Abstract:
BACKGROUND:Sepsis is common in surgical patients, and its presence influences the outcomes in those to undergo surgery. Factors such as advanced age, presence of comorbidities and many other conditions increase mortality in surgical patients with sepsis. The sequential organ failure assessment (SOFA) score simplified into qSOFA helps to define sepsis and to identify patients who are likely to die from it. Sepsis in surgery is under investigated in low- and middle-income countries and so are the factors for mortality in that specific surgical population. Our aim was to develop a prognostic tool accurate in predicting outcomes in surgical patients with sepsis who present at University Teaching Hospitals of Kigali (CHUK) and Butare (CHUB) and in other centers with limited resources METHODS: This was a prospective cohort study conducted over a period of 1 year from February 2018 to January 2019. The surgical patients with sepsis recruited in the first 6 months at CHUK served as the derivation cohort and those recruited in the next 6 months from both CHUK and CHUB served as the validation cohort. The Kigali surgical sepsis (KiSS) score was derived, and to determine its accuracy in predicting mortality, we measured sensitivity, specificity and area under receiver operator characteristic (AUROC) curve. We then compared this with qSOFA score. RESULTS:A total of 288 patients were recruited with 144 in each cohort. The mean age was 36.5, and median age was 32.6. The mean length of hospital stay (LoHS) was 22.9 days. The overall intensive care unit (ICU) admission rate was 51.4%, and the surgical sepsis-related hospital mortality rate was 21.7%. Factors associated with surgical sepsis-related hospital mortality were age above 55 years (p = 0.034), presence of comorbidities (p = 0.069), hypotension (p = 0.014), tachycardia (p = 0.061), tachypnea (p = 0.028), decreased level of consciousness (p = 0.021), presence of GIT perforation (p = 0.026) and number of impaired organ function (p = 0.035). A predictive score (KiSS score) consisting of six parameters was derived from these factors and compared to qSOFA score. The sensitivity of KiSS score in predicting mortality was 73% (vs 52% for qSOFA), and the specificity was 97% (vs 87% for qSOFA). The predictive validity for hospital mortality was assessed by AUROC curve, and it was 0.939 (95% CI, p < 0.001) for KiSS and 0.684 (95% CI, p < 0.001) for qSOFA. CONCLUSION:The KiSS score was effective in predicting surgical sepsis-related hospital mortality in low-resource setting. The KiSS score showed an added advantage of stratifying septic surgical patients to be operated on into those with good, variable and poor prognosis.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Niyongombwa I,Sibomana I,Karenzi ID,Kiswezi A,Rickard Jdoi
10.1007/s00268-020-05708-7subject
Has Abstractpub_date
2020-11-01 00:00:00pages
3651-3657issue
11eissn
0364-2313issn
1432-2323pii
10.1007/s00268-020-05708-7journal_volume
44pub_type
杂志文章abstract:BACKGROUND:Surgery for Graves' disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well-controlled GD with those undergoing rapid pre-ope...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05125-5
更新日期:2019-12-01 00:00:00
abstract::Patients with early-stage non-small-cell lung cancer (NSCLC) should be treated with complete surgical resection whenever possible. Incomplete resections do not cure, and the optimal pulmonary resection is anatomic lobectomy. Limited resections (wedge resection and segmentectomy) are associated with a threefold increas...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002680020017
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate and investigate the complications of carotid endarterectomy (CEA) and carotid artery stenting (CAS) by performing a meta-analysis based on prospective randomized controlled trials (RCTs). METHODS:We performed a search of multiple electronic databases for RCTs containing...
journal_title:World journal of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00268-008-9862-8
更新日期:2009-03-01 00:00:00
abstract::Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients-high-fidelity, manikin-based si...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9354-2
更新日期:2008-02-01 00:00:00
abstract::The role of liver transplantation in malignancy has been discussed, but controversially, over the past two decades. This is particularly true for hepatic metastases from neuroendocrine tumors, which have a wide variety of primary tumor localizations, morphologic types, functional activities, and clinical presentations...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0016-5
更新日期:2001-06-01 00:00:00
abstract:BACKGROUND:Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO. METHODS:The outcomes of all patients hospitalized at a single center for acute...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2733-6
更新日期:2014-12-01 00:00:00
abstract::To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59) or simple esoph...
