Factors influencing early postoperative complications following surgery for symptomatic spinal metastasis: a single-center series and multivariate analysis.

HighlightsWhat are the main findings?A risk factor for early postoperative complications in neonates that have undergone surgical intervention for esophageal atresia is complications during delivery.The risk factors for late postoperative complications in neonates that have undergone surgical intervention for esophageal atresia are preoperative mechanical ventilation, postoperative sepsis, and belonging to relatively high- and high-risk groups according to the Spitz classification.What are the implications of the main findings?Neonates with esophageal atresia and complications during delivery should be monitored during the perioperative period to promptly recognize or prevent the onset of early postoperative complications.In the postsurgical period, neonates with esophageal atresia who have been on preoperative mechanical ventilation or diagnosed with postoperative sepsis or who belong to relatively high- and high-risk groups according to the Spitz classification should be continuously monitored to promptly prevent or recognize late postoperative complications.Background and Aim: Atresia is the most common congenital anomaly of the esophagus, with an increased risk of complications after surgical correction. The aim of our study was to evaluate the risk factors associated with early and late postoperative complications in neonatal patients with esophageal atresia. Methods: The study sample comprised 109 neonatal patients aged between 0 and 27 days of life who were prenatally diagnosed with esophageal atresia or diagnosed at birth. For the purpose of this study, neonatal and perinatal factors and factors associated with the mother’s medical condition were analyzed. Complications after surgical intervention were classified as early and late. Results: Patients with early postoperative complications experienced significantly more frequent complications during delivery (p = 0.002), asphyxia (p = 0.038), and postoperative sepsis (p = 0.045) and were more likely to have received medicamentous therapy (p = 0.035). Patients with late postoperative complications had significantly more frequent complications during delivery (p = 0.025), respiratory distress (p = 0.043), and postoperative sepsis (p = 0.010), were more likely to have received preoperative mechanical ventilation (p = 0.014), and showed a significantly different frequency distribution among the different classes of the Spitz classification (p = 0.008). A risk factor for early postoperative complications in patients with atresia in the upper part was complications during delivery (OR-3.09; p = 0.007). The risk factors for late postoperative complications for patients with upper atresia were preoperative mechanical ventilation (OR: 2.77; p = 0.041), postoperative sepsis (OR: 2.60; p = 0.028), and belonging to relatively high- and high-risk groups according to the Spitz classification (OR: 3.50; p = 0.022). Conclusions: In neonates who have undergone surgical intervention for esophageal atresia, a risk factor for early postoperative complications is complications during delivery, while the risk factors for late postoperative complications are preoperative mechanical ventilation, postoperative sepsis, and belonging to relatively high- and high-risk groups according to the Spitz classification. Therefore, a multidisciplinary approach and continuous monitoring are essential to reduce morbidity and mortality, as well as to improve quality of life, in these patients.

Infliximab is widely used in severe and refractory ulcerative colitis (UC). The results of clinical studies are inconsistent on whether preoperative infliximab use increases early postoperative complications in UC patients. To determine the clinical safety and efficacy of preoperative infliximab treatment in UC patients with regard to short-term outcomes following abdominal surgery. PubMed, Embase databases were searched for controlled observational studies comparing postsurgical morbidity in UC patients receiving infliximab preoperatively with those not on infliximab. The primary endpoint was total complication rate. Secondary endpoints included the rate of infectious and non-infectious complications. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) as summary measures. A total of 13 studies involving 2933 patients were included in our meta-analysis. There was no significant association between infliximab therapy preoperatively and total (OR = 1.09, 95% CI: 0.87-1.37, P = 0.47), infectious (OR = 1.10, 95% CI: 0.51-2.38, P = 0.81) and non-infectious (OR = 1.10, 95% CI: 0.76-1.59, P = 0.61) postoperative complications respectively. Infliximab might be a protective factor against infection for the use within 12 weeks prior to surgery (OR = 0.43, 95% CI: 0.22-0.83, P = 0.01). No publication bias was found. Preoperative infliximab use does not increase the risk of early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery.

Objective. The effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn's disease (CD) was examined. Material and methods. A series of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN. Results. During the preoperative TPN, all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity. Conclusions.This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications.

