Manipulation of local and systemic host defence in the prevention of perioperative sepsis

Windsor, Alastair; Klava, A.; Somers, SS; Guillou, Pierre J.; Reynolds, John V.

doi:10.1002/bjs.1800821106

Cited by 32 publications

(12 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Postoperative infections are common causes of morbidity [24]. The postoperative period of reduced monocyte class II expression may represent the time at greatest risk of infection [13,25].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial

McHoney

Eaton

Wade

et al. 2005

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial

McHoney

Eaton

Wade

et al. 2005

Journal of Pediatric Surgery

View full text Add to dashboard Cite

“…The intestinal mucosal barrier plays an important role in the host defenses against infections [1,6]. In systemic inflammation, the intestine plays important roles against the development of multi-organ failure [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, early enteral nutrition (EN) has been shown to preserve the integrity of the gut mucosa and to maintain immunological function [1,2]. Moreover, EN has been reported to reduce the duration of postoperative admissions to the intensive care unit (ICU), particularly after highly invasive gastrointestinal surgery, such as thoracic esophagectomy [3].…”

Section: Introductionmentioning

confidence: 99%

Early Enteral Nutrition Reduces the Rate of Life-Threatening Complications after Thoracic Esophagectomy in Patients with Esophageal Cancer

Fujita

Daiko

Nishimura³

2012

Eur Surg Res

View full text Add to dashboard Cite

Background: Early postoperative enteral nutrition has been suggested to improve the nutritional status of patients after esophageal surgery. However, whether enteral nutrition decreases rates of surgical complications and increases the completion rate of the clinical management pathway is unclear. Methods: We analyzed 154 patients who were randomly assigned to either an enteral or parenteral nutrition group after undergoing esophagectomy, compared the incidence of surgical complications, and evaluated the completion rate of the clinical pathway. In these 2 patient groups, perioperative management was performed through identical clinical pathways, except for nutrition. Results: The overall rate of surgical complications of any type did not differ between patients who received early enteral nutrition and those who did not (p = 0.50); however, the rate of life-threatening surgical complications was significantly lower in patients who received early enteral nutrition (p = 0.02). The rate of non-life-threatening surgical complications did not differ between the groups (p = 0.98). In patients who received enteral nutrition, the completion rate of the clinical pathway was higher (p = 0.03), and the postoperative hospital stay was shorter (p = 0.04). Conclusions: Early enteral nutrition reduces the incidence of life-threatening surgical complications and improves the completion rate of the clinical pathway for thoracic esophagectomy.

show abstract

“…Surgery patients can be defined as a high-risk group for developing sepsis, as procedures evoke substantial metabolic, hematologic, and immunologic responses [4]. The immune function after surgery may be transformed substantially by perioperative bacterial infection, hemorrhage, blood transfusion, or anesthesia up to severe suppression that promotes sepsis [4–8]. …”

mentioning

confidence: 99%

Trends in Postoperative Sepsis: Are We Improving Outcomes?

Vogel¹,

Dombrovskiy²,

Lowry³

2009

Surgical Infections

View full text Add to dashboard Cite

Background and Purpose Each year, as many as two million operations are complicated by surgical site infections in the United States, and surgical patients account for 30% of patients with sepsis. The purpose of this study was to determine recent trends in sepsis incidence, severity, and mortality rate after surgical procedures and to evaluate changes in the pattern of septicemia pathogens over time. Methods Analysis of the 1990–2006 hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New Jersey. Patients ≥18 years who developed sepsis after surgery were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes as defined by the Patient Safety Indicator “Postoperative Sepsis” developed by the Agency for Healthcare Research and Quality (AHRQ). Severe sepsis was defined as sepsis complicated by organ dysfunction. Results A total of 1,276,451 surgery discharges (537,843 elective [42.1%] and 738,608 non-elective [57.9%] procedures) were identified. After elective surgery, 5,865 patients (1.09%) developed postoperative sepsis, of whom 2,778 (0.52%) had severe sepsis. The incidence of postoperative sepsis after elective surgery increased from 0.67% to 1.74% (p < 0.0001) and severe sepsis after elective surgery from 0.22% to 1.12% (p < 0.0001). The sepsis mortality rate for elective procedures showed no significant change over time. The proportion of severe sepsis after elective cases increased from 32.9% to 64.6% (p < 0.0002). The rates of postoperative sepsis (4.24%) and severe sepsis (2.28%) were significantly greater for non-elective than for elective procedures (p < 0.0002). Non-elective surgical procedures had a significant increase in the rates of postoperative sepsis (3.74% to 4.51%) and severe sepsis (1.79% to 3.15%) over time (p < 0.0001) with the proportion of severe sepsis increasing from 47.7% to 69.9% (p < 0.0002). The in-hospital mortality rate after non-elective surgery decreased from 37.9% to 29.8% (p < 0.0001). Conclusions Sepsis and death were more likely after non-elective than elective surgery. Sepsis and severe sepsis has increased significantly after elective and non-elective procedures over the last 17 years. The hospital mortality rate was reduced significantly after non-elective surgery, but no improvements were found for elective surgery patients who developed sepsis. Disparities in age, sex, and ethnicity and the development of postoperative surgical sepsis were found. Population-based studies may assist in defining temporal trends, disparities, and outcomes in sepsis not elucidated in smaller studies.

show abstract

Manipulation of local and systemic host defence in the prevention of perioperative sepsis

Cited by 32 publications

References 98 publications

Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial

Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial

Early Enteral Nutrition Reduces the Rate of Life-Threatening Complications after Thoracic Esophagectomy in Patients with Esophageal Cancer

Trends in Postoperative Sepsis: Are We Improving Outcomes?

Contact Info

Product

Resources

About