Gemellus

Abstract

From Sydney, Australia comes a paper that Gemellus believes will strike fear in any surgical heart (Diseases of the Colon and Rectum 2018; 61 (11): 1306–1315). It outlines the complications arising from anticoagulant and antiplatelet therapy in colorectal surgery. With these drugs being prescribed more and more, this topic has a growing relevance for Gemellus and his colleagues. This was a retrospective cross-sectional study conducted at a single quaternary referral centre in patients undergoing major colorectal and abdominal wall surgery during three 12-month intervals (2005, 2010, and 2015). The primary outcomes measured were the rate of complications relating to postoperative haemorrhage or thromboembolism. One thousand one hundred and twenty-six patients were included (mean age, 61.4 years (SD 16.3); 575 (51.1%) male) with 229 (21.7%) patients on anticoagulant and antiplatelet agents. Unsurprisingly to Gemellus, there was an increase in the proportion of patients on clopidogrel, dual antiplatelet therapy, and novel oral anticoagulants over the decade. One hundred and seven (9.5%) cases were complicated by haemorrhage or thromboembolism. Aspirin (OR, 2.22; 95% CI, 1.38–3.57), warfarin/enoxaparin (OR, 3.10; 95% CI, 1.67–5.77), and dual antiplatelet therapy (OR, 2.99; 95% CI, 1.37–6.53) were most implicated with complications on univariate analysis. Patients with atrial fibrillation (adjusted OR 2.67; 95% CI, 1.47–4.85), ischemic heart disease (adjusted OR, 2.14; 95% CI, 1.04–4.40), and mechanical valves (adjusted OR, 7.40; 95% CI 1.11–49.29) were at increased risk of complications on multivariate analysis. The severity of these events was mainly limited to Clavien-Dindo 1 (n = 37) and 2 (n = 46) complications. Outcomes. Prospective studies are required to formalize protocols in these ‘high-risk’ patients. So with complications from these cursed, but necessary drugs running at about three times than in normal patients, Gemellus notes this is just about the same as the increase in minor proctology cases reported in Colorectal Disease a few years ago. Blunt abdominal trauma in Qatar