Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-Operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy:Does preoperative tumor recognition reduce the positive surgical margin in a specific location?Experience from a Thailand prostate cancer specialized center

Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.

Peritonitis: Perioperative Care in Surgical Emergencies CHU Ignace Deen

Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic. Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis, i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension, i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours, i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%. Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.

Early Postoperative Deaths in the Surgical Intensive Care Unit of CHU-Kara

Aim: Review of early postoperative deaths in the surgical intensive care unit at CHU-Kara. Introduction: Surgery, one of the means of treatment of diseases, also presents risks for the patient, including early postoperative death linked to numerous risk factors. Methodology: This was a retrospective descriptive study conducted on the records of patients who died within 48 hours after surgery from November 1, 2019 to April 30, 2021. The study was conducted in the surgical intensive care unit and in the operating room. Results: Thirty-two early postoperative deaths or 2.22% out of 1442 operated with 30 deaths retained for the study. Male gender predominated (70%). The average age was 31.22 years. Farmers were more concerned (66.67%). The time to surgery was 1.6 days. ASA1 patients (40%) predominated followed by ASA IV (30%). 80% of patients were operated on as an emergency. Digestive pathologies 80% were more represented. General anaesthesia 86.66% was more practiced associating Propofol, Fentanyl, Ketamine and Atropine more frequently. The average duration of the procedures was 132.5 minutes. Intraoperative complications were associated with cardiac arrest and hemorrhage (33.34%). ASA class higher than 2, dirty surgery (46.67%), and delayed recovery (13.34%) were the incriminating risk factors. Death by hemodynamic shock and respiratory distress were the main causes 26.66%. Conclusion: Early postoperative mortality was high and involved all ages. Anesthesia and surgery, the low level of qualification of the intraoperative actors, the lesser intraoperative security;the association of anesthetic effects, the complexity of intraoperative lesions led to the increase of mortality. The combination of two or more factors was pejorative for the deaths.

Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes:A scoping review

The detrimental effects of both diabetes mellitus(DM)and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration(BGC)in a variety of clinical settings.It is now appreciated that acute BGC spikes,hypoglycemia,and high glycemic variability(GV)lead to more endothelial dysfunction and oxidative stress than uncomplicated,chronically elevated BGC.In the perioperative setting,fasting is the primary approach to reducing the risk for pulmonary aspiration;however,prolonged fasting drives the body into a catabolic state and therefore may increase GV.Elevated GV in the perioperative period is associated with an increased risk for postoperative complications,including morbidity and mortality.These challenges pose a conundrum for the management of patients typically instructed to fast for at least 8 h before surgery.Preliminary evidence suggests that the administration of an oral preoperative carbohydrate load(PCL)to stimulate endogenous insulin production and reduce GV in the perioperative period may attenuate BGC spikes and ultimately decrease postoperative morbidity,without significantly increasing the risk of pulmonary aspiration.The aim of this scoping review is to summarize the available evidence on the impact of PCL on perioperative GV and surgical outcomes,with an emphasis on evidence pertaining to patients with DM.The clinical relevance of GV will be summarized,the relationship between GV and postoperative course will be explored,and the impact of PCL on GV and surgical outcomes will be presented.A total of 13 articles,presented in three sections,were chosen for inclusion.This scoping review concludes that the benefits of a PCL outweigh the risks in most patients,even in those with well controlled type 2 DM.The administration of a PCL might effectively minimize metabolic derangements such as GV and ultimately result in reduced postoperative morbidity and mortality,but this remains to be proven.Future efforts to standardize the content and timing of a PCL are needed.Ultimately,a rigorous data-driven consensus opinion regarding PCL administration that identifies optimal carbohydrate content,volume,and timing of ingestion should be established.

