Abstract
BackgroundPatients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group.MethodsWe performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events.ResultsOf a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01–1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33–5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21–4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03–4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98–1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00–4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55–27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75–0.84, p < 0.001).ConclusionsOur findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.
Highlights
Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival
In our prospective observational study, we found that, in cancer patients undergoing abdominal surgery, age, American society of anesthesiologists (ASA) score, preoperative anaemia and intraoperative bleeding, use of colloids, higher amount of fluids and vasopressors were identified as predictors of major postoperative complications including mortality
These findings suggest that a perioperative strategy based on the treatment of preoperative anaemia, implementation of conservative blood management and effective bleeding control and haemodynamic management during surgery may improve
Summary
Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. Survival related to cancer has increased due to advances in diagnostic and therapeutic interventions, including implementation of management protocol (e.g. goal-directed hemodynamic therapy) in perioperative care [1,2,3]. Perioperative complications negatively affect quality of life and may delay or preclude further cancer treatment, such as adjuvant chemotherapy. Identification of predictive factors for complications is critical for several reasons. First of all, it allows a more accurate risk stratification and adequate planning of perioperative management. Identification of predictive factors helps to identify areas for future investigations
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