journal_title:World journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1007/BF00294722
更新日期:1995-07-01 00:00:00
abstract::With limited resources and the current concerns about using animals for research purposes, the needs must be clear when setting up trauma and sepsis experiments for pharmacologic interventions. Such interventions are performed typically for four reasons: (1) to study the pathophysiologic role of certain mediators (whi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900077
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Traditional perioperative care for colonic surgery in elderly patients is associated with increased morbidity and mortality compared to that of younger patients. Although multimodal perioperative rehabilitation has evolved as a valid concept to improve postoperative outcome, its use has not yet been establis...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-009-0018-2
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers of systemic inflammation in patients undergoing open repair of intact and ruptured AAA. METHODS:One-hundred twelve patients were entered into a prospective observational study. Preope...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9014-6
更新日期:2007-06-01 00:00:00
abstract::To pursue a suitable central airway replacement, we conducted central airway reconstruction using autologous pulmonary tissue flaps lined with alloy stents in five patients after extensive tracheal resection. Preoperative and postoperative arterial blood gas analysis and pulmonary function tests were used to evaluate ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3066-9
更新日期:2015-08-01 00:00:00
abstract::Surgical resection is the treatment of choice for patients with stage I and stage II non-small-cell lung cancer (NSCLC--squamous cell, adenocarcinoma, and large-cell carcinoma). Distant recurrence is an important cause of death after complete surgical resection, occurring in 30-60% of patients. Postoperative adjuvant ...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01659083
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:A small remnant liver volume is an important risk factor for posthepatectomy liver failure and can be predicted accurately by computed tomography (CT) volumetry using radiologic image analysis software. Unfortunately, this software is expensive and usually requires support by a radiologist. ImageJ is a freel...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9197-x
更新日期:2007-11-01 00:00:00
abstract::A review of the literature describing the management of hepatic and splenic injuries indicates that as many as 67% of exploratory celiotomies for blunt trauma are reported as nontherapeutic. Avoiding unnecessary surgery through nonoperative management offers an attractive alternative. Nonetheless, nonoperative managem...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-001-0138-9
更新日期:2001-11-01 00:00:00
abstract:PURPOSE:Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications. METHODS:The outcome of patients who underwe...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9504-1
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:The goal of the present study was to determine the frequency, mode of presentation, and need for reoperation in the treatment of recurrent inguinal hernia at Liaquat University Hospital, Jamshoro, Sindh, Pakistan. METHODS:This descriptive, cross-sectional study was conducted over a period of four years, fro...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1897-1
更新日期:2013-03-01 00:00:00
abstract::Knowledge of how factors related to esophageal cancer resection affect long-term quality of life after surgery is scarce, and no population-based studies are available. Therefore, we conducted a Swedish nationwide, prospective, population-based study of how esophageal surgery-related factors influence quality of life ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-7887-9
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:The aim of this study was to compare the perioperative outcomes when using a micropuncture access set (MS) to those when using a conventional puncture set (CS) for implantation of totally implantable venous access device (TAVID). METHODS:A total of 314 patients undergoing chemotherapy for colorectal cancer ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05336-w
更新日期:2020-04-01 00:00:00
abstract::The surgical management of pancreatic islet cell carcinomas poses a complicated set of questions resulting from their rare occurrence and the difficulty in establishing a diagnosis in early cases or, conversely, the problems inherent in dealing with metastatic disease. However, because their biologic behavior is rathe...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01655109
更新日期:1993-07-01 00:00:00
abstract::The prognosis of patients who undergo resection for pancreatic ductal adenocarcinoma with curative intention is generally poor unless they have early-stage disease. Based on our 25-year experience, the results of 194 patients after a standardized Kausch-Whipple resection for adenocarcinoma of the pancreatic head were ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6659-z
更新日期:2003-03-01 00:00:00
abstract:INTRODUCTION:Accidental intraoperative gallbladder perforation is a problem in laparoscopic surgery, especially in cases with incidental gallbladder carcinoma (IGBC). The question is whether intraoperative gallbladder perforation has a prognostic disadvantage or a retrieval bag provides protection against tumor dissemi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0163-7
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:The decision to proceed to simple underwater seal drainage or apply active suction to the underwater seal after lung resection is mostly based on surgeon preference. The purpose of this study was to test whether routine application of active suction is necessary after lobectomy. PATIENTS AND METHODS:This wa...
journal_title:World journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00268-008-9741-3
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:The recent development and spread of ultrasonography and ultrasonography-guided fine needle aspiration biopsy (FNAB) has facilitated the detection of small papillary microcarcinomas of the thyroid measuring 1 cm or less (PMC). The marked difference in prevalence between clinical thyroid carcinoma and PMC det...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0303-0
更新日期:2010-01-01 00:00:00
abstract::Controversy remains regarding the best surgical approach for toxic multinodular goiter (MNG). The aim of this study was to evaluate the results of various thyroid operations for managing toxic MNG. A group of 100 patients with toxic MNG were divided into three groups and managed with total thyroidectomy (TT; group I, ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-7767-3
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques. METHODS:A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analy...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0787-7
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:The histone deacetylase (HDAC) inhibitors have emerged as the useful reagents that epigenetically modulate the expression of various genes. In the present study, the effects of HDAC inhibitors on the expression of inflammation-related genes and lung injury during sepsis were investigated. METHODS:Mice were ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0493-5
更新日期:2010-07-01 00:00:00
abstract::From January, 1972 to June, 1989, 51 patients with liver hemangiomas (32 females and 19 males, mean age 35 years) were evaluated for surgical treatment. Diameters of the masses were 5 cm to 20 cm (median 8.5 cm). Nine of the patients had already been treated for cancer. Twenty-two (43.1%) of the 51 patients were sympt...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF02104457
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Efficient DNA damage repair by MutL-homolog DNA mismatch repair (MMR) enzymes, MLH1, MLH3, PMS1 and PMS2, are required to maintain thyrocyte genomic integrity. We hypothesized that persistent oxidative stress and consequent transcriptional dysregulation observed in thyroid follicles will lead to MMR deficien...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4299-6
更新日期:2018-02-01 00:00:00
abstract::We sought to determine whether early eschar excision en masse (EEE) at one operation would be effective in the prevention and treatment of postburn organ dysfunction (OD) and multiple organ dysfunction syndrome (MODS). A total of 60 patients, with total body surface burned area over 35% and a third degree burn area ov...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900661
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:This study assessed the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score-II), POSSUM (Physiologic and Operative Severity Score for Enumeration of Morbidity and Mortality), and P-POSSUM (Portsmouth-POSSUM) in patients with colorectal cancer undergoing c...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9321-y
更新日期:2008-04-01 00:00:00