postoperative complications
2 articles
Elective versus emergency umbilical hernia repair in patients with decompensated cirrhosis: a retrospective cohort study
Introduction.
Evidence on umbilical hernia repair in patients with decompensated cirrhosis, ascites, and Child–Pugh class C is limited. In this population, outcomes after emergency repair may reflect both the urgency of the presentation and the greater hepatic, renal, inflammatory, and metabolic derangement present at the time of surgery.
Materials and methods.
This retrospective single-center cohort study included all 40 eligible adults with decompensated cirrhosis, ascites, and Child–Pugh class C at admission who underwent open primary non-mesh umbilical hernia repair between January 2019 and December 2025. Twenty patients underwent elective repair, defined as definitive repair scheduled after a short period of inpatient optimization, and 20 underwent emergency repair after limited stabilization because an acute hernia-related indication made postponement unsafe. The primary outcome was all-cause 30-day mortality. Secondary outcomes were in-hospital mortality, acute kidney injury, sepsis, wound infection, persistent ascitic leakage, reoperation, length of hospital stay, and early postoperative clinical-biochemical status. Analyses were unadjusted and exploratory; no multivariable model was fitted.
Results.
At admission, the emergency group had higher total bilirubin, international normalized ratio, creatinine, leukocyte count, Child–Pugh score and MELD-Na score, and lower serum albumin and sodium (all p ≤ 0.006). During a median elective optimization interval of 4.5 (3.0–6.0) days, the MELD-Na score decreased by a median of 2 (1–3) points. On postoperative days 2–3, every reported clinical-biochemical indicator remained less favorable in the emergency group. Median hospital stay was 14.5 versus 11.0 days (p = 0.038). Thirty-day mortality was 35.0% versus 10.0% (risk difference 25.0%, 95% confidence interval −1.3 to 47.9; p = 0.127).
Conclusions.
Patients undergoing emergency repair reached surgery with substantially greater clinical and biochemical derangement, had a less favorable early postoperative profile and stayed longer in the hospital, while the mortality difference did not reach statistical significance. Because operative timing was determined by the clinical course, the groups were not comparable at baseline and no causal effect of urgency or of preoperative optimization can be inferred. The findings support early multidisciplinary assessment while an elective operative pathway remains feasible.
Postoperative urinary retention - prevalence and risk factors: prospective, cohort study
Introduction
Ensuring perioperative urination maintenance can often be challenging, as postoperative urinary retention is frequently overlooked in favor of more clearly defined goals such as successful surgery, comprehensive postoperative pain control, reducing the risk of postoperative cardiorespiratory complications and shortening the patient's overall hospital stay. However, the inability to initiate urination and empty the bladder in the early postoperative period may negatively affect each of the listed success criteria.
Material and methods
A single-center, prospective, observational, cohort study was conducted, enrolling elderly patients without severe comorbidities. A total of 127 complete datasets were analyzed. Anthropometric parameters, type of surgery, duration of anesthesia and surgery; and several parameters previously reported as risk factors for postoperative urinary retention were recorded. The main objective wasto identify the prevalence of postoperative urinary retention in a surgical group in the Republic of Moldova. The secondary objective was to test the predictive value of a series of parameters (modifiable and non-modifiable) related to the patient or surgical treatment received as risk factors for urinary retention in the first 24 hours postoperatively. Statistical software used: Social Science Statistics (https://www.socscistatistics.com).
Results
The studied surgical population was homogeneous in terms of body mass, height, duration of surgery and anesthesia; heterogeneous by gender (62.2% male) and type of anesthesia (64% general anesthesia). Depending on the definition criteria, the prevalence of postoperative urinary retention varied between 5.5% and 7.9%. The preoperative unmodifiable risk factors for postoperative urinary retention: positive history for hypertension OR = 9.0 (X2 (1, N = 127) = 5.6, p = 0.017), diabetes mellitus OR = 5.1 (X2 (1, N = 127) = 5.36, p = 0.021) and stroke OR = 4.83 (X2 (1, N = 127) = 2.098, p = 0.148).
Conclusions
The prevalence of postoperative urinary retention in a single-center surgical population from the Republic of Moldova varies between 5.5% and 7.9%, depending on the criteria for postoperative urinary retention applied. This variation highlights the need for a consensus on diagnostic criteria for postoperative urinary retention is needed. Patients with hypertension and diabetes mellitus were more likely to develop postoperative urinary retention. Patients with pre-existing neurological disorders such as positive history for stroke and diabetic polyneuropathy were more susceptible for postoperative urinary retention.