Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Clinical study of neoplastic thyroid swellings

The prospective study of 108 patients of thyroid malignancy were studied with regard to surgical management in SKIMS, Srinagar. Thyroidmalignancy constituted 0.12%of total hospital admissions. It was seenmainly in patients belonging to rural areas (66.67%).The commonest observed thyroidmalignancywas papillary carcinoma (48.15%), followed by follicular carcinoma (37.04%), anaplastic carcinoma (7.41%), medullary carcinoma (5.55%) and malignant lymphoma (1.85%). Femaleswere affectedmore commonlywith a female tomale ration of 3.1:1.Patients ranged in age from 8 years to 70 years. Maximum number of cases with papillary carcinoma (34.62%), follicular carcinoma (40%) and anaplastic carcinoma (66.67%) presented in 4th, 5th and 6th decades of life respectivelywith a mean age of 34.85 years, 42.40 years and 61.25 years for papillary, follicular and anaplastic carcinoma respectively. Swelling in front of neckwas themost common (96.29%) presenting symptom, followed by hoarseness of voice. The majority of patients were having hard swellings with nodular surfaces and the swelling were free.No patient had retrosternal extension of thyroid swelling. 18.51% of patients had clinically palpable lymph nodes. Fine needle aspiration cytology was an important adjuvant to pre-operative diagnosis having sensitivity of 92.59%and specificity of 100%.Thyroid scan detected cold nodule/nodules inmaximumnumber (90.74%) of patients. Indirect laryngoscopy detected vocal cord palsy in 14.81% patients pre-operatively. Total thyroidectomy was performed in maximum (83.33%) number of patients followed by near total thyroidectomy. The main post-operative complications were hypoparathyroidism (12.96%) and recurrent laryngeal nerve palsy (11.11%). Anaplastic carcinoma was found a rapidlygrowing tumour,with a limited surgical scope.Department of General Surgery SKIMS, Soura, Srinagar (India