New trends in the surgical management of soft tissue sarcoma: The role of preoperative biopsy

Soft tissue sarcoma(STS)accounts for 1%of all malignant neoplasms in adults.Their diagnosis and management constitute a challenging target.They originate from the mesenchyme,and 50 subtypes with various cytogenetic profiles concerning soft tissue and bones have been recognized.These tumors mainly affect middle-aged adults but may be present at any age.Half of the patients have metastatic disease at the time of diagnosis and require systemic therapy.Tumors above 3-5 cm in size must be suspected of potential malignancy.A thorough history,clinical examination and imaging that must precede biopsy are necessary.Modern imaging techniques include ultrasound,computed tomography(CT),new magnetic resonance imaging(MRI),and positron emission tomography/CT.MRI findings may distinguish low-grade from high-grade STS based on a diagnostic score(tumor heterogeneity,intratumoral and peritumoral enhancement).A score≥2 indicates a high-grade lesion,and a score≤1 indicates a lowgrade lesion.For disease staging,abdominal imaging is recommended to detect early abdominal or retroperitoneal metastases.Liquid biopsy by detecting genomic material in serum is a novel diagnostic tool.A preoperative biopsy is necessary for diagnosis,prognosis and optimal planning of surgical intervention.Core needle biopsy is the most indicative and effective.Its correct performance influences surgical management.An unsuccessful biopsy means the dissemination of cancer cells into healthy anatomical structures that ultimately affect resectability and survival.Complete therapeutic excision(R0)with an acceptable resection margin of 1 cm is the method of choice.However,near significant structures,i.e.,vessels,nerves,an R2 resection(macroscopic margin involvement)preserving functionality but having a risk of local recurrence can be an acceptable choice,after informing the patient,to prevent an unavoidable amputation.For borderline resectability of the tumor,neoadjuvant chemo/radiotherapy has a place.Likewise,after surgical excision,adjuvant therapy is indicated,but chemotherapy in nonmetastatic disease is still debatable.The five-year survival rate reaches up to 55%.Reresection is considered after positive or uncertain resection margins.Current strategies are based on novel chemotherapeutic agents,improved radiotherapy applications to limit local side effects and targeted biological therapy or immunotherapy,including vaccines.Young age is a risk factor for distant metastasis within 6 mo following primary tumor resection.Neoadjuvant radiotherapy lasting 5-6 wk and surgical resection are indicated for highgrade STS(grade 2 or 3).Wide surgical excision alone may be acceptable for patients older than 70 years.However,locally advanced disease requires a multidisciplinary task of decision-making for amputation or limb salvage.

Rural implementation of the perioperative surgical home:A case-control study

BACKGROUND Perioperative surgical home(PSH)is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction.PSH has proven success in large urban health centers by reducing surgery cancellation,operating room time,length of stay(LOS),and readmission rates.Yet,only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.METHODS The research study was conducted at an 83-bed,licensed level-III trauma rural community hospital.A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts(n=2305).To evaluate the importance of PSH in the rural surgical system,a case-control study was performed to compare TJR surgical outcomes(LOS,discharge disposition,and 90-d readmission)of the PSH cohort against two control cohorts[Control-1 PSH(C1-PSH)(n=1413)and Control-2 PSH(C2-PSH)(n=892)].Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables.The general linear models(Poisson regression and binomial logistic regression)were performed to fit adjusted models.RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts(median PSH=34 h,C1-PSH=53 h,C2-PSH=35 h)(P value<0.05).Similarly,the PSH cohort had lower percentages of discharges to other facilities(PSH=3.5%,C1-PSH=15.5%,C2-PSH=6.7%)(P value<0.05).There was no statistical difference observed in 90-d readmission between control and PSH cohorts.However,the PSH implementation reduced the 90-d readmission percentage(PSH=4.7%,C1-PSH=6.1%,C2-PSH=3.6%)lower than the national average 30-d readmission percentage which is 5.5%.The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician comanagement.The elements of PSH including preoperative assessment,patient education and optimization,and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS,increased directto-home discharge,and reduced 90-d readmission percentages.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

Postoperative sleep disorders and their potential impacts on surgical outcomes

Postoperative sleep disturbance is a common occurrence with significant adverse effects on patients including delayed recovery,impairment of cognitive function,pain sensitivity and cardiovascular events.The development of postoperative sleep disturbance is multifactorial and involves the surgical inflammatory response,the severity of surgical trauma,pain,anxiety,the use of anesthetics and environmental factors such as nocturnal noise and light levels.Many of these factors can be managed perioperatively to minimize the deleterious impact on sleep.Pharmacological and non-pharmacological treatment strategies for postoperative sleep disturbance include dexmedetomidine,zolpidem,melatonin,enhanced recovery after surgery(ERAS) protocol and controlling of environmental noise and light levels.It is likely that a combination of pharmacological and non-pharmacological therapies will have the greatest impact;however,further research is required before their use can be routinely recommended.

