Category Archives: Preoperative

Impact of preoperative absolute neutrophil count (ANC), steroids, and prophylactic antibiotics on port infection risk

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“Subcutaneous ports are frequently implanted for patients requiring long term central venous access for infusion of medications, chemotherapy, or total parental nutrition. The most common indication for port placement in the pediatric population is for delivery of chemotherapy, and a significant fraction of these children have neutropenia associated with their cancer diagnosis. While often a marker of immunosuppression, there are conflicting
studies in the literature regarding the relationship between absolute neutrophil count (ANC), as well as other preoperative factors, and port infection, with some reporting no association and others showing increased complications with preoperative neutropenia. These studies vary significantly in cohort size, the provision of antibiotics, and diagnoses included. This lack of consensus and weak evidence regarding risk factors for port infection was highlighted in a recent meta-analysis by the American Pediatric Surgical Association Cancer Committee, which emphasized the need for further investigation.”

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Prebiopsy Steroids and Diagnostic Yield in Patients With Diffuse Large B-Cell Lymphoma

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“Tissue biopsy remains essential for the histopathologic and immunophenotypic evaluation of DLBCL, as treatment decisions hinge on diagnostic accuracy. Steroids induce cytolysis of malignant B cells, resulting in apoptosis and tumor necrosis, and are therefore hypothesized to compromise diagnostic yield. Steroid-induced B-cell lysis can lead to increased infiltration by reactive macrophages and lymphocytes, potentially obscuring diagnostic features.8-10 In addition, steroids may alter cluster of differentiation (CD20) immunoreactivity—a key diagnostic marker—leading to patchy or atypical staining patterns. Radiologically, this effect has been observed as rapid tumor involution on imaging, earning the descriptor ghost tumor. Nonetheless, more recent evidence suggests that a steroid administration before baseline positron emission tomography or computed tomography does not diminish diagnostic yield in DLBC.”

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Multi-Institutional Analysis of Pancreaticoduodenectomy for Nonfamilial Periampullary Adenoma

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“Preoperative assessment of underlying malignancy in non-FAP-related PAs requiring PD may be difficult, as endoscopic biopsy carries a false-negative rate as high as 50%. Although PD aims at preempting malignant transformation through complete removal of DA, it comes with significant morbidity and mortality risks. This is particularly relevant in patients with benign or premalignant pathology due to soft pancreatic parenchymal texture and small pancreatic duct diameter.”

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Preoperative pulmonary risk stratification for noncardiothoracic surgery

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“Postoperative pulmonary complications contribute importantly to the risk for surgery and anesthesia. The most important and morbid postoperative pulmonary complications are atelectasis, pneumonia, respiratory failure, and exacerbation of underlying chronic lung disease. Clinicians who care for patients in the perioperative period may be surprised to learn that postoperative pulmonary complications are equally prevalent and contribute similarly to morbidity, mortality, and length of stay.”

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The negative appendectomy rate: who benefits from preoperative CT?

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“Preoperative CT quite consistently has been shown to lower the negative appendectomy rate among women. Relatively few studies, however, have shown a lower negative appendectomy rate with preoperative CT for both sexes. Furthermore, any suggested utility of preoperative CT in men is contradicted by a number of studies that have shown that men derive no benefit from preoperative CT when there is clinical suspicion of acute appendicitis. Nevertheless, CT is used routinely among men with suspected appendicitis at our institution and has been assumed by both surgeons and radiologists to be a useful practice. Therefore, we performed this study to determine the negative appendectomy rates of patients who did and did not undergo preoperative CT and to determine, more specifically, whether men benefit from preoperative CT.”

Negative Appendectomy Rates for Patients Who Did and Did Not Undergo Preoperative Imaging
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Evaluation of pre- and post- operative cognitive function and neurodegenerative markers

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“One of the largest controversies in perioperative medicine over the last quarter century has been whether anesthesia and surgery contribute to long-term cognitive decline and/or the development of dementia in older adults. This question has major public health implications, since approximately half of adults over 65 will undergo at least one surgery, and over 120,000 Americans will die of Alzheimer’s disease (AD) per year.”

“Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβor tau/Aβratios).”

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PREOPERATIVE URETERAL STENT PLACEMENT IN THE IDENTIFICATION OF INTRAOPERATIVE IDENTIFICATION OF IATROGENIC URETERAL INJURY?

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“The use of prophylactic ureteral stents remains controversial and could help in the intraoperative identification of ureteral injury.”

Methods:
Patients undergoing elective abdominal colorectal surgery and preoperative ureteral stent placement at three enterprise-wide tertiary referral hospitals between 2015 and 2021 were retrospectively identified through their billing records. The main study endpoint was ureteral injury identified within 30 days postoperatively. The decision to place ureteral stents was at the discretion of the treating surgeon. A number of demographic, disease-related, and treatment-related variables were examined for possible association with ureteral stent placement. We compared the incidence of ureteral injury and timing of the identification according to use of ureteral stents. Bivariate associations were examined using Kruskal-Wallis tests for continuous variables and Chi-square tests for categorical variables.


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