30-day Postoperative Mortality Research Articles

Neoadjuvant SHR-1701 (a bifunctional anti-PD-L1/TGF-βRII agent) combined with chemoradiotherapy for resectable locally advanced esophageal squamous cell carcinoma (ESCC): A phase II trial.

410 Background: Neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is the standard of care for resectable locally advanced ESCC. SHR-1701, a new bifunctional fusion protein composed of a monoclonal antibody against PD-L1 fused with the extracellular domain of TGF-β receptor II, may enhance antitumor activity in combination with neoadjuvant standard therapies in ESCC patients (pts). The aim of this phase II trial is to determine the safety and efficacy of neoadjuvant chemoradiotherapy plus SHR-1701 followed by esophagectomy in pts with locally advanced resectable ESCC. Methods: Pts with resectable thoracic ESCC, diagnosed as clinical stage of cT1b-cT2N+M0 or cT3-cT4aNxM0 per AJCC 8th were eligible. Preoperative therapy included SHR-1701 (30 mg/kg every 3 weeks for 2 cycles), albumin paclitaxel (50 mg/m 2 , once a week for 5 weeks), carboplatin (AUC=2, once a week for 5 weeks) and radiotherapy (41.4Gy in 23 fractions). Following esophagectomy, pts received SHR-1701 up to 1 year. The primary endpoint was pathological complete response (pCR) rate in the per-protocol population. Secondary endpoints included R0 resection rate, major pathological response (MPR) rate, disease free survival (DFS) and safety. Results: Between Dec. 2021 and Feb. 2023, 43 pts were screened and 41 met the inclusion criteria, among whom the clinical stage I, II, III, and IVa at baseline were 1 (2.4%), 8 (19.5%), 31 (75.6%), and 1 (2.4%), respectively. All 41 pts received neoadjuvant SHR-1701 combined with chemoradiotherapy. As of Mar. 2024, 30 pts underwent surgery, and all achieved R0 resection. There was no in-hospital and postoperative 30-day mortality. 9 (30.0%) pts achieved pCR in both primary tumor and lymph nodes (ypT0N0), and 12 (40.0%) pts had complete pathological response of the primary tumor with residual disease in lymph nodes alone (ypT0N+). Treatment-related adverse events (TRAEs) occurred in all pts, and most of TRAEs were grade 1-2. Notable toxicity included pneumonitis (31.7%) and anastomotic leak (12.2%). Conclusions: The addition of SHR-1701 to neoadjuvant chemoradiotherapy in ESCC demonstrated promising efficacy with acceptable toxicity, and might be a promising approach for neoadjuvant treatment. Clinical trial information: ChiCTR2000041562.

Hyponatremia is associated with malignant brain edema after mechanical thrombectomy in acute ischemic stroke

BackgroundHyponatremia (< 135 mmol/L) is the most common electrolyte disturbance in patients with stroke. However, few studies have reported the relationship between hyponatremia at admission and outcomes in patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). This study is aimed to explore the association between hyponatremia and clinical outcomes following MT.MethodsA retrospective study was conducted at our center. The primary outcome was postoperative malignant brain edema (MBE). The secondary outcomes included mortality and adverse function at the 90-day follow-up, which were defined as modified Rankin scale scores of 6 and > 2, respectively. Patients were classified into hyponatremia and nonhyponatremia groups based on their serum sodium concentration at admission before drug use. The occurrence of MBE was evaluated via computed tomography after MT, and 90-day outcomes were obtained through in-person interviews at the clinic or via telephone. Multivariate analysis was performed to investigate the associations among postoperative MBE, 90-day mortality, adverse function and hyponatremia.ResultsA total of 342 patients were enrolled into the study, of whom 52 (15.2%) had hyponatremia, 86 (25.1%) developed postoperative MBE, 93 (27.2%) died within 90 days after MT, and 201 (58.8%) had adverse functions at the 90-day follow-up. Multivariate analysis revealed that hyponatremia was significantly associated with postoperative MBE (odds ratio [OR] 3.91, 95% confidence interval [CI] 1.66 − 9.23, p = 0.002), 90-day mortality (OR 5.49, 95% CI 2.48 − 12.14, p < 0.001), and 90-day adverse function (OR 3.25, 95% CI 1.29 − 8.12, p = 0.012). In addition, mediation analysis revealed that postoperative MBE may partially account for the 90-day mortality/adverse function of patients with hyponatremia (regression coefficients changed by 18.6% and 23.9%, respectively).ConclusionHyponatremia is an independent predictor of postoperative MBE, 90-day mortality, and adverse function. Correction of hyponatremia may reduce the postoperative MBE to improve the prognosis of patients.