Objective To investigate the risk factors of early postoperative complications after pancreaticoduodenectomy.Methods The clinical data of 159 patients undergoing pancreaticoduodenectomy from March 2005 to October 2010 was analyzed retrospectively.The related factors of early postoperative complications were analyzed.Results The incidence rate of early postoperative complications was 30.8％ (49/159).Univariate analysis showed that preoperative fasting blood glucose level,total serum bilirubin level,serum albumin level,high density lipoproteins level and intraoperative bleeding were closely correlated with early postoperative complications in patients undergoing pancreaticoduodenectomy (P ＜ 0.05),but gender,age,preoperative jaundice,history of diabetes mellitus,operation time and whether portal vein reconstruction were no significantly associated with early postoperative complications in patients undergoing pancreaticoduodenectomy (P ＞ 0.05).Multivariate analysis showed that preoperative fasting blood glucose level( ≥6.1 mmol/L),total serum bilirubin level ( ≥ 171 μ mol/L) and serum albumin level( ＜ 35 g/L) were the important independent risk factors of early postoperative complications in patients undergoing pancreaticoduodenectomy.Conclusion The risk factors of pancreaticoduodenectomy should be fully recognized and dealt with promptly. Key words: Pancreaticoduodenectomy; Postoperative complications; Risk factors

C-reactive Protein for Predicting Early Postoperative Complications in Patients Undergoing Laparoscopic Shaving for Deep Infiltrating Endometriosis

40. Surgical Site Infection in Spinal Metastasis - Risk Factor and Countermeasure

To assess the incidence and characteristics of early postoperative complications in patients following neurosurgical procedures. All patients undergoing neurosurgery during a four month period were followed postoperatively for up to four hours in the post anesthetic care unit or intensive care unit. Patient information and all complications were documented by the investigators on a standardized form. Complications were classified as respiratory, cardiovascular, nausea and vomiting, shivering and other. Risk factors analyzed for the occurrence of complications included age, sex, ASA status, type of surgery, elective or emergency surgery and postoperative placement. Four hundred eighty six adult patients were followed, but in 55 patients the trachea remained intubated during the four hour study period and they were eliminated from the analysis of postoperative complications. At least one complication occurred in 54.5% of the remaining 431 patients. Respiratory problems occurred in 2.8%, trauma to the airway in 4.4%, cardiovascular complications in 6.7%, neurological in 5.7% and nausea and/or vomiting in 38%. The highest incidence of patients with complications was during spine (65%) and vascular (66%) surgery, compared with tumour (47%) and other (43%) surgery, P < 0.05. Other risk factors included age < 70 yr for nausea and vomiting (P < 0.02), and elective surgery for spine and vascular surgery (P < 0.001 ). There was a high incidence of early postoperative complications in neurosurgical patients. The most common problem was nausea and vomiting especially in the younger patient undergoing elective spine surgery.

To assess the incidence and characteristics of early postoperative complications in patients following neurosurgical procedures. All patients undergoing neurosurgery during a four month period were followed postoperatively for up to four hours in the post anesthetic care unit or intensive care unit. Patient information and all complications were documented by the investigators on a standardized form. Complications were classified as respiratory, cardiovascular, nausea and vomiting, shivering and other. Risk factors analyzed for the occurrence of complications included age, sex, ASA status, type of surgery, elective or emergency surgery and postoperative placement. Four hundred eighty six adult patients were followed, but in 55 patients the trachea remained intubated during the four hour study period and they were eliminated from the analysis of postoperative complications. At least one complication occurred in 54.5% of the remaining 431 patients. Respiratory problems occurred in 2.8%, trauma to the airway in 4.4%, cardiovascular complications in 6.7%, neurological in 5.7% and nausea and/or vomiting in 38%. The highest incidence of patients with complications was during spine (65%) and vascular (66%) surgery, compared with tumour (47%) and other (43%) surgery, P < 0.05. Other risk factors included age < 70 yr for nausea and vomiting (P < 0.02), and elective surgery for spine and vascular surgery (P < 0.001). There was a high incidence of early postoperative complications in neurosurgical patients. The most common problem was nausea and vomiting especially in the younger patient undergoing elective spine surgery.

