Investigation of the effect of acute to chronic glycemic ratio on major amputation development after surgical thromboembolectomy in patients with acute lower extremity ischemia

BACKGROUND

Acute limb ischemia (ALI) is an emergency vascular pathology in which perfusion is disrupted in the lower extremity and threatens extremity viability. The admission blood glucose (ABG)/estimated average glucose (eAG) value has recently been shown as a prognostic marker in acute cardiovascular events. In this study, we aimed to investigate the predictive role of an ABG/eAG value in predicting development of early postoperative major amputation after emergency thromboembolectomy operations in patients presenting with ALI.

METHOD

Patients who admitted to our hospital with ALI between November 01, 2016 and September 01, 2021 and underwent surgical thromboembolectomy were retrospectively included in the study. Patients who did not undergo postoperative limb amputation were recorded as Group 1, and patients who underwent major amputation in the early postoperative period (in-hospital), were recorded as Group 2.

RESULTS

The median age of the 226 patients included in Group 1 and 72 patients in Group 2 were 58 (34-86) years and 69 (33-91) years, respectively (p<0.001). In univariate analysis, in-hospital amputation was found to significantly correlate with age>70 years (odds ratio [OR]: 1.914, 95% confidence interval [CI]: 1.351-2.319, p<0.001), PAD (OR: 1.698, 95% CI: 1.270-1.992, p = 0.002 re-embolectomy (OR: 2.184, 95% CI: 1.663-3.085, p < 0.001), admission Rutherford class (OR: 0.762, 95% CI: 0.591-0.859, p = 0.032), admission time>6 h (OR: 1.770, 95% CI: 1.480-1.152, p = 0.009), ABG (OR: 1.275, 95% CI: 1.050-1.790, p < 0.001), and ABG/eAG (OR: 1.669, 95% CI: 1.315-2.239, p < 0.001).

CONCLUSION

According to our study, we can predict patient groups with a high risk of major amputation with the ABG/eAG value calculated from the blood values of the patients at the time of admission.

Simultaneous pectus excavatum repair using sternal plate in a patient undergoing the Bentall procedure

Objective: Pectus excavatum is a deformity that occurs at the lower part of the sternum of the thorax, including the xiphoid process. Deformity generally causes cosmetic and psychosocial problems. Life-threatening conditions may ensue in patients with severe deformities. Ravitch surgery and Nuss's minimally invasive surgical procedures are the main procedures for correcting the pectus excavatum. A rare method of pectus excavatum is the stabilization of the sternum by using sternal plates. In this report, we present a case; successful pectus excavatum repair using the sternal plate simultaneously in a 48-year-old male patient who underwent Bentall operation due to ascending aortic aneurysm and aortic valve insufficiency. Case presentation: The patient was admitted with complaint of dyspnea. Examinations including clinical examinations, echocardiography, computed tomography  and pulmonary tests revealed pectus excavatum, with Haller index&qt;3.5,   reduced forced vital capacity 72% and ascending aorta aneurysm of 5.7 cm and moderate aortic valve regurgitation. The decision  to proceed with simultaneous aortic root and aortic valve replacement with pectus excavatum correction was taken. The operation were performed successfully under cardiopulmonary bypass without complications. Patient was discharged  on 9th postoperative day. Conclusion: In patients with pectus excavatum deformity who undergo cardiac surgery (in our case ascending aorta and aortic valve replacement) with median sternotomy, simultaneous sternal repair using a sternal plate is safe and preferable because it positively affects cardiac and pulmonary surgical outcomes. Therefore, we recommend simultaneous sternal plate application in patients with pectus excavatum who will have a cardiac operation.

The ımportance of ınflammatory parameters ın predıctıng deep sternal wound ınfectıons after open heart surgery

OBJECTIVE

The aim of this study was to investigate the relationship between the development of deep sternal wound infection after open heart surgery and inflammatory parameters obtained from routine biochemical tests.

METHODS

A total of 280 patients who underwent cardiac surgery with median sternotomy between January 2015 and January 2020 were examined retrospectively. Patients who developed deep sternal wound infection were identified as "Group 1," and those who did not develop deep sternal wound infection were identified as "Group 2."

RESULTS

There were 70 patients with a mean age of 61.6±9.9 years in Group 1 and 210 patients with a mean age of 62.7±9.8 years in Group 2. As a result of the analysis, it was found that the presence of concomitant chronic obstructive pulmonary disease, concomitant diabetes mellitus, blood and blood product transfusion, postoperative 2nd day C-reactive protein, postoperative 1st day neutrophil-to-lymphocyte ratio, and delta neutrophil-to-lymphocyte ratio was found as independent predictive factors of postoperative deep sternal wound infection development (p=0.043, p=0.012, p=0.029, p=0.009, p=0.002, and p<0.001; respectively). As a predictor of deep sternal wound infections development, postoperative 1st day neutrophil-to-lymphocyte ratio cutoff value was 11.2 (area under the curve [AUC] 0.598; p=0.014; 60% sensitivity, and 65.2% specificity), and delta neutrophil-to-lymphocyte ratio cutoff value was 9.6 (AUC 0.716; p<0.001; 57.1% sensitivity, and 73.8% specificity).

CONCLUSIONS

Deep sternal wound infection development can be predicted with inflammatory parameters such as neutrophil-to-lymphocyte ratio and C-reactive protein that are obtained from cheap and easily available routine biochemical tests.

The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery

INTRODUCTION

Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery.

METHODS

Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (<36%) in Group 1 and patients with preoperative normal hematocrit levels (≥36%) in Group 2.

RESULTS

Forty-six patients in Group 1 (mean age: 63.6 ± 7.9 years) and 48 patients in Group 2 (mean age: 56.5 ± 8.8 years) were enrolled. European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring was statistically significantly higher in Group 1 (p = 0.011). In the postoperative period, the amount of drainage, transfusion of blood, and blood products were significantly higher in Group 1 (p < 0.001). The mortality rate of Group 1 was statistically higher in the first 30 days postoperatively (p = 0.020).

CONCLUSION

Low preoperative hematocrit levels are associated with increased mortality after CABG surgery. We suggest that patients' preoperative hematocrit levels must be added to the risk scoring systems as an assessment parameter.