Impact of hospital volume on survival in patients with locally advanced colon cancer - A Dutch population-based study.

Locally advanced colon cancer (LACC) often necessitates complex prognosis-determining treatment. This study investigated the impact of hospital volume on short- and long-term outcomes following surgery for LACC. Data involving all patients with LACC categorized as clinical T4 and/or N2, between 2015 and 2019 in the Netherlands, were extracted from the Netherlands Cancer Registry. Hospitals were stratified into low volume (1-19 LACC resections per year), medium volume (20-29 LACC resections per year) and high volume (≥30 LACC resections per year). Data were analysed using Kaplan-Meier curves, logistic regression analysis and Cox-regression models. A total of 49 298 patients were diagnosed with colon cancer, of whom 9206 (18.7%) had locally advanced disease. Of these 9206 patients, resection was performed in 8537 with a median age of 71 (interquartile range: 63-78) years. Patients were more likely to undergo laparoscopic procedures in high-volume hospitals than in low-volume hospitals (OR = 1.28, 95% CI: 1.12-1.46). No risk differences in anastomotic leakage or postoperative 90-day mortality were observed according to hospital volume. Five-year overall survival rates were comparable among high-, medium- and low-volume hospitals (58.7% vs. 58.0% vs. 60.0%, p = 0.62). Hospital volume was not associated with overall survival in multivariable analysis. Independent predictors of worse overall survival included older age, higher American Society of Anaesthesiologists score, emergency/urgent setting, anastomotic leakage, higher pTNM status, involved resection margins and no adjuvant chemotherapy. Despite the complexity of surgical treatment, hospital volume was not associated with survival in LACC. Hospital volume might be an imperfect surrogate for quality assessment.

Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study.

The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care. This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity. Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions. These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.

Comparison of Outcomes Between Low-Risk Aortic Valve Replacement Trials and a Surgical Registry

It remains unknown whether outcomes of the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) and Evolut Low Risk trials are comparable with surgical outcomes in nontrial settings, considering the added risk of concomitant cardiac operations. To compare 30-day mortality and stroke incidences of patients in the surgical aortic valve replacement (SAVR) arm of low-risk trials with those of similar patients in the US Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). A cross-sectional sampling study was conducted of adults in the STS ACSD with severe aortic stenosis at low surgical risk for AVR who underwent SAVR during the years low-risk AVR trials (PARTNER 3 and Evolut Low Risk) were enrolling (calendar years 2016-2018). After trial exclusion criteria were applied, 1000 samples were created, each including 1000 patients selected from the STS ACSD according to the likelihood-based selection probabilities to achieve similar STS predicted risk of mortality (PROM) distribution to the trial participants. The distribution of 30-day mortality and stroke rates among these samples were compared with the results from the trials. The analysis was conducted between October 2, 2023, and May 27, 2024. The main outcomes were 30-day postoperative mortality and stroke. Among 25 811 patients at low risk undergoing SAVR, the mean (SD) age was 71 (7) years, including 650 220 men (65%). The probability-based sampling yielded a trial-like sample with STS PROM (mean [SD], 1.9% [0.6%]) and concomitant coronary artery bypass graft surgery frequencies of 13%, comparable with the trials. Among the sampled cohorts, the mean (SD) 30-day mortality rate was 1.39% (0.38%) which was not significantly different from the mortality rate in PARTNER 3 (1.1%) (P = .83) and Evolut Low Risk (1.3%) (P = .65). The stroke rate was 1.25% (0.36%), significantly lower than PARTNER 3 (2.4%) (P = .002) and Evolut Low Risk (3.4%) (P < .001). In this cross-sectional study, the national samples of low-risk trial-like patients undergoing SAVR during the trial enrollment period had similar 30-day mortality but a lower incidence of stroke compared with the SAVR arm of both low-risk trials. These findings overall suggest that the low-risk trial findings may be generalizable to the broader national SAVR cohort.

