The relationship between clinical signs of respiratory system disorders and lung lesions at slaughter in veal calves

The presence and severity of lung lesions recorded post-mortem is commonly used as an indicator to assess the prevalence of respiratory problems in batches of bovines. In the context of a welfare monitoring based on on-farm measures, the recording of clinical signs on calves at the farm would be more convenient than the recording of lung lesions at slaughter. The aim of the present study was to investigate the relationship between clinical respiratory signs at farm and post-mortem analyses of lung lesions observed at slaughter in veal calves. If clinical signs were a good predictor of lung lesions it could be possible to integrate only those measures in a welfare monitoring system. One-hundred-and-seventy-four batches of calves were observed 3 times: at 3 and 13 weeks after arrival of the calves at the unit and at 2 weeks before slaughter. For each batch a maximum of 300 calves was observed and the proportions of calves showing abnormal breathing, nasal discharge and coughing were recorded. Post-mortem inspection was carried out on a sample of lungs belonging to calves from the observed batches. Each examined lung was classified according to a 4-point scale for pneumonia from healthy lung (score 0) to severe lesions (score 3). The clinical signs recorded infra vitam were significantly correlated with moderate and severe lung lesions for observations at 13 weeks and 2 weeks before slaughter and the level of the correlation was highly variable (rsp from 0.16 to 0.40). Receiver operating characteristic (ROC) curves were created and the area under the curves showed that batches with a high proportion of lungs with moderate or severe lesions could not be accurately detected by the three clinical signs of respiratory disorders. These results suggest that both clinical signs and post-mortem inspection of lung lesions must be included in a welfare monitoring schemes for veal calve

Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis

Background Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation. Methods We searched MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials for observational studies and randomised controlled trials published up to April, 2014, comparing lung-protective mechanical ventilation with conventional mechanical ventilation during abdominal or thoracic surgery in adults. Individual patients' data were assessed. Attributable mortality was calculated by subtracting the in-hospital mortality of patients without postoperative lung injury from that of patients with postoperative lung injury. Findings We identified 12 investigations involving 3365 patients. The total incidence of postoperative lung injury was similar for abdominal and thoracic surgery (3\ub74% vs 4\ub73%, p=0\ub7198). Patients who developed postoperative lung injury were older, had higher American Society of Anesthesiology scores and prevalence of sepsis or pneumonia, more frequently had received blood transfusions during surgery, and received ventilation with higher tidal volumes, lower positive end-expiratory pressure levels, or both, than patients who did not. Patients with postoperative lung injury spent longer in intensive care (8\ub70 [SD 12\ub74] vs 1\ub71 [3\ub77] days, p<0\ub70001) and hospital (20\ub79 [18\ub71] vs 14\ub77 [14\ub73] days, p<0\ub70001) and had higher in-hospital mortality (20\ub73% vs 1\ub74% p<0\ub70001) than those without injury. Overall attributable mortality for postoperative lung injury was 19% (95% CI 18\u201419), and differed significantly between abdominal and thoracic surgery patients (12\ub72%, 95% CI 12\ub70\u201412\ub76 vs 26\ub75%, 26\ub72\u201427\ub70, p=0\ub70008). The risk of in-hospital mortality was independent of ventilation strategy (adjusted HR 0\ub771, 95% CI 0\ub741\u20141\ub722). Interpretation Postoperative lung injury is associated with increases in in-hospital mortality and durations of stay in intensive care and hospital. Attributable mortality due to postoperative lung injury is higher after thoracic surgery than after abdominal surgery. Lung-protective mechanical ventilation strategies reduce incidence of postoperative lung injury but does not improve mortality

Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit

Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p 65 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery