Keywords : complications
CORRELATION BETWEEN HEMOGLOBIN A1C IN DIABETIC PATIENTS WITH RATE OF INFECTION AND WOUND COMPLICATIONS FOLLOWING DECOMPRESSIVE SPINE SURGERY
Basrah Journal of Surgery,
2019, Volume 25, Issue 2, Pages 89-94
Diabetes mellitus (DM) is known as an important risk factor for surgical site infection(SSI) in spine surgery. A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infection. Such infection increases morbidity, length of stay, and overall cost. The present study was designed to assess the correlation between pre-operative hemoglobin A1c (HbA1c) and the incidence of post-operative infection in surgical patients undergoing decomperssive spine operations.
Forty diabetic patients who underwent decompressive spine surgery at different levels of spine were included in this retrospective study. These include 23 females and 17 males with mean age of 57.5 years. The patients data were collected from hospitals and private clinics archives including value of preoperative hemoglobin A1c, random blood sugar, postoperative C-reactive protein (CRP) and white blood cells count (WBC) as a diagnostic laboratory tests for identification of postoperative infection in follow-up periods.
The overall rate of infection in our study was 12.5%, which was categorized into 2 groups (Uncontrolled diabetes hemoglobin A1c >7 and controlled hemoglobin A1C ≤7), so the rate of infection was 19.2% among patients with uncontrolled diabetes compared with 0% among patients with controlled diabetes (p=0.143). The mean hemoglobin A1c among patients with uncontrolled diabetes who developed infection was 9.72% compared with 7.34% among those with no infection (p <0.001)
In conclusion, diabetic patients whose blood glucose levels were poorly controlled before surgery as indicated by high hemoglobin A1c were at high risk for postoperative wound infection. Preoperative hemoglobin A1c above 7.34% could serve as a threshold value for significant increased risk of postoperative surgical site infection.
Key words: Diabetes Mellitus, HbA1C, decompressive spine surgery, infection, complications.
Basrah Journal of Surgery,
2019, Volume 25, Issue 1, Pages 43-47
Abdulkareem Jabbar Ghadban Al-Ebadi Consultant General & Laparoscopic Surgeon, MB,ChB, CABS, FACS, SAGES, Al-Sadr Teaching Hospital, Basrah, Iraq. Abstract Bile leakage is a very dangerous condition after laparoscopic cholecystectomy and may lead to fatal complications and serious care should be taken to diagnose the cause as early as possible because it may be sign of bile duct injury which is a major concern to the surgeons as if it is not diagnosed early, it will lead to dangerous complications such as biliary peritonitis, hepatic failure and even death. Early diagnosis is important to decrease morbidity and mortality. This study aimed to determine the incidence of bile leakage, its types of management and the outcome in patients with gall stone who are submitted to laparoscopic cholecystectomy. This prospective study was done in Basrah Al-Sadr Teaching Hospital in a two-year period from October 2013 to October 2015 on 560 patients, they were 378 females and 182 males. All of them have symptomatic gall stones and underwent laparoscopic cholecystectomy. All converted cases to open cholecystectomy were excluded. From the total number of 560 patients, nine patients developed bile leak in early post-operative period, 6 of them have drains and the other three have no drain and they were presented with signs and symptoms of intra-abdominal collection. The causes of leak were: common bile duct (CBD) injury in 2 cases, accessory duct in 3 patients, leak from the gall bladder bed in 3 cases and one case iatrogenic from intra-hepatic drain. All the patients were treated conservatively except the two patients with CBD injury who were treated; one with the aid endoscopic retrograde cholangio-pancreatography (ERCP) and the other by re-exploration. In conclusion, bile leak is a serious complication after laparoscopic cholecystectomy, although it is not common but it is important to identify the site of leak and should be treated urgently especially by drainage to avoid more severe results which may lead to increased morbidity and mortality
Basrah Journal of Surgery,
2018, Volume 24, Issue 1, Pages 1-2
LESSONS TO BE LEARNED LESSONS TO BE AVOIDED IN THE FUTURE
Thamer A Hamdan MB,ChB, FRCS, FICS, FACS, Professor of Orthopedic Surgery, Chancellor of Basrah University, Basrah, IRAQ.
It is a well-known fact that lucky is the one whose mistakes can be counted. There is not a single surgeon who has not had complications of one type or another. Those who deny complications either have not done enough surgery or not telling the truth. I Surgeons may have complications in spite of good judgment and proper execution of surgical procedures. Simply speaking, complications should be the pillars for future rectification of personal and colleague’s careers. It is a shame when surgeons discover at time of surgery, that something was missed prior to putting the knife on the patient’s body. Certainly, this situation is embarrassing or even perplexing for the surgeon, because he may feel, he do not know how to behave when he faces a surprise. It is really painful when he feels he is guilty by the sin of omission or commission. At the same time, we should admit that we have faced some unexpected findings at the time of surgery. However, we may not be blamed because this was not due to lack of proper pre-operative evaluation but because of similarities of clinical manifestations or due to masking of the cardinal clinical features. One of the best example is emergency operation for acute appendicitis, while the operative findings are suggestive of ovarian cys