BackgroundEarly complications increase in-hospital stay and mortality after intestinal obstruction surgery. It is important to identify the risk of postoperative early complications for patients with intestinal obstruction at a sufficiently early stage, which would allow preemptive individualized enhanced therapy to be conducted to improve the prognosis of patients with intestinal obstruction. A risk predictive model based on machine learning is helpful for early diagnosis and timely intervention.ObjectiveThis study aimed to construct an online risk calculator for early postoperative complications in patients after intestinal obstruction surgery based on machine learning algorithms.MethodsA total of 396 patients undergoing intestinal obstruction surgery from April 2013 to April 2021 at an independent medical center were enrolled as the training cohort. Overall, 7 machine learning methods were used to establish prediction models, with their performance appraised via the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and F1-score. The best model was validated through 2 independent medical centers, a publicly available perioperative dataset the Informative Surgical Patient dataset for Innovative Research Environment (INSPIRE), and a mixed cohort consisting of the above 3 datasets, involving 50, 66, 48, and 164 cases, respectively. Shapley Additive Explanations were measured to identify risk factors.ResultsThe incidence of postoperative complications in the training cohort was 47.44% (176/371), while the incidences in 4 external validation cohorts were 34% (17/50), 56.06% (37/66), 52.08% (25/48), and 48.17% (79/164), respectively. Postoperative complications were associated with 8-item features: Physiological Severity Score for the Enumeration of Mortality and Morbidity (POSSUM physiological score), the amount of colloid infusion, shock index before anesthesia induction, ASA (American Society of Anesthesiologists) classification, the percentage of neutrophils, shock index at the end of surgery, age, and total protein. The random forest model showed the best overall performance, with an AUROC of 0.788 (95% CI 0.709-0.869), accuracy of 0.756, sensitivity of 0.695, specificity of 0.810, and F1-score of 0.727 in the training cohort. The random forest model also achieved a comparable AUROC of 0.755 (95% CI 0.652-0.839) in validation cohort 1, a greater AUROC of 0.817 (95% CI 0.695-0.913) in validation cohort 2, a similar AUROC of 0.786 (95% CI 0.628-0.902) in validation cohort 3, and the comparable AUROC of 0.720 (95% CI 0.671-0.768) in validation cohort 4. We visualized the random forest model and created a web-based online risk calculator.ConclusionsWe have developed and validated a generalizable random forest model to predict postoperative early complications in patients undergoing intestinal obstruction surgery, enabling clinicians to screen high-risk patients and implement early individualized interventions. An online risk calculator for early postoperative complications was developed to make the random forest model accessible to clinicians around the world.

BackgroundFew studies have investigated the correlation between visceral fat area (VFA) and early postoperative complications in patients with obesity undergoing bariatric surgery. This study aimed to investigate the relationship between VFA and early postoperative complications in patients with obesity following bariatric surgery.MethodsThe study was conducted at a tertiary university hospital. Patients with obesity who underwent laparoscopic sleeve gastrectomy between June 2016 and October 2020 were divided into two groups based on umbilical level VFA: high-VFA group (umbilical level VFA ≥ 100 cm2) and low-VFA group (umbilical level VFA < 100 cm2). Baseline characteristics, intraoperative and postoperative conditions, and early postoperative complications were compared between the groups. The primary outcome was early postoperative complications, and the secondary outcome was postoperative hospital stay.ResultsThe study included 152 patients, with 82 patients in the low-VFA group and 70 patients in the high-VFA group. The high-VFA group had a higher incidence of early postoperative complications (14.29% vs. 2.44%, P = 0.013) than the low-VFA group. The length of postoperative hospital stay did not differ significantly between the groups.ConclusionsOur study suggests that excess VFA is an independent risk factor for early postoperative complications following bariatric surgery, and VFA may be used in preoperative evaluations.

Objective This study aimed to construct a nomogram based on body composition parameters and the prognostic nutritional index (PNI) using quantitative computed tomography (QCT) to predict early postoperative complications in patients with colorectal cancer (CRC). Materials and Methods We retrospectively analyzed the data of 157 patients who underwent radical resection for CRC between January 2019 and April 2024. All patients underwent QCT 1 month prior to surgery. Body composition was assessed at the level of the third lumbar vertebra, including measurements of the visceral fat area, subcutaneous fat area, and intramuscular fat infiltration (MFI) of the posterior vertebral muscles. The visceral-to-subcutaneous fat ratio (VSR) was calculated. Results Among the 157 patients, 31 (19.7%) experienced early postoperative complications. Univariate analysis revealed that the PNI, albumin level, VSR, and MFI were significantly associated with these complications. Multivariate logistic regression analysis identified the PNI (odds ratio [OR] = 0.801; 95% confidence interval (CI): 0.653–0.983), VSR (OR = 3.084; 95% CI: 1.365–6.968), and MFI (OR = 1.074; 95% CI: 1.009–1.145) as independent risk factors for early postoperative complications in CRC. The areas under the receiver operating characteristic curves for the PNI, VSR, MFI, and nomogram model for predicting postoperative complications were 0.796, 0.798, 0.648, and 0.879, respectively. Based on these three independent risk factors, the nomogram demonstrated good discrimination, calibration, goodness of fit, and clinical utility. Conclusions The nomogram model utilizing QCT-based body composition metrics and the PNI exhibited strong predictive capability for early postoperative complications in patients with CRC.