Comparison of treatment outcomes between graft replacement and aneurysmorrhaphy with graft preservation for type 2 endoleaks after endovascular abdominal aortic aneurysm repair.

This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion. Forty patients underwent open surgical conversion (graft replacement, n=9; graft preservation, n=31). There were no significant differences in patient characteristics or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < .001 and 710 vs. 2,567 mL, P = .030, respectively). There was no difference in the occurrence of postoperative complications between the two groups (P = .645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = .789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = .239). Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.

Is there relationship between obesity and early postoperative survival after off-pump CABG?

The article studies and analyzes the prevalence of excess body weight and obesity in patients with coronary artery disease, as a leading medical and biological risk factor for the development of diseases of the circulatory system. The presence of obesity is associated with such concomitant diseases as arterial hypertension, dyslipidemia, type II diabetes. The relationship of excess body weight and obesity with 30-day postoperative mortality, age and gender of patients was analyzed. The body mass index was determined and its value was interpreted in relation to the presence of excess body weight and obesity. It was established that in the sample of patients with coronary heart disease, the average height was 172.3 cm, the average body weight was 81.9 kg; the average value of the body mass index is 29.7 (variations of the body mass index from 18.3 to 44.9). As a result of the analysis of the received data, a high prevalence of excess body weight (45.5%) and obesity (40.1%) among patients with coronary artery disease was found. It was found that among male patients, normal body weight (χ²=8.26; p=0.004) and excess body weight (χ²=66.25; p=0.0001) were significantly more common, compared to female patients. And obesity (χ²=42.49; p=0.0001) and severe obesity (III degree), (χ²=4.21; p=0.04) were significantly more common among female patients. It was found that patients with normal body weight were 3.1 years older, which is reliable relative to obese patients (χ²=25.83; p=0.0001). It was determined that the highest frequency of 30-day mortality was observed in patients with normal body weight (1.1%), while in obese patients the corresponding frequency was 0.6%. It was found that deceased patients with normal body weight were significantly older than deceased patients with obesity (χ²=13.63; p=0.0001) and deceased patients who had excess body weight (χ2=6.10; p=0.01). Keywords: ischemic heart disease, risk factors, clinical and anthropological studies, body mass index, early postoperative mortality.

Risk factors for mortality after 3-column osteotomy.

Three-column osteotomies (3COs), such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are used to surgically correct rigid adult spinal deformity (ASD). While extensive research exists about complications associated with 3COs, there remains a paucity of studies analyzing risk factors for mortality following 3CO. We believe the mortality rate after 3-column osteotomy will be low with specific identifiable demographic or medical risk factors. A retrospective analysis was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing 3CO were identified via CPT codes. The primary outcome of interest was 30-day postoperative mortality. Univariate statistical analysis was performed, followed by multivariable logistic regression controlling for age, sex, and body mass index (BMI). The analysis included 1,441 patients. 446 patients had thoracic osteotomies, 996 patients had lumbar osteotomies, and 226 had multilevel osteotomies. The overall 30-day mortality rate was 1.2% (18 patients). On univariate analysis, mortality was more likely in patients with diabetes (2.8% vs. 1.2%, P = 0.029) and COPD (7.0% vs. 1.2%, P < 0.001). Mortality was associated with higher 5-factor modified frailty index (P = 0.004). After controlling for age, sex, and BMI, multivariable analysis revealed that mortality rates were independently associated with longer operative times (OR = 1.28, 95% CI:1.06-1.54, P = 0.010) and COPD (OR = 10.36, 95% CI: [2.17-49.47], P = 0.003). Thirty-day mortality after 3CO is 1.2% globally. The greatest univariate risk factors are diabetes, COPD, and frailty. Regardless of age, sex, or BMI, it was found that COPD and duration of surgery were independently associated with increased rates of mortality.

