Surgery for acute cholecystitis has become the most frequent abdominal surgery in most hospitals, yet aspects of its management remain controversial. The aim of this study was to focus on the recent trends by demonstrating the principal differences between 2 series of patients operated on during 10-year intervals. Two hundred fifty-six consecutive operations for acute cholecystitis were performed from 1970 to 1977 (group O) and were compared to 260 cases operated from 1980 to 1987 (group N). Thirty-six variables were recorded in each case. All data obtained were computer recorded and analyzed. Several trends were observed in group N: 1. The population was significantly older with a higher proportion of males and diabetics. 2. There was a marked increase in common bile duct stones, acalculous cholecystitis, and gangrenous changes in the gallbladder. 3. There was a significant increase in patients operated on within 48 hours of admission. 4. There was a significant increase in the number of patients without previous history of biliary symptoms. 5. There was a significant decrease in the rate of wound infections and no statistically significant differences in mortality (N: 3.0%, O: 2.7%). 6. A decrease of the average postoperative hospital stay of 3.2 days was observed. In spite of the older and sicker population in group N, no significant increase in mortality occurred and the postoperative hospital stay was reduced.

Acute Disease↗

PubMedDate not supplied

Multifactorial analysis of septic bile and septic complications in biliary surgery.

A unifactorial analysis for possible risk factors was applied to 2,700 consecutive operations for benign disease of the biliary tract. A series of high risk factors in relation to positive bacteriology and septic complication could be identified. These risk factors were patients who were elderly (greater than 70 years; p less than 0.001), those who were diabetic, those who had a serum bilirubin greater than 1.1 mg% (p less than 0.001), those who had acute cholecystitis (p less than 0.001), and those in whom choledochal stones were found (p less than 0.001). Using a multivariate analysis, we concluded that in patients with no risk factors (56.9%) the incidence of a positive bacteriology was low (10.9%) and they should receive no antibiotic prophylaxis. Patients with one risk factor (24%), had a 36% incidence of positive bacteriology and minimal pre-operative prophylaxis is recommended. Patients with two or more risk factors (19.1%) had a 77.6% incidence of positive bacteriology and full peri-operative prophylaxis is recommended, starting pre-operatively and continuing for 3 to 5 days postoperatively. The aim of this study was to identify patients at risk for septic complication in biliary surgery and to create new guidelines for the antibiotic treatment of selected groups.

Adolescent↗

PubMedDate not supplied

Surgical problems in octogenarians: epidemiological analysis of 1,083 consecutive admissions.

Patients older than 80 years of age are the most rapidly increasing group among surgical admissions and patients visiting emergency rooms. Epidemiological data of this group are of enormous medical and economic relevance. The principle aim of this study was to determine factors predictive of operative mortality in octagenarians, their clinical profiles, and length of stay compared to younger patients in similar diagnostic categories. A computer-based registry of geriatric surgery was used to record and analyze all relevant clinical and epidemiological data. The rate of admissions in octogenarians increased during the 18-year period (1973-1989) from 0.7% to 7.5% of all admissions. The number of patients undergoing surgery was 700. Three hundred and seventy-one of the procedures were elective and 329 were emergencies. Operations in octagenarians as a percentage of all operative procedures increased during the period considered from 1.1% to 5.1%. The operative mortality in this series was 10.5% prior to 1984 and decreased to 6% during the last 5 years. The average hospital stay of octagenarians was 9.8 days as opposed to 4.9 days in patients less than 70 years of age. The prognostic classification described by the authors proved very helpful in predicting mortality.

Age Factors↗