PurposeTo assess the incidence and factors predictive of early postoperative complications in Korean patients who undergo surgery for Crohn's disease (CD).MethodsWe retrospectively assessed 350 patients (246 males, 104 females; mean age, 30 ± 9 years) who underwent surgery for primary or recurrent CD at Asan Medical Center between January 1991 and May 2010. The incidence and predictive factors of early postoperative complications were analyzed by both univariate and multivariate analyses.ResultsOf the 350 patients, 81 patients (23.1%) developed postoperative complications, the most common being septic complications (54 patients), including 19 cases of wound infection. Thirty patients (8.6%) required re-operations, and only one patient died. Multivariate analysis showed that four factors were independently associated with a high risk of early postoperative complications; preoperative moderate to severe anemia (hematocrit concentration <30%; odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6 to 5.9), hypoalbuminemia (serum albumin level <3.0 g/dL; OR, 2.6; 95% CI, 1.4 to 4.7), emergency surgery (OR, 4.0; 95% CI, 1.5 to 10.6), and covering stoma (OR, 2.6; 95% CI, 1.3 to 5.4). Correction of preoperative moderate to severe anemia and hypoalbuminemia decreased the incidence of postoperative complications. Mean hospital stay was significantly longer in patients with than without postoperative complications (31.3 ± 27.2 days vs. 10.3 ± 3.8 days, P < 0.001).ConclusionPreoperative anemia, low albumin level, emergency surgery, and covering stoma significantly increased the risk of early postoperative complications in patients with CD. Correcting preoperatively deficient nutritional factors may reduce postoperative morbidities.

Obesity is a complex endocrine and metabolic disorder with increased mortality and morbidity worldwide. Laparoscopic sleeve gastrectomy is currently one of the most commonly performed bariatric procedures. This study aims to identify early postoperative complications in patients who underwent laparoscopic sleeve gastrectomy due to obesity and to examine the risk factors in the development of postoperative complications. Patients who underwent laparoscopic sleeve gastrectomy for obesity in our clinic between March 2018 and December 2019 were included in the study. Patients who did not develop postoperative complications constituted group-1, and patients who developed postoperative complications constituted group-2. Variables that may be effective in the development of postoperative complications were analyzed by univariate and multivariate analyses. Of the 253 patients included in the study, 184 (72.7%) were women, and 69 (27.3%) were man. The median age was 35 (min: 18-max: 63). The postoperative complication rate was 9.1%. The major complication rate was 2.4%, and the minor complication rate was 6.7%. In multivariate analysis, man gender (p=0.008), pulmonary comorbidity (p=0.027), preoperative hemoglobin value (p <0.001), and operation time (p <0.001) were determined as independent risk factors for postoperative complication development. We believe that identifying and optimizing risk factors that may be predictive for early postoperative complications after laparoscopic sleeve gastrectomy can provide better management for the possible early postoperative complications and improve the results.

Information regarding patient outcomes, complications, and mortality after surgery for spinal metastasis has previously been derived from single-institution series. The aim of this study was to report inpatient mortality, complications, and outcomes on a national level. The National Inpatient Sample (NIS) was utilized to identify 26,233 admissions of surgically managed spinal metastasis in the U.S. from 1993 through 2002. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on outcomes such as mortality, complications, discharge disposition, and length of stay. The in-hospital mortality rate was 5.6% and the complication rate was 21.9%. Pulmonary (6.7%) and postoperative hemorrhages or hematomas (5.9%) were the most common complications reported. A single postoperative complication increased the mean length of stay (LOS) by 7 days and the mortality rate by 11%. Multivariate analysis showed that complications were more likely in older patients and in patients with 2 or more comorbidities. With patients having no comorbidities as the reference group, 1 comorbidity increased the risk of in-hospital death by almost 4-fold. Mortality was significantly higher in men, in patients who had postoperative complications, and in patients who were operated in the earlier (1993-1997) year group. A national perspective is provided on inpatient complications and outcomes after surgery for spinal metastasis in the U.S. The significant negative effect of postoperative complications on mortality and resource utilization is demonstrated. Furthermore, preoperative comorbidity is identified as an important risk factor and its impact is defined on patient outcomes.