Protocol for the impact of machine learning-based clinician decision support algorithims in perioperative care (IMAGINATIVE) in Singapore general hospital : a large prospective randomised controlled trial

IntroductionAs surgical accessibility improves, the incidence of postoperative complications is expected to rise. The implementation of a precise and objective risk stratification tool holds the potential to mitigate these complications...

Heart Disease and Pectus Excavatum: An Underestimated Issue-Single Center Experience and Literature Review.

Pectus excavatum (PE) can be associated with either congenital or acquired heart disease. This study highlights the importance of PE surgical repair in cases of severe chest depression on the heart in underlying cardiac diseases exacerbating cardiopulmonary impairment. From January 2023 to March 2024, four male patients underwent PE repair, having heart disease including pericarditis, mitral valve prolapse, ventricular fibrillation arrest and type 1 second-degree atrioventricular block. PE severity was determined by the Haller index (HI). Preoperative assessment included a pulmonary function test, chest computed tomography and cardiac evaluation. The Nuss procedure was performed in three patients, whereas, in one patient, it was performed in combination with a modified Ravitch procedure. The median HI was five. The median time of chest tube removal was 6.5 days. Postoperative complications were prolonged air leak, atrial fibrillation and atelectasis. The median length of hospital stay was 19.5 days, and no 30-day postoperative mortality was recorded. In all patients, surgical repair helped to resolve the underlying cardiological issues, and surgical follow-ups were deemed regular. PE is generally an isolated congenital chest wall abnormality, and, when associated with a heart disease, it can have severe life-threatening hemodynamic consequences due to mechanical compression on the heart for which surgical corrections should be considered.

Prognostic analysis of acute type A aortic dissection after different surgical interventions: a cohort study.

Acute type A aortic dissection (ATAAD) requires emergency surgery, but the choice of primary surgery remains controversial. It is believed that simple ascending aorta replacement may lead to higher postoperative survival rate, while the Sun procedure [frozen elephant trunk (FET) + total arch replacement (TAR)] performed in the first stage may obtain better long-term results. The study aimed to compare the outcome of ATAAD patients who underwent the Sun procedure with those without TAR + FET. Data of 452 patients with ATAAD admitted to Beijing Anzhen Hospital for surgical treatment from August 1, 2020, to August 16, 2022, were collected and analyzed. Patients with the Sun procedure (n=344) were compared to those without the Sun procedure (n=108). The two groups of patients were matched using propensity score matching (PSM), and the risk factors of poor prognosis were analyzed. The average postoperative follow-up period was 976±414 days, and the loss of follow-up rate was 0. The postoperative 30-day mortality rates were 12.56% and 5.38% in the Sun procedure group and the non-Sun procedure group after PSM matching, respectively (P=0.06). Multivariate logistic regression analysis showed that postoperative cardiogenic shock, postoperative cerebral malperfusion syndrome (MPS), postoperative spinal MPS, and need for continuous renal replacement therapy (CRRT) were independent risk factors for postoperative 30-day death. The 3-year survival rates were 85.02% and 91.40% in the Sun procedure group and the non-Sun procedure group after PSM matching, respectively (P=0.12). According to multivariate cox regression analysis, the independent risk factors associated with postoperative midterm death were consistent with those associated with 30-day postoperative death that pointed out by logistic regression. The incidence of spinal MPS after the Sun procedure was higher than that in the non-Sun procedure group (P=0.003). At 3-year follow-up, the probability of no distal aortic events (DAEs) was 97.17% and 91.59%, in the Sun procedure group and non-Sun procedure group, respectively, representing a significant difference (P=0.02). Multivariate Cox regression showed that Marfan syndrome and non-Sun procedure were risk factors for DAEs. Fine-Gray analysis also produced results similar to multifactor cox regression analysis, that Marfan syndrome and non-Sun procedure were risk factors for DAEs. There was no significant difference in postoperative mortality between the Sun procedure group and the non-Sun procedure group. The incidence of spinal MPS in the Sun procedure group was higher than that in the non-Sun procedure group, while the incidence of DAEs in the Sun procedure group was lower than that in non-Sun procedure group.

