Incidence and Preoperative Risk Factors for Major Complications After Capsulectomy: Analysis of 3,048 Patients

Background While there are many indications for periprosthetic breast capsulectomy, heightened public attention surrounding breast implant illness has resulted in increased rates of capsulectomy. Objectives This study aims to identify the incidence of major complications and risk factors associated with capsulectomy. Methods Using a prospectively enrolled cosmetic surgery insurance database, CosmetAssure (Birmingham, AL, USA), patients undergoing capsulectomy between January 2, 2017 and July 31, 2019 were identified. Outcomes measured included the occurrence of and risk factors for major complication(s) necessitating an emergency department visit, hospitalization, or reoperation within 45 postoperative days. Results Among 76,128 patients evaluated, 3048 (4.0%) underwent capsulectomy. There was a significant increase in number of capsulectomies following January 6, 2019 (2.7/day vs 5.2/day, p<0.05). Capsulectomy patients had more likely to have any complication and specifically hematoma than those undergoing breast implant removal or replacement without capsulectomy (2.8% vs 1.9% and 1.6% vs 0.9%, respectively, p<0.05). Eighty-four (2.8%) developed at least one complication. The most common complications included hematoma (1.6%) followed by infection (0.5%). ASA class III/IV was an independent risk factor for any complication and BMI ≥30 and office-based surgical suites were risk factors for infection. Conclusions There is a growing number of capsulectomies being performed. The most common major complication is hematoma. Patients undergoing capsulectomy confer a higher complication rate compared to those undergoing breast implant removal or replacement without capsulectomy. Patients should be counseled regarding the potential for major complications.

Risk Factors and Prevention Measures for Postoperative Sternomediastinitis (Literature Review)

Median sternotomy remains the most common access in cardiac surgery, while postoperative sternomediastinitis is one of the most severe complications of the transsternal approach. The article analyzes the preoperative risk factors for the development of this complication, including concomitant pathology, constitutional features, bad habits, length of hospital stay, and the urgency of the operation. It was also noted that intraoperative risk factors consist of technical errors in the performance of the operation, intraoperative features of the course of surgery, the nature of the choice of the shunt during myocardial vascularization and the final stage of the operation. Postoperative risk factors include the specific management of the postoperative period in cardiac surgery patients, which can lead to the development of sternomediastinitis. The analysis of measures taken by cardiac surgeons to prevent the development of this complication was carried out

P-BN63 Requirement of preoperative group and save testing prior to cholecystectomy: A systematic review

Background Group and save (G&S) testing is usually performed prior to cholecystectomy. However, there are no standard national or international guidelines regarding the routine use of preoperative G&S testing for patients undergoing emergency laparoscopy. Methods We evaluated the available literature on the necessity of G&S prior to cholecystectomy to determine whether this was required preoperatively. Studies from January 1980 to May 2021 assessing the requirement of G&S were retrieved from MEDLINE and EMBASE databases. Number of patients, co-morbidities, operation performed, number of patients that underwent preoperative G&S testing, perioperative transfusion rates and financial costs were extracted. Results We initially screened 194 studies of which 11 retrospective studies reported on cholecystectomy. A total of 177,692/474,485 (37.4%) patients underwent preoperative G&S testing with a perioperative transfusion rate of 2.07% (9803/474,485 patients, range 0.0% to 1.6%). The main preoperative risk factors, where recorded, associated with perioperative blood transfusion identified include cardiovascular co-morbidity (16/45, 35%), coagulopathy (13/45 patients, 28%), anaemia (9/45 patients, 20%) and haematological malignancy (6/45, 13%). All 11 studies concluded that routine G&S is not warranted. Conclusions The current evidence, though limited, suggests that G&S is not necessarily required for all patients undergoing cholecystectomy. Preoperative testing should be performed in selected cases, for example in septic coagulopathy, anaemia and haematological malignancy. There is no evidence to suggest that routine G&S screening benefits patient outcomes. Having a targeted G&S approach would reduce delays in elective and emergency lists, reduce the burden on the blood transfusion service and have financial implications.