Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens

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

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

Effect Some Medicinal Plants Diets on Mono Sex Nile Tilapia (Oreochromis niloticus), Growth Performance, Feed Utilization and Physiological Parameters

AbstractThirteen experimental diets containing 30% crude protein and 438.09 Kcal gross energy/100g were formulated to contain six different medical plants fenugreek meal (FM),Trigonella foenum-graecum; fenugreek sprouts meal (FSM); eucalyptus fresh leaves (EFL), Eucalyptus citriodora; hot pepper meal (HPM) Capsicum frutescens L. var. abbreviatum; thyme seeds meal (TSM) Thymus vulgaris and chamomile flowers meal (CFM), Matricaria recutita Lat three different levels (0.00; 1.00 and 2.00%) from each of such medicinal plant on the growth performance,feed utilization and whole body composition and physiological parameters of Nile tilapia Oreochromis niloticus fry. Fish were reared in twenty six glass aquaria with an average initial weight of 0.82 ± 0.3g/fish. The results of the present study illustrated that the averages of growth performance and feed utilization values as affected with medicinal plant sources indicate that FSM showed the highest growth performance and feed utilization values (P≤0.05) followed in a significant decreasing order by fenugreek meal (FM) and eucalyptus fresh leaves (EFL) then by hot pepper meal (HPM)and both Thyme meal (TM) and Chamomile flowers meal (CFM),respectively. Regardless of medicinal plants sources, The analysis of variance for medicinal plant levels (MPL) indicate that supplementation level of 1% revealed significant (P≤0.05) the highest growth performance and feed utilization values followed in a significant (P≤0.05) decreasing order by 0.00 and 2.00% level,respectively. Concerning the interaction between medicinal plants sources and their levels (0.00,1.00 and 2.00%) the highest growth performance and feed utilization values (P≤0.05) were obtained by group 1% FSM (diet No.4),while the lowest was recorded by the group 2% TSM (diet No.11).On the other hand, the interactions between medicinal plants sources and their levels observed the lowest total plasma protein(g/dl), total plasma lipid (g/dl), Hb (g/dl), Ht (%), AST (U/L), ALT (U/L) and uric acid concentrations (mg/dl) parameters were obtained by group 1% FSM (diet No.4),while the highest parameters were recorded by the 2% TSM (diet No.11). In general, and based on the obtained results it could be concluded that addition of 1% LMP to the diet which contain FSM is considered optimal for growth of mono-sex Nile tilapia,O. niloticus,fingerlings without any adverse effect on fish health