Postoperative complications and mortality after major gastrointestinal surgery

Jakobson, Triin; Karjagin, Juri; Vipp, Liisa; Padar, Martin; Parik, Ants-Hendrik; Starkopf, Liis; Kern, Hartmut; Tammik, Olavi; Starkopf, Joel

doi:10.1016/j.medici.2014.06.002

Cited by 123 publications

(118 citation statements)

References 27 publications

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“…Although mortality has improved for patients undergoing major abdominal surgery for gastrointestinal, 36 pancreatic, 37 and peritoneal surface 38 malignancies, morbidity is still significant and can affect up to 50% of patients. 39 Based on our retrospective experience with NPWT in surgical oncology patients, 28 we embarked on a randomized phase II trial of NPWT compared with SSD to confirm our initial findings. However, when studied in a prospective fashion, the use of NPWT did not decrease SSIs or wound complications in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies.…”

Section: Discussionmentioning

confidence: 90%

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

Shen

Blackham

Lewis

et al. 2017

Journal of the American College of Surgeons

102

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BACKGROUND Surgical site infections (SSIs) remain a major source of morbidity and cost after resection of intra-abdominal malignancies. Negative-pressure wound therapy (NPWT) has been reported to significantly reduce SSIs when applied to the closed laparotomy incision. This article reports the results of a randomized clinical trial examining the effect of NPWT on SSI rates in surgical oncology patients with increased risk for infectious complications. STUDY DESIGN From 2012 to 2016, two hundred and sixty-five patients who underwent open resection of intra-abdominal neoplasms were stratified into 3 groups: gastrointestinal (n = 57), pancreas (n = 73), or peritoneal surface (n = 135) malignancy. They were randomized to receive NPWT or standard surgical dressing (SSD) applied to the incision from postoperative days 1 through 4. Primary outcomes of combined incisional (superficial and deep) SSI rates were assessed up to 30 days after surgery. RESULTS There were no significant differences in superficial SSIs (12.8% vs 12.9%; p > 0.99) or deep SSI (3.0% vs 3.0%; p > 0.99) rates between the SSD and NPWT groups, respectively. When stratified by type of surgery, there were still no differences in combined incisional SSI rates for gastrointestinal (25% vs 24%; p > 0.99), pancreas (22% vs 22%; p > 0.99), and peritoneal surface malignancy (9% vs 9%; p > 0.99) patients. When performing univariate and multivariate logistic regression analysis of demographic and operative factors for the development of combined incisional SSI, the only independent predictors were preoperative albumin (p = 0.0031) and type of operation (p = 0.018). CONCLUSIONS Use of NPWT did not significantly reduce incisional SSI rates in patients having open resection of gastrointestinal, pancreatic, or peritoneal surface malignancies. Based on these results, at this time NPWT cannot be recommended as a therapeutic intervention to decrease infectious complications in these patient populations.

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Section: Discussionmentioning

confidence: 90%

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

Shen

Blackham

Lewis

et al. 2017

Journal of the American College of Surgeons

102

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“…The occurrence of postoperative delirium sometimes leads to fatal complications, and the length of the patient's hospital stay may be prolonged due to these complications [13] . Despite the presence of several diagnostic scales for delirium [7,[14][15][16] , no prediction scale that is specific for postoperative delirium is available.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Delirium in Abdominal Surgery: A Proposal of a Postoperative Delirium Risk Score in Abdominal Surgery

Miyagawa

Yokoyama²,

Fukuzawa³

et al. 2016

Dig Surg

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Background/Aims: Despite the presence of several diagnosis scales for delirium, no prediction scale that is specific for postoperative delirium after abdominal surgery is available. We sought to create a novel delirium prediction system that is specific for abdominal surgery. Methods: This study included 213 consecutive patients who required management in the surgical ICU following abdominal surgery. The Neelon and Champagne (NEECHAM) Confusion score was monitored throughout the postoperative course and patients with low NEECHAM score (≤26) were diagnosed as having delirium. Results: Seventy-three patients (34%) were categorized in the delirium group. Multivariate analyses indicated that an age >70 years, hypertension, those undergoing hepatopancreatobiliary or upper gastrointestinal surgeries, a serum albumin level <2.5 g/dl on postoperative day (POD) 3 or 5 and a ≥6 mEq/l gap in the serum sodium level between the preoperative value and that on POD 3 were independently associated with a low NEECHAM score (≤26). When the presence of each risk was counted as 1 point, 21 patients had ≥4 points and 15 of them (71%) had low NEECHAM score. Conclusion: The scoring system combining multiple risk factors may be useful for predicting patients with an elevated risk for postoperative delirium after abdominal surgery.

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“…In the last decade, many studies investigated the impact of postoperative complications on hospital costs, survival, and cancer recurrence [7][8][9][10]. In those studies, authors showed that postoperative complications impacted prognosis, recurrence of some types of cancers, and increased hospital costs.…”

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confidence: 99%

The impact of postoperative complications on the recovery of elderly surgical patients

et al. 2015

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Postoperative complications and mortality after major gastrointestinal surgery

Abstract: The complication rate after major gastro-intestinal surgery is high. ASA physical status and revised cardiac risk index adequately reflect increased risk for postoperative complications and worse short and long-term outcome.

Cited by 123 publications

References 27 publications

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

Risk Factors for Postoperative Delirium in Abdominal Surgery: A Proposal of a Postoperative Delirium Risk Score in Abdominal Surgery

The impact of postoperative complications on the recovery of elderly surgical patients

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