Incidencia de la infección de la herida quirúrgica en cirugía colorrectal electiva y su relación con factores perioperatorios

Relationship between nutritional status and immediate complications in patients undergoing colorectal surgery

Introduction several complications may occur during colorectal surgical procedures and factors, such as nutritional status, substantially contribute to this problem.

Objective evaluate the relationship between nutritional status (determined by different tools) and the emergence of early postoperative complications, as well as analyze social parameters, lifestyle, food intake, and time to diet reintroduction.

Methods case series study conducted in the surgical proctologic ward of the Hospital Barão de Lucena, Recife, Pernambuco, with individuals of both sexes diagnosed with colorectal cancer who underwent a surgical procedure involving at least one anastomosis. Social, demographic and clinical data, life style, dietary intake, nutritional status, and the immediate postsurgical complications were evaluated.

Results among the 31 patients studied, there was a higher prevalence of females (74.2%), mean age of 61.9 ± 12.4 years old, and the rectum was the primary site of cancer in 54.8%. Most patients came from the countryside, were retirees, had lower education, consumed too much red meat, processed meats, and fats, with low consumption of fruits and vegetables, and were sedentary. Regarding nutritional status, nutritional risk was found in 58.1%, mean BMI of 25.7 ± 6.8 kg/m2, and 54.8% had significant weight loss. Additionally, 38.7% had some of the immediate complications, particularly paralytic ileus and abdominal distension. There was a delay in the onset of renourishment, and there was no association between nutritional status and immediate complications.

Conclusion colorectal cancer is closely related to eating habits and lifestyle. Patients with this malignancy have a marked weight loss; however, in this study, we found no association between nutritional status and the incidence of postoperative complications.

Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study

INTRODUCTION

Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery.

METHODS

Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model.

RESULTS

The study included 154 patients, with a mean age of 69.5±12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05).

CONCLUSIONS

The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs.

Colorectal surgery and surgical site infection: is a change of attitude necessary?

INTRODUCTION

Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery.

APPLIED METHOD

Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented.

RESULTS

One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery.

CONCLUSIONS

The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery? A Prospective Study

BACKGROUND

Infections are the most frequent complication after colorectal surgery. It has been suggested that adipose tissue metabolism could be related to the risk of post-operative infection, but this could be partially related to the body-mass index. The aim of this study was to look for a relation between adipocytokine levels and the risk of post-operative infection and its type.

METHODS

This prospective cohort study was conducted between March 2013 and March 2014 in two French teaching hospitals. Pre-operative plasma levels of adiponectin and leptin were measured in consecutive patients undergoing elective colorectal surgery. All infections in the 30 d following surgery were recorded.

RESULTS

Among the 142 patients included, 29 (20.4%) presented a post-operative infection: 26 surgical site infections and three extra-abdominal infections. Adiponectin and leptin levels correlated weakly but substantially with the body mass index (rspearman=-0.26 and +0.31, respectively). While there was no substantial difference between patients with and those without post-operative infection for adiponectin, median pre-operative leptin was substantially greater in patients with post-operative infection (8.67 vs. 4.37 ng/mL, p=0.003). A substantial interaction was found between leptin and cancer. In patients operated on for cancer, the area under the receiver-operating characteristic (ROC) curve was lower than in patients with benign diseases (0.597 vs. 0.858, p=0.011). Similar results were observed for intra-abdominal infection and surgical site infection.

CONCLUSION

Patients with greater levels of leptin before colorectal surgery have an increased risk of post-operative surgical infection. This effect is stronger in patients without cancer. Adiponectin levels are not related to the risk of infection in Western patients.

Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double-blind randomized, controlled trial in colorectal surgery

AIM

The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine.

METHOD

Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end-point was total morphine consumption in surgery and afterwards through a patient-controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared.

RESULTS

Sixty-seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range (IQR)] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25-42.75)] than in the saline group [52 mg (24.5-64)] (P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6-34.7)] than in the saline group [52.5 (22.5-65) ml] (P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty-six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination.

CONCLUSION

Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.

Incidence and management of anastomotic bleeding after ileocolic anastomosis

AIM

Ileocolic anastomosis is performed using a stapled or manual technique, but with either there is a risk of bleeding from the suture line. The aim of this study was to analyse, retrospectively, bleeding after different anastomotic techniques.

METHOD

Patients having elective right colectomy were divided, according to the type of ileocolic anastomosis, into Group 1 (circular, double-stapled, end-to-side), Group 2 (linear-stapled, side-to-side) and Group 3 (handsewn, side-to-side). Postoperative lower gastrointestinal bleeding (LGIB) was studied in the three groups. Uni- and multivariate analysis was performed to study risk factors for LGIB and the need for postoperative allogeneic blood transfusion.

RESULTS

Three-hundred and fifty patients were included: 174 in Group 1, 59 in Group 2 and 117 in Group 3. The postoperative LGIB rate was 4.9% and occurred exclusively in Group 1. Five patients had severe anastomotic bleeding. Postoperative blood transfusion was indicated in Groups 1, 2 and 3 in 19.0%, 5.1% and 13.7% of patients. In the five patients with severe bleeding, four attempts of colonoscopic arrest were made, achieving bleeding control in one. Angiographic embolization was successful in one patient. There were no procedure-specific complications.

CONCLUSION

End-to-side, circular, double-stapling ileocolic anastomosis seems to be related to an increased incidence of anastomotic bleeding and of postoperative blood transfusion compared with patients having other techniques of ileocolic anastomosis.