Background
Prolonged postoperative ileus (PPOI) represents a frequent complication following colorectal surgery, affecting approximately 10–15% of these patients. The objective of this study was to ...evaluate the perioperative risk factors for PPOI development in colorectal surgery.
Methods
The present systematic review and meta-analysis was conducted in accordance with the PRISMA Statement. PubMed, EMBASE, SciELO, and LILACS databases were searched, without language or time restrictions, from inception until December 2018. The keywords used were: Ileus, colon, colorectal, sigmoid, rectal, postoperative, postoperatory, surgery, risk, factors. The Newcastle–Ottawa scale and the Jadad scale were used for bias assessment, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels.
Results
Of the 64 studies included, 42 were evaluated in the meta-analysis, comprising 29,736 patients (51.84% males; mean age 62 years), of whom 2844 (9.56%) developed PPOI. Significant risk factors for PPOI development were: male sex (OR 1.43; 95% CI 1.25–1.63), age (MD 3.17; 95% CI 1.63–4.71), cardiac comorbidities (OR 1.54; 95% CI 1.19–2.00), previous abdominal surgery (OR 1.44; 95% CI 1.19, 1.75), laparotomy (OR 2.47; 95% CI 1.77–3.44), and ostomy creation (OR 1.44; 95% CI 1.04–1.98). Included studies evidenced a moderate heterogeneity. The quality of evidence was regarded as very low-moderate according to the GRADE approach.
Conclusions
Multiple factors, including demographic characteristics, past medical history, and surgical approach, may increase the risk of developing PPOI in colorectal surgery patients. The awareness of these will allow a more accurate assessment of PPOI risk in order to take measures to decrease its impact on this population.
Abstract
Background
HIV/AIDS-related infections are commonly presented in a disseminated form, compromising a high variety of organs and systems, mainly the Respiratory and Central Nervous System ...(CNS). In developing countries, the opportunistic agent spectrum varies from what is reported in the rest of the world, being the anatomical compromise also different from developed countries reports. In Colombia there has not been published any study that characterizes the anatomopathological findings of opportunistic infections in a sample of HIV/AIDS patients this size.
Methods
Descriptive retrospective study, adjusted to the current regulations on human research. A review of the autopsy protocols performed at the Department of Pathology of the Universidad Industrial de Santander (UIS) between 2004 and 2016 was executed, selecting those with HIV/AIDS and at least one opportunistic infection as the final diagnosis, of these there were evaluated the pathological findings and demographic variables.
Results
Among 3497 autopsy protocols reviewed, there were found 249 cases of HIV/AIDS associated to opportunistic infections, 183 men (73,5%) and 66 women (26,5%), with an average age of 37.94 ± 12.56 years. The main compromised systems were the Lower Respiratory Tract (LRT) with 184 cases (73,8%), mainly by M. tuberculosis (76 cases; 41,3%), followed by the Central Nervous System (CNS) with 95 cases (38,1%), mainly by Toxoplasma gondii (38 cases; 20,6%), and in third place the Lymphoreticular System (LRS) with 92 cases (50%), mainly by Histoplasma capsulatum (39 cases; 21,1%). Less prevalent agents like Trypanosoma cruzi were found compromising multiple systems, with 6 infecting the CNS and 7 causing Chagasic myocarditis.
Conclusion
Disseminated forms and simultaneous multiple agent compromise of one system are common features in HIV/AIDS patients, because of this the clinician must have a high level of suspicion for diagnosing coinfection when approaching a determinated organ or system compromised by an infectious agent.
Disclosures
All authors: No reported disclosures.
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