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

Joint arthroplasty Perioperative Surgical Home:Impact of patient characteristics on postoperative outcomes

AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

Predictability of Surgical Apgar Score for postoperative outcomes in hip fractures: A prospective observational study

Objective:To assess the utility and validation of the Surgical Apgar Score(SAS)in predicting postoperative complications of hip fractures.Methods:This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery,Liaquat National Hospital and Medical College.Patients were followed at the outpatient department,and complications and mortality were recorded through phone calls.The predictability of SAS for postoperative complications was assessed.Results:SAS≤4 was found as a significant predictor for postoperative pulmonary(P=0.008)and cardiac complications(P=0.042)as well as blood transfusion required to optimize postoperative hemoglobin(P=0.03)in the patients with hip fractures.Conclusions:SAS provides reliable feedback information about patients'postoperative risk during the surgery.Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge.

Is perioperative home the future of surgical patient care?

Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.

Surgical Outcome of Extradural Hematoma Patients in Relation to Preoperative Neurological Status

Introduction: Epidural hematoma (EDH) is characterized by the acute onset of traumatic haemorrhage into potential space between the dura mater and skull following head injury. About 85% of the epidural cases are caused by skull fracture with rupture of the middle meningeal artery or its branches and rest of 1the time ruptured venous sinuses, fractured diploic bone. The BTF recommends that all patients with an EDH volume of greater than 30 cc should undergo surgical evacuation regardless of Glasgow Coma Scale (GCS). Aim of the Study: To assess the surgical outcome of extradural hematoma patients by using Glasgow Outcome Scale (GOS) postoperatively. Material & Methods: This prospective study was conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), during the period of January 2016 to December 2017. A total of 98 patients of both sex and any age with EDH were selected purposively. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 22.0 for Windows (SPSS Inc., IBM and New York, USA). Prior to commencement of this study, the “Research Review Committee” & the “Ethical Committee” of DMCH, Dhaka, approved the research protocol. Results: In this study, 98 patients were included;they were divided into 6 groups. Age range was 04 - 55 years. It was observed that majority, 30 (30.60%) patients were from 21 - 30 years of age. The mean age was found 25.24 ± 12.2 years. Other age related distributions were shown in the table. Male patients were 78 (78.55%) and 22 (22.44%) patients were female. A male predominance was observed. Among admitting GCS 3-8, 56.25% patients had unfavorable outcome and 43.25% had favorable outcome. Admitting GCS 9-13, 2.5% patients had unfavorable outcome and 97.5% had favorable outcome. Admitting GCS 14-15, all patients (100.0%) had favorable outcome. Unfavorable outcome was observed in 9 (9.18%), 1 (1.00%) patients who belong 3-8, 9-13 GCS on admission. Mean GCS on admission was found 6.7 ± 2.44 score in unfavorable outcome group and 13.45 ± 2.30 score in favorable outcome group. Conclusion: This study revealed good surgical outcome in extradural hematoma patients. Preoperative GCS is an important predictor of outcome. Other preoperative neurological statuses like pupillary changes, neurological focal deficit, cranial nerve involvement, plantar reflexes and seizure also influence the surgical outcome.

Effects of Surgical Anesthesia on Postoperative Cognitive Function of Elderly Patients

Postoperative cognitive dysfunction in elderly patients is a common complication after surgical anesthesia.The occurrence of complications is also related to many other factors,and the cause is still unclear.This paper reviews the influencing factors and corresponding measures for postoperative cognitive function of elderly patients caused by anesthesia.