Effects of glucocorticoids on postoperative delirium in patients undergoing elective non-cardiac surgery:A systematic review and meta-analysis.

Postoperative delirium (POD) is common postoperative complications in non-cardiac surgery. While delirium prophylaxis has not yielded unequivocal support. The clinical effects of glucocorticoids on POD remains unclear. To evaluate the effects of glucocorticoids on postoperative delirium (POD) in patients undergoing non-cardiac surgery. Systematic review with meta-analysis. In strict accordance with the PRISMA statement, a systematic literature search was undertaken across PubMed, EMBASE, Web of Science and Cochrane Library databases in May 2023. We updated the search results on June 28, 2024. We used the Grading of the Recommendation Assessment, Development, and Evaluation (GRADE) system to evaluate the quality of evidence. This meta-analysis included twelve randomized controlled trials involving 1044 participants undergoing non-cardiac surgery. Compared with the control group, glucocorticoids significantly reduced the incidence of POD in patients undergoing non-cardiac surgery (RR:0.50, 95%CI:0.41 to 0.60, P<0.00001, I2=26%, GRADE=high). Meanwhile, glucocorticoids was associated with reducing the severity of POD (RR: -0.67, 95%CI: -1.10 to -0.23, P=0.003, I2=89%, GRADE=low). However, there were no significant differences with regards to patients receiving antipsychotic drug (RR: 0.91, 95%CI:0.43 to 1.92, P=0.80, I2=0%, GRADE=moderate), length of hospital stay (RR: -0.52, 95%CI: -1.41 to 0.36, P=0.24, I2=0%, GRADE=moderate), 30-day postoperative mortality (RR: 0.70, 95%CI:0.23 to 2.15, P=0.54, I2=0%, GRADE=low) and postoperative infection (RR: 0.87 95%CI: 0.58 to 1.30, P=0.50, I2=33%, GRADE=moderate). This systematic review and meta-analysis suggests that glucocorticoids reduce the incidence of POD among adults and children undergoing non-cardiac surgery and mitigate the severity of POD in adults, which indicates that glucocorticoids exhibit preventive or therapeutic effects on POD. CRD42023426836 (PROSPERO).

Uniportal Robotic Lobectomy and Lymphadenectomy for Invasive Lung Cancer: A Novel Approach and Perioperative Outcomes.

Multiport robot-assisted thoracoscopic surgery (mRATS) has been comprehensively evaluated for its clinical efficacy in numerous studies. Nevertheless, the safety and feasibility of uniportal robotic lobectomy and lymphadenectomy require further validation. The clinical data of 34 consecutive patients with lung cancer who underwent improved uniportal robotic-assisted thoracoscopic surgery (uRATS) at our hospital between November 2023 and June 2024 were reviewed retrospectively. Camera-centered uRATS was conducted using the da Vinci Surgical Xi system (Intuitive Surgical Inc., 1266 Kifer Road, Sunnyvale, CA 94086, USA). Descriptive statistics are expressed as numbers with percentages for categorical data or medians (ranges) or means with standard deviations for continuous data. Improved uRATS lobectomy and lymphadenectomy were conducted in 34 patients with postoperative pathology-diagnosed invasive lung cancer. Among the patients, the median number of lymph nodes dissected was 24.5 (range 10-42), and the median number of stations with lymph nodes dissected was 8 (range 6-11). The median durations of the operation and the uRATS procedure were 200 min (range, 142-330 min) and 140 min (range, 80-242 min), and the median intraoperative blood loss volume was 20 mL (range, 10-100 mL), respectively. All postoperative complications, including pneumonia (2/34, 5.8%), air leakage > 5 days (2/34, 5.8%), prolonged wound healing (1/34, 2.9%), and arrhythmia (1/34, 2.9%), were graded as Clavien-Dindo grades I-II. There were no cases of wound infection or postoperative 30-day mortality. The safety and feasibility of uRATS lobectomy and lymphadenectomy using the da Vinci Surgical Xi system have been preliminarily validated.

