Preoperative MELD-Na Score Predicts 30-day Post-operative Complications After Colorectal Resection for Malignancy

Introduction:Predicting possible complications in colon surgery is important in terms of reducing postoperative mortality and morbidity rates. Various scoring methods have been used to predict these complications. The MELD score was developed to predict mortality following Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in cirrhotic patients. This model was revised by adding Na data and used to predict complications in non-cirrhotic patients. We investigated the value of the MELD-Na score in predicting postoperative 30-day complications in patients undergoing colorectal resection for malignancy.Methods:Patients who underwent colorectal resection for malignant diseases were included in the study. Demographics and clinical outcomes were recorded. The MELD-Na scores of the patients were calculated within 48 h before the surgery. Patients were divided into 2 groups according to the status of development of any complication.Results:Age, gender, operative time, and length of stay was not statistically significant for developing complications. The MELD-Na score was significantly higher in patients with any complications. Also, MELD-NA score, stoma creation, and postoperative erythrocyte suspension replacement were found to be independent risk factors for developing complications in patients undergoing surgery for colon cancer.Conclusion:The MELD-Na score may predict the complications that may develop in the first 30 days postoperatively in patients undergoing colorectal resection for malignant diseases

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries