Introduction:Malnutrition is a frequent concomitant of surgical illness, especially in gastrointestinal cancer surgery. The aim of the study was to assess the prevalence of malnutrition in the GI cancer patients and its relation with clinical outcome. We also examined associations between the energy balance and clinical outcomes in these patients.Methods:Prospective study on 694 surgical patients treated in the ICU of the UHC of Tirana. Patients were divided into well-nourished and malnourished groups according to their nutritional status. Multiple regression analysis was used to analyze the effect of malnutrition and cumulated energy balance on clinical outcome.Results:The prevalence of pre-operative malnutrition was 65.3% for all surgical patients and 84.9% for gastrointestinal cancer patients. Malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor for higher complications, infections, and mortality, longer stay in the ventilator and ICU. Also this model showed that cumulated energy balance correlated with infections, and mortality and was independently associated with the length ventilator and ICU stay.Conclusion:This study shows that malnutrition is a significant problem in surgical patients, especially in patients with gastrointestinal cancer. Malnutrition and cumulated energy deficit in gastro-intestinal surgery patients with malignancy is an independent risk factor on increased post-operative morbidity and mortality.

PurposeMany investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18–64 years), and to examine the negative consequences associated with risk of malnutrition in older adults.Materials and methodsA prospective cohort study in the ICU of the University Hospital Center of Tirana, Albania, was conducted. Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay, the duration of being on the ventilator, the total complications, the infectious complications, and the mortality.ResultsIn this study, 963 patients participated, of whom 459 patients (47.7%) were aged ≥65 years. The prevalence of malnutrition risk at the time of ICU admission of the patients aged ≥65 years old was 71.24%. Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients, for 1) infections (odds ratio [OR] =4.37; 95% confidence interval [CI]: 2.61–7.31); 2) complications (OR =6.73; 95% CI: 4.26–10.62); 3) mortality (OR =2.68; 95% CI: 1.72–4.18); and 4) ICU length of stay >14 days (OR =5.18, 95% CI: 2.43–11.06).ConclusionMalnutrition risk is highly prevalent among elderly ICU patients, especially among severely ill patients with malignancy admitted to the emergency ward. ICU elderly patients at malnutrition risk will have higher complication and infection rates, longer duration of ICU stay, and increased mortality. Efforts should be made to implement a variety of nutritional care strategies, to change the nutritional practices not only at ward level, but nationally, according to the best clinical practice and recent guidelines.

BACKGROUND:Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.AIM:The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.MATERIALS AND METHODS:A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.RESULTS:A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95% CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95% CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01).CONCLUSION:We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

Background and Goal of Study:Interventional radiology (IR) came of age with the medical profession's desire to develop minimally invasive therapies1. Some of these procedures cause significant patient discomfort, and yet require relative patient immobility for optimal results calling for an increasing need for sedation and anaesthesia. Our study aimed to assess the provision of sedation service in IR. Materials and Methods: 101 radiology departments in acute hospital trusts in England and Wales responded to a telephone survey using a standardised questionnaire which was analysed. Results and Discussion: 76% of respondents were from the district general hospitals, 80% of which have dedicated IR lists. These provide services for hepatobiliary (84%), vascular (82%), cancer (68%), Gynaecology (61%), neuroradiology (23%) and miscellanous (25%). In 88% of the departments, a dedicated person, which may be a nurse (52%), radiologist (41%), anaesthetist (35%) and others (10%), provides sedation. Half of the departments have a sedation protocol and 49% of departments require a competency-based training for giving sedation. 20% of departments have a lead anaesthetist responsible for IR. 52% of the IR lists have anaesthetic cover and 81% of them have a dedicated anaesthetic assistant. Concerns about the safety and need of training of non-anaesthetic staff in the provision of sedation, monitoring and recovery of patients have been widely publicised1. Our survey revealed suboptimal involvement of anaesthetic departments in IR, and the lack of training for sedation provision. This may be due to poor inter-departmental co-operation and a general lack of resources. The Royal College of Radiologists 2 and the Joint Commission for Accreditation of Healthcare Organizations recommend that sedation practice throughout the hospitals be 'monitored and evaluated by the Department of Anaesthesia'3 Conclusion(s): We identified the need for further participation of anaesthetists in IR to provide a service, support, and to develop training for sedation provision by non-anaesthetists. This can be achieved by a lead anaesthetist in IR who maintains close links between the departments especially with regard to producing local protocols.

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