Higher compliance with the enhanced recovery after surgery protocol improves postoperative recovery and 6-month mortality in upper gastrointestinal surgery

IntroductionThe enhanced recovery after surgery (ERAS) protocol has been proven to accelerate recovery without increasing morbidity, but few data are available from developing countries. We aimed to demonstrate the correlation between compliance with the ERAS protocol and short-term outcomes in upper gastrointestinal (UGI) surgery. Materials and MethodsPatients that underwent esophageal and gastric surgeries during March 2019 to June 2021 were prospectively enrolled in this nonrandomized cohort study. The ERAS protocol was applied based on patient-doctor agreement. Patients were categorized into conventional care (CC), moderate-compliance (MC), and high-compliance (HC) groups. Short-term outcomes including gastrointestinal (GI) function recovery, length of hospital stay (LOS), postoperative complications and mortality rate were compared. Results158 patients were enrolled: 58 in the CC, 33 in the MC, and 67 in the HC group. The HC group demonstrated reduced time to tolerate oral diet (8 vs 7 vs 3 days; p = 0.034), recovery of GI function (72 vs 96 vs 61 h; p = 0.001) and median LOS (12.5 vs 10 vs 6 days; p < 0.001). Postoperative overall (p = 0.08) and major complications (p = 0.09) were not significantly different. Non-surgical complications were lower in the HC group (31.0 % vs 54.5 % vs 25.4 %; p = 0.013). The 28-day readmission rate was not different (8.6 % vs 3.0 % vs 1.5 %; p = 0.14). The 30-day postoperative mortality was not different (0 % vs 3.1 % vs 0 %; p = 0.15), but the 6-month mortality rate was significantly lower in the HC group (13.8 % vs 15.2 % vs 0 %; p < 0.001). ConclusionThe level of compliance with the ERAS protocol is associated with improved short-term postoperative outcome in UGI surgery. High compliance patients recovered faster, were discharged sooner, and had better 6-month survival.

Comparison of clinical outcomes between Castor single-branched stent graft and in situ fenestration in treating Stanford type B aortic dissection involving the left subclavian artery: A retrospective case-control study.

Stanford type B aortic dissection involving the left subclavian artery (LSA) poses significant clinical challenges. The Castor single-branch stent graft and in situ fenestration are commonly used techniques, but the better endovascular treatment remains debated. This study evaluates the clinical effects of the Castor single-branched stent graft versus in situ fenestration in treating Stanford type B aortic dissection involving the LSA. We selected 75 patients with Stanford type B aortic dissection involving the LSA, admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to May 2022. All patients underwent thoracic endovascular aortic repair; 34 received the Castor single-branched stent graft, while 41 underwent in situ fenestration. Clinical efficacy and perioperative complications were compared. The technical success rate of the Castor single-branch stent graft was significantly higher than that of in situ fenestration (97.06% vs 80.49%, P = .04). The Castor group exhibited significantly better outcomes in operative time (136.45 ± 25.53 min vs 157.08 ± 18.14 min), LSA blood flow recovery time (6.8 ± 2.3 min vs 20.1 ± 9.8 min), blood loss (29.03 ± 9.78 mL vs 35.69 ± 10.77 mL), contrast medium usage (288.71 ± 72.70 mL vs 352.78 ± 81.02 mL), and immediate postoperative endoleaks (1/34 vs 7/41) (P < .05). Stroke incidence (1/34 vs 2/41) and perioperative mortality (0/34 vs 1/41) were similar (P > .05). Hospital stays were comparable (15.71 ± 6.04 days vs 14.22 ± 5.01 days, P = .28). However, the cost of medical supplies (154,168.62 ± 28,288.44 CNY vs 119,589.72 ± 34,199.67 CNY) and total hospital expenses (192,665.88 ± 40,027.99 CNY vs 153,920.47 ± 42,670.87 CNY) were significantly higher in the Castor group (P < .05). The median follow-up time was 9 months (1-60 months). Follow-up showed similar 30-day postoperative mortality (1/41 vs 0/34, P = 1.00), stent patency (33/34 vs 39/41, P = .67), and stent migration rates (0/34 vs 1/41, P = 1.00). However, the endoleak rate was significantly higher in the in situ fenestration group (11/41 vs 1/34, P = .01). Both the Castor single-branch stent graft and the in situ fenestration technique effectively protect and reconstruct the LSA in Stanford type B aortic dissection, with the Castor single-branch stent graft showing higher technical success and fewer complications, indicating better clinical potential.

