BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and intercentre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n¼1713) underwent planned critical care admissions from theatre. Some 3.1% (n¼86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n¼133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51e19.97) than planned admissions (OR: 2.32, 95% CI: 1.43e3.85). Some 26.7% of patients (n¼1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8e51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n¼10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P<.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P<.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

Background: Diabetic-foot syndrome is a difficult & debilitating complication of inadequately regulated Diabetes Mellitus. Attributed to neural & vascular pathology, the condition is further potentiated by glycemic healing impairment.  A wide array of microorganisms have been implicated & sensitivity-guided antibiotics are essential to save both limb as well as to minimize rampant microbial resistance. Present study aims to determine the culture & sensitivity pattern of bacteria in stated cohort of patients at a Surgical Unit. Materials & Methods: This prospective cohort study was conducted over a period of 1 year-duration at a tertiary-care-Hospital. All patients presenting with diabetic-foot who had not been subjected to empiric antibiotic-therapy were enrolled. Demographic & lesion-based variables were studied and the Culture & Sensitivity pattern was evaluated and statistically analyzed. Results:100 patients were included in the study,of which 80 were male (mean-age 60.8±12.7 years) & rest female (mean-age 58.4±11.3-years).35% cultures yielded no growth. Remaining cases showed following pathogens in descending order of incidence. Maximal sensitivity was also reported as mentioned. 1) Staphylococcus-aureus & Klebseilla-Pneumoenae– Piperacillin/Tazobactam,2) Pseudomonas-Aerugionas-Cefotaxime,3)E-coli–Amikacin& Sulbactam,4) Proteus -Gentamicin, 5) Streptococci– Amikacin and 6) Bacteroides – Cefoperazone & Aztreonam. Of 71 cases, 70  had aerobic-organisms isolates & only 1 had anaerobic-isolate.   Conclusions: Six pathogens were identified in present study of which Staphylococcus-Aureus was the most prevalent as well as the most resistant. Streptococci & Gram-negative Organisms were observed in remaining cases. While formulation of an adequate antibiotic regime is rendered difficult by resistance & mixed infections, targeted antibiotic administration is decisively crucial to achieve optimal & timely outcome in diabetic foot.

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