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PubMed1987

Value of nutritional parameters in the prediction of postoperative complications in elective gastrointestinal surgery.

The following nutritional parameters were assessed in 117 patients before major gastrointestinal surgery: percentage recent weight loss: percentage ideal body weight; tricipital skinfold; arm muscular area; grip strength dynamometry; serum albumin (ALB); serum transferrin (TFN); delayed hypersensitivity skin tests (DH); total lymphocyte count; prognostic nutritional index (PNI) and clinical assessment of malnutrition. Comparing the results in patients without complications (n = 99) with those in patients with complications (n = 18) and the results in patients who survived (n = 109) with those who died (n = 8), we found that only ALB, DH, TFN and PNI showed significant differences in both comparisons. Correlations of complications with combined parameters was made by multiple linear regression analysis; a modified PNI (mPNI), including these three single variables, has emerged. Considering its risk values, the nutritional parameters showed the following sensitivity and specificity, respectively: ALB less than 3.2 g/dl (72 and 71 per cent), anergy (67 and 64 per cent), TFN less than 205 mg/dl (67 and 55 per cent) and mPNI less than 20 (72 and 70 per cent). Using Bayes' theorems, ALB, DH and calculated indices showed the same predictive capacity and we conclude that single or multiple association of nutritional parameters have no additive effect. To predict complications of nutritional origin it seems only necessary to consider ALB, taking into account the type of operation and the normal duration of postoperative hospital stay without oral intake.

Adult↗
PubMed2006

[Pyogenic spondylitis by Enterobacter cloacae as a postoperative complication of TURP: a case report].

We report a case of pyogenic spondylitis caused by Enterobacter cloacae as a rare complication of transurethral resection of the prostate (TURP). A 79-year-old man underwent TURP. Immediate after removal of urethral catheter on postoperative day (POD) 7, he developed high fever > 40 degrees C with increased acute inflammatory reaction. Urine and blood culture detected E. cloacae and methicillin-resistant Staplylococcus aureus. He complained of lumbago since POD 9. Two-week administration of imipenem and teicoplanin resulted in resolution of fever as well as laboratory data, so intravenous antibiotics were changed to oral gatifloxacin. However, his lumbago worsened and gait disturbance appeared. On POD 39, diagnosis of pyogenic spondylitis was finally obtained by Ga-scintigraphy and magnetic resonance imaging. Aspiration of the intervertebral disk (L4-5) revealed E. cloacae as the causative organism of pyogenic spondylitis. His condition improved after conservative treatment with teicoplanin, meropenem and ciplofloxacin for 9 weeks.

Aged↗
PubMed1997

Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington.

Since the late 1970's, an empirical relationship between the volume of procedures performed by a provider (a hospital or surgeon) and the outcome has been documented for various operations. The present study examines the relationship between the volume of hip replacements performed by surgeons and hospitals and the postoperative rate of complications. A statewide hospital discharge registry was used to identify patients who had had an elective hip replacement between 1988 and 1991. Patients who had had a revision procedure, who had been referred on an emergency basis, or who had had a diagnosis of a fracture or a malignant tumor on admission were excluded. There were 7936 eligible patients who had had 8774 hip replacements. The average annual number of all hip replacements performed from 1987 through 1991 was subsequently determined for each hospital and surgeon who had cared for at least one patient in the study cohort. The rate of operative complications was modeled as a function of the volume of procedures performed by the surgeon or hospital (the surgeon or hospital volume), with adjustment for the age of the patient, gender, co-morbidity, and operative diagnosis. We noted significant differences in the case mix of low-volume providers compared with that of high-volume providers (p < 0.01). In general, surgeons and hospitals with a volume below the fortieth percentile managed patients who had a more adverse risk profile in terms of age, co-morbidity, and diagnosis. Even after adjustment for the case mix, there was a significant relationship between surgeons who averaged fewer than two hip replacements annually (low-volume surgeons) and a worse outcome (p < 0.05). Patients managed by these low-volume surgeons tended to have higher mortality rates, more infections, higher rates of revision operations, and more serious complications during the index hospitalization. The duration of hospitalization was inversely related to surgeon volume and directly associated with hospital volume. Hospital charges were inversely related to hospital volume, even after adjustment for patient-related factors as well as the duration of hospitalization, the year of the operation, and the destination after discharge (p < 0.05). More detailed information is required to investigate the reason for these observed variations in the rates of complications. If future studies confirm an association between low-volume providers and an adverse outcome, performance of some types of elective total hip replacements at regional centers should be considered.

Aged↗