OBJECTIVE: Malnutrition has adverse postoperative outcomes, especially in emergency surgery. Among the numerous tools for nutritional assessment, this study aims to investigate malnutrition diagnosed by Global Leadership Initiative on Malnutrition criteria and the Global Leadership Initiative on Malnutrition predictive value for outcomes after emergency abdominal surgery.
METHODS: This was a prospective observational study. Among the 468 patients undergoing emergency abdominal surgery admitted to a department of emergency surgery from June 2020 to December 2021, 53 patients were not eligible for enrollment, and 19 patients had missing data. Thus, the final number of participants was 396. Muscle mass was evaluated by skeletal muscle index at the third lumbar vertebra on computed tomography scans, and the lower quartile was defined as the threshold of muscle mass reduction. The associations of Global Leadership Initiative on Malnutrition, Global Leadership Initiative on Malnutrition (muscle mass reduction excluded), and skeletal muscle index with in-hospital mortality, postoperative complications, and postoperative stay were evaluated using χ2. In addition, confounding factors were screened, regression models were established, and the Global Leadership Initiative on Malnutrition predictive value was analyzed for clinical outcome. Ethical approval was obtained from the appropriate department.
RESULTS: Malnutrition was observed in 19.9% of the total 396 patients based on the Global Leadership Initiative on Malnutrition and in 12.4% on the Global Leadership Initiative on Malnutrition (muscle mass reduction excluded). Sarcopenia by skeletal muscle index was found in 24.7% of patients. Univariate analysis indicated that in-hospital mortality, postoperative complications, infective complication rate, and postoperative hospital stay were significantly higher in malnourished and sarcopenic patients. Multivariate analysis found that malnutrition diagnosed by the Global Leadership Initiative on Malnutrition was predictive for complications, infective complications, and postoperative stay (total postoperative complications: odds ratio = 3.620; 95% CI, 1.635-8.015; P = 0.002; infective complications: odds ratio = 3.127; 95% CI, 1.194-8.192; P = 0.020; and postoperative stay: regression coefficient = 2.622; P = 0.022). The Global Leadership Initiative on Malnutrition (muscle mass reduction excluded) identified postoperative complications and postoperative stay (total postoperative complications: odds ratio = 3.364; 95% CI, 1.247-9.075; P = 0.017 and postoperative stay: regression coefficient = 3.547; P = 0.009). Sarcopenia by skeletal muscle index was a risk factor for postoperative complications (odds ratio = 3.366; 95% CI, 1.587-7.140; P = 0.002).
CONCLUSIONS: The Global Leadership Initiative on Malnutrition and Global Leadership Initiative on Malnutritison (muscle mass reduction excluded) had predictive value for adverse clinical outcomes due to malnutrition in patients undergoing emergency abdominal surgery.

UNASSIGNED: To investigate the relationship between intraoperative anesthesia-related factors and postoperative complications in patients undergoing emergency abdominal surgery, and to identify risk factors for these postoperative complications.
UNASSIGNED: We retrospectively analyzed 942 emergency surgery patients who underwent general anesthesia and emergency abdominal operations at Jiangsu Province Hospital during the period September 2015 to December 2016. Logistic regression analysis was performed to analyze the association between preoperative or intraoperative parameters and postoperative complications.
UNASSIGNED: Among the 942 patients whose data were analyzed, 226 (24.0%) had major postoperative complications within 30 days after surgery. The most common postoperative complications were respiratory complications (31.8% of those experiencing complications). After adjusting for the role of multiple confounding factors, multivariable analysis showed that the independent risk factors for postoperative complications were patient age (OR 1.648; 95% CI 1.352-2.008), the ASA classification (OR 3.220; 95% CI 2.492-4.162), intraoperative hypotension lasting more than 20 min (OR 2.031; 95% CI 1.256-3.285), intraoperative tachyarrhythmias (OR 2.205; 95% CI 1.114-4.365), and the surgical level (i.e. type and difficulty level) [OR 1.895; 95% CI 1.306-2.750].
