications. Results From 114 patients (83%), the NOD2 mutation status was available. Of these, 60 (53%) had a NOD2 wildtype, whereas eleven (10%) were homozygous for the high risk p.Leu1007fsX1008 (rs2066847) variant. Major postoperative complications occurred in 28 patients (20%). Twenty-seven of these (96%) were intraabdominal septic complications such as anastomotic leakage or abscess. Male gender (P = 0.029; OR 3.052, the duration of CD (time [months] from initial diagnosis of CD to surgery; P = 0.001; OR 1.009), previous abdominal surgery for CD (P = 0.017; OR 3.49), and the presence of enteric fistulas (P = 0.023; OR 3.21) were identified as independent risk factors for major postoperative complications. Homozygosity for the NOD2 high-risk variant p.Leu1007fsX1008 did not show increased postoperative morbidity in the short and long-term outcome. Conclusions We could detect independent risk factors for major postoperative complications after ileocolic resection for Crohn’s disease. However, patients with the high-risk variant p.Leu1007fsX1008 of the NOD2 gene did not show increased postoperative morbidity.
ObjectiveAnastomotic leakage, surgical site infections, and other infectious complications are still common complications in gastrointestinal surgery. The concept of perioperative antibiotic bowel decontamination demonstrates beneficial effects in single randomized controlled trials (RCTs), but data from routine clinical use are still sparse. Our aim was to analyze the data from the routine clinical use of perioperative antibiotic bowel decontamination in gastrointestinal surgery.MethodsBased on 20 years’ experience, we performed a retrospective analysis of all cases in oncologic gastrointestinal surgery with the use of antibiotic bowel decontamination in gastric, sigmoid, and rectal cancer. Clinical data and perioperative outcomes were analyzed, especially regarding anastomotic leakage, surgical site infections, and other infectious complications.ResultsA total of n = 477 cases of gastrointestinal surgery in gastric cancer (n = 80), sigmoid cancer (n = 168), and rectal cancer (n = 229) using a perioperative regimen of antibiotic bowel decontamination could be included in this analysis. Overall, anastomotic leakage occurred in 4.4% (2.5% gastric cancer, 3.0% sigmoid cancer, 6.1% rectal cancer) and surgical site infections in 9.6% (6.3% gastric cancer, 9.5% sigmoid cancer, 10.9% rectal cancer). The incidence of all infectious complications was 13.6% (12.5% gastric cancer, 11.3% sigmoid cancer, 15.7% rectal cancer). Mortality was low, with an overall rate of 1.1% (1.3% gastric cancer, 1.8% sigmoid cancer, 0.4% rectal cancer). Antibiotic decontamination was completed in 98.5%. No adverse effects of antibiotic bowel decontamination could be observed.ConclusionOverall, in this large cohort, we can report low rates of surgery-related serious morbidity and mortality when perioperative antibiotic bowel decontamination is performed. The rates are lower than other clinical reports. In our clinical experience, the use of perioperative antibiotic bowel decontamination appears to improve patient safety and surgical outcomes during gastrointestinal oncologic procedures in a routine clinical setting.
Zusammenfassung Einleitung Die neue, vermehrt kompetenzbasierte Weiterbildungsordnung für die chirurgische Weiterbildung (WBO) trat in Bayern im August 2022 in Kraft. Methoden Von Mai bis Juli 2022 führten wir eine anonymisierte Onlineumfrage unter den bayerischen Allgemein- und Viszeralchirurginnen und -cChirurgen sowie den Ärzt*innen in Weiterbildung (ÄiW) durch. Ziel war die Erfragung der Erwartungen an die Effekte der neuen WBO. Ergebnisse Die Rücklaufquote betrug 35 %; insgesamt konnten Daten von 80 Personen erhoben werden: 36 ÄiW (45 %), 30 Fach- und Oberärzt*innen (37,5 %) und 14 Chefärzt*innen (17,5 %). Die Mehrheit der Befragten arbeitete an einem Universitätsklinikum (38,8 %) oder Regelversorger (35 %). Eine Stärkung der Handlungskompetenz durch Umsetzung der neuen WBO erwarten 41,3 % und 55,7 % sehen als Ziel ein „selbstständiges Operieren unter teilweiser Aufsicht durch den Ausbilder“. 50 % sehen die geforderten Richtzahlen als nicht erreichbar an, bzw. 55,1 % verneinen ein Erreichen derselben im Zeitraum von 6 Jahren. Etwa 60 % erwarten, nicht die gleiche Anzahl an ÄiW in der gleichen Zeit ausbilden zu können. Fast 75 % der Befragten geben an, dass aus ihrer Sicht eine gute Weiterbildung mit Erreichen einer soliden Handlungskompetenz ohne Überstunden nicht funktioniere. Etwa 44 % der Befragten erwarten, dass die volle Weiterbildung an ihrem Haus auch weiterhin möglich sei. Schlussfolgerung Sowohl unter den Weiterbilder*innen als auch unter den ÄiW besteht tendenziell die Sorge, dass eine realistische Weiterbildung – insbesondere das Erreichen der Richtzahlen in der bisher üblichen Weiterbildungszeit – nicht möglich sein wird. Notwendig ist daher die konsequente Umsetzung einer strukturierten Weiterbildung mit hoher Transparenz der Ausbildung.
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