Abstract

To investigate the incidence of systemic inflammatory response syndrome (SIRS) on emergency department admission and the prognostic significance of SIRS in patients undergoing emergency surgery. This is a retrospective study of 889 adults who were admitted as emergency cases and were operated on within 24 hours of admission. Data on patient demography, clinical information including comorbidities, categories of surgery, American Society of Anesthesiologists physical status, SIRS score, postoperative outcomes including duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay, and mortality were collected. SIRS occurred in 43% of the patients and was associated with a significantly worse outcome in terms of duration of ventilator use (10.5 ± 15.4 vs. 3.5 ± 4.4 days, p < 0.001), ICU stay (11.2 ± 13.6 vs. 5.0 ± 5.4 days, p < 0.001), hospital length of stay (19.4 ± 22.4 vs. 7.1 ± 7.6 days, p < 0.001) and mortality (12.7% vs. 0.4%, p < 0.001). After adjusting for covariates (including age, gender, American Society of Anesthesiologists physical status, comorbid conditions, and surgery categories), SIRS was independently associated with higher mortality (adjusted odd ratio, 21.5, 95% confidence interval (CI), 4.9–93.2), longer ventilator duration (adjusted coefficient, 7.8, 95% CI, 3.2–12.5), longer ICU stay (adjusted coefficient, 6.2, 95% CI, 2.6–9.8) and longer hospital stay (adjusted coefficient, 9.7, 95% CI, 7.5–11.9). The presence of SIRS at admission in patients receiving emergency surgery predicted worse outcomes and higher mortality rates.

Abstract

In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response.