TITLE: Effect of intra-operative and post-operative topical tranexamic acid on early post-operative complications in patients undergoing axillary lymph node dissection for breast cancer. Authors: PACHIMATLA AKHIL GOUD1, ISHITHA LARAOIYA2, SIDDHANT KHARE3, R N NAGA SANTHOSH IRRINKI2, GURPREET SINGH4. Affiliation: 1. Junior Resident, Department of General Surgery, Post Graduate Institute of Medical Education &amp; Research (P.G.I.M.E.R.), Chandigarh. 2. Assistant professor, Department of General Surgery, Post Graduate Institute of Medical Education &amp; Research (P.G.I.M.E.R.), Chandigarh. 3. Associate professor, Department of General Surgery, Post Graduate Institute of Medical Education &amp; Research (P.G.I.M.E.R.), Chandigarh. 4. Professor and Head (retired), Department of General Surgery, Post Graduate Institute of Medical Education &amp; Research (P.G.I.M.E.R.), Chandigarh. BACKGROUND: Seroma formation after breast surgery has been a consistent problem with no established causes or risk factors. The role of topical tranexamic acid in reducing the incidence of seroma after axillary clearance in breast cancer is controversial. AIMS &amp; OBJECTIVES: To study the effect of intra-operative and post-operative topical Tranexamic acid on the duration of drain and volume of seroma in patients undergoing axillary lymph node dissection (ALND) for breast cancer. MATERIALS AND METHODS: In this prospective, non-blinded, triple-arm randomized controlled trial conducted at the Department of General Surgery, PGIMER, 154 breast cancer patients were enrolled and studied from July 2020-July 2021. They were randomized into three groups. Group A (n=51) received a single dose of diluted topical tranexamic acid intra-operatively, Group B (n=52) received intra-operative dose and daily post-operative doses till day-5 through the suction drain placed intra-operatively, and Group C(n=51) did not receive any topical tranexamic acid. The study groups were primarily compared for the total drain duration and total drainage volume. Daily drain volume for the first five days, complications like seroma, wound infection and severity of surgical site infections using Southampton score, and adverse reactions of the drug were compared. RESULTS Out of the 154 patients, four have failed to maintain appropriate records and analysis was done with 150 patients. The mean age of the study population was 52.17±8.69 yrs, with a mean BMI of 26.20±4.14. The final analysis showed no significant difference in total drain volume across the three groups, but patients receiving multiple doses of topical tranexamic acid had the lowest total volume drained compared to patients receiving a single dose or no dose (1763ml Vs 1597 Vs 1773ml: p=0.269. There was no significant change in the duration of the post-operative drain (21.6 Vs 19.2 Vs 19.55 days: p=0.54). There was no statistically significant difference in complications between the groups. Seroma was seen in 6 vs 7 vs 4%(p=0.629) patients in groups A, B and C respectively. Wound site infection was noted in 11 vs 13 vs 10% of patients (p= 0.766). None of the patient characteristics like age, BMI, co-morbidities, previous lumpectomy, menopause, and length of history significantly correlated with seroma formation in the study population. CONCLUSION There was no significant reduction in drain volume or duration with either single or multiple doses of topical tranexamic acid after the axillary clearance for breast cancer. Even though not significant, an increasing trend in wound site infections was noted among the patients who received multiple doses of tranexamic acid was noted. Citation Format: AKHIL GOUD PACHIMATLA, R N NAGA SANTOSH IRRINKI, ISHITA LAROIYA, SIDDHANT KHARE. Effect Of Intra-operative And Post-operative Topical Tranexamic Acid On early post-operative complications In Patients Undergoing Axillary Lymph Node Dissection For Breast Cancer- A randomized controlled study. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-14.