Analysis of Risk Factors, Treatment Patterns, and Survival Outcomes After Emergency Presentation With Colorectal Cancer: A Prospective Multicenter Cohort Study in Nigeria.

Prospective data on presentation and outcomes of colorectal cancer (CRC) in Nigeria are limited; however, emergency presentation with advanced disease is thought common. Consecutive CRC patients presenting at six sites over 6 years were included. Risk factors for emergency presentation were evaluated using logistic regression methods. Overall survival (OS) was compared between emergent and elective patients using Kaplan-Meier methods and the log-rank test. Of 535 patients, 30.7% presented emergently. Median age was 56 years, 55% were men, and 5.0% reported a cancer family history. Emergency patients had more proximal cancers (42.1% vs. 24.0%), Stage IV disease (61.6% vs. 40.2%; p < 0.001), lower household income (₦35 000/month vs. ₦50 000/month), lower education levels (p = 0.008) and accessed care with nonmotorized transport (50.6% vs. 37.2%; p = 0.005). Median OS was shorter in the emergency group (6.4 vs. 17.4 months; p < 0.001). Across clinical stages, emergency presentation was associated with worse OS (Stage IV median OS 4.8 vs. 9.4 months; p = 0.002). Surgery improved survival in both groups, although emergency patients had higher 30-day postoperative mortality (23.2% vs. 9.1%; p < 0.001). Emergent Nigerian CRC patients have worse OS than elective patients. Cancer control efforts should focus on faster cancer detection, early presentation, diagnosis, and treatment.

The correlation between severe asymptomatic carotid artery stenosis and severe multi-organ dysfunction after off-pump coronary artery bypass grafting.

The current research aimed to demonstrate the independent association between preoperative severe asymptomatic carotid artery stenosis (ACAS) and severe multi-organ dysfunction after off-pump coronary artery bypass grafting (OPCAB), which may further indicate the relationship between severe ACAS and adverse 30-day postoperative outcomes of patients undergoing OPCAB. This was a single-center, retrospective observational study including patients without a history of stroke or Transient Ischemic Attacks (TIA) (asymptomatic), who underwent for an isolated OPCAB in the center for operative treatment of coronary artery disease of Beijing Anzhen Hospital from January 2020 to December 2021. All enrolled patients underwent carotid artery ultrasound prior to OPCAB. The information was extracted independently by two authors of the study from the medical records. Both univariate and multivariate analyses were conducted. A total of 562 patients met the inclusion criteria for the current study. 63 (11.2%) suffered from severe ACAS. The Sequential Organ Failure Assessment (SOFA) maximum in the severe ACAS group was significantly higher than that in the non-severe ACAS group (9.76 ± 3.03 vs. 7.75 ± 2.96, p < 0.0001), and a higher proportion of patients in the severe ACAS group exhibited severe multi-organ dysfunction (44.4% vs. 14.0%, p < 0.0001). In addition, severe ACAS was related to an increased rate of 30-day postoperative major adverse cardiovascular and cerebral events (MACCEs), including a 30-day postoperative stroke. Severe ACAS was associated with an elevated risk of delirium, and acute kidney injury (AKI). The results of the multivariate analysis demonstrated that severe ACAS may be independently associated with severe multi-organ dysfunction (OR, 7.37, 95% CI 4.80-14.30, p < 0.0001) after OPCAB. Also, severe ACAS may be independently associated with 30-day postoperative stroke (OR, 2.83, 95% CI 1.03-7.75, p = 0,043). Severe ACAS was independently associated with severe multi-organ dysