Risk score for predicting abdominal complications after coronary artery bypass grafting

BACKGROUND Although early abdominal complications after coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB)are rare,the associated mortality remains high.AIM To develop a risk score for the prediction of early abdominal complications after CABG with CPB.METHODS This retrospective study was performed in the Federal State Budgetary Establishment“Federal Center of Cardiovascular Surgery”of the Ministry of Health of Russia(the city of Chelyabinsk)and included data of 6586 patients who underwent CABG with CPB during 2011-2017.The risk factors taken for evaluation were compared between patients with early abdominal complications(n=73)and without them(n=6513).We identified the most important risk factors and their influence on the development of early abdominal complications after CABG with CPB.RESULTS Gender and the presence of postinfarction cardiosclerosis,chronic kidney disease,or diabetes in the anamnesis did not affect the occurrence of abdominal complications.The leading risk factors of the early abdominal complications after CABG with CPB were multifocal atherosclerosis,extracorporeal membrane oxygenation,intra-aortic balloon pump,atrial fibrillation,perioperative myocardial infarction,and the need for resternotomy in the postoperative period.The average value of the predicted probability was 0.087±0.015 in patients with early abdominal complications after CABG with CPB and 0.0094±0.0003 in patients without these complications.The percentage of correct classification turned out to be 98.9%.After calculating a score for each of the leading risk factors,we counted a total score for each particular patient.The highest risk was noted in patients with a total score of 7 or more.CONCLUSION The developed score predicts the risk of early abdominal complications after CABG with CPB and makes it possible to stratify patients by risk groups.

Antimicrobial approach of abdominal post-surgical infections

Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted materials.Currently,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development Index.The purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.

Development of a Risk Model for Abdominal Wound Dehiscence

Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in the department of surgery, SMHS Hospital Srinagar from March 2009 to April 2015. For each case of abdominal wound dehiscence, three controls were selected from a group of patients who had undergone open abdominal surgery as close as possible in time. Preoperative, perioperative, and postoperative variables and in-hospital mortality were studied for all patients. Cases were compared with controls using the chi-square test or the Mann-Whitney U-test for categorical or continuous data, respectively. Subsequently, multivariate stepwise logistic regression with backwards elimination test used to identify main independent risk factors of abdominal wound dehiscence. The resulting regression coefficients for the major risk factors were used as weights for these variables to calculate a risk score for abdominal wound dehiscence. Results: 140 cases of abdominal wound dehiscence were reported and compared with 420 selected controls. All variables that were significant in univariate analyses were entered in a multivariate stepwise logistic regression to determine which variables were significant independent risk factors. Major independent risk factors were male gender, chronic pulmonary disease, corticosteroid use, smoking, obesity, anemia, jaundice, ascites, and sepsis, type of surgery, postoperative coughing, and wound infection. Based on these findings, a risk model was developed. Conclusions: The model can give an estimate of the risk of abdominal wound dehiscence for individual patients. High-risk patients may be planned preventive wound closing with reinforcements as mesh.

Ureteroscopic holmium laser to transect the greater omentum to remove an abdominal drain:Four case reports

BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes.Currently,known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation.Ureteroscopy and the holmium laser have been used in various surgical techniques in urology,and in theory,they are expected to be a good strategy for solving the problem of tissue incarceration.CASE SUMMARY Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported.All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope,and a new 16-F drain was then placed in the abdominal or pelvic cavity.The efficacy of this technique was evaluated by intraoperative conditions,success rate,and operating time;safety was evaluated by perioperative conditions and the probability of postoperative complications.All four operations went smoothly,and the drains were successfully removed in all patients.The average operating time was 24.5 min.Intraoperatively,the average irrigation volume was 892.0 mL,the average drainage volume was 638.5 mL,and no bleeding or damage to surrounding tissues was observed.Postoperatively,the average drainage volume was 32.8 mL and the new drains were removed within 36 h.All patients were able to get out of bed and move around within 12 h.Their visual analogue pain scores were all below 3.The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted.CONCLUSION Ureteroscopic holmium laser surgery is an effective,safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.