UNASSIGNED: Prolonged intraoperative hypotension (>20 min) and the occurrence of tachyarrhythmias are independent risk factors for postoperative complications in patients who undergo emergency abdominal surgery. During hemodynamic management of these patients, systolic blood pressure should be controlled to within 20% of the baseline value to reduce the risk of postoperative complications. In addition, a higher patient age, higher ASA grade, and a higher surgical classification level also significantly increase the risk of postoperative complications.

Objective: Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence. Methods: Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS. Results: A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ(2)=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ(2)=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ(2)=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ(2)=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ(2)=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ(2)=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ(2)=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions: For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.
目的： 手术部位感染（SSI）是急诊腹部手术（EAS）患者术后最易发生的感染性并发症。在很大程度上大多SSI可以提前预防，但我国相关研究较少。本研究主要了解中国EAS后SSI发生的现状，并进一步探讨其发生的风险因素。 方法： 采用多中心横断面研究的方法。收集2019年5月1日至6月7日期间全国33家医院进行EAS患者的基本信息，包括围手术期有关资料和感染切口微生物培养结果。主要结局指标为EAS术后SSI发生率，次要结局变量为术后住院时间、重症监护室（ICU）入住率、ICU住院时间、治疗费用及30 d病死率。采用单因素及多因素Logistic回归分析EAS后SSI发生的风险因素。 结果： 本研究共纳入660例EAS患者，年龄（47.9±18.3）岁，男性占56.5%（373/660），术后发生SSI者占7.4%（49/660）。SSI的主要病原菌是大肠埃希菌[培养阳性率为32.7%（16/49）]。发生SSI的患者较未发生SSI患者的中位年龄更大（56岁比46岁，U=19 973.5，P<0.001），男性[71.4%（35/49）比56.1%（343/611），χ(2)=4.334，P=0.037]和糖尿病[14.3%（7/49）比5.1%（31/611），χ(2)=5.498，P=0.015]患者占比较高，术前血红蛋白水平（中位数：122.0 g/L比143.5 g/L，U=11 471.5，P=0.006）和白蛋白水平（中位数：35.5 g/L比40.8 g/L,U=9 452.0，P<0.001）偏低，血糖偏高（中位数：6.9 mmol/L比6.0 mmol/L，U=17 754.5，P<0.001），合并梗阻者[32.7%（16/49）比9.2%（56/611），χ(2)=25.749，P<0.001]和美国麻醉医师协会评分为3~4级者[42.9%（21/49）比13.9%（85/611），χ(2)=25.563，P<0.001]以及手术风险高者[49.0%（24/49）比7.0%（43/611），χ(2)=105.301，P<0.001]居多，手术方式以开腹者为主[81.6%（40/49）比35.7%（218/611），χ(2)=40.232，P<0.001]，手术时间较长（中位数：150 min比75 min，U=25 183.5，P<0.001）；从临床结局来看，SSI组患者ICU入住率[51.0%（25/49）比19.5%（119/611），χ(2)=26.461，P<0.001]和住院费用（中位数：4.4万元比1.5万元，U=24 660.0，P<0.001）增加，术后住院时间（中位数：10 d比5 d，U=23 100.0，P<0.001）和ICU入住时间（中位数：0 d比0 d，U=19 541.5，P<0.001）延长；差异均有统计学意义（均P<0.05）。多因素Logistic回归分析显示，年龄较大（OR=3.253，95% CI：1.178~8.985，P=0.023）、结直肠手术（OR=9.156，95% CI：3.655~22.937，P<0.001）及手术时间较长（OR=15.912，95% CI：6.858~36.916，P<0.001）是SSI发生的独立危险因素，腹腔镜或机器人手术（OR=0.288，95% CI：0.119~0.694，P=0.006）是SSI发生的独立保护因素。 结论： 对拟行EAS的患者，应关注中老年患者与结直肠手术患者，在条件允许的情况下应尽量选择腹腔镜手术，尽可能缩短手术时间，以降低SSI的发生率，减轻患者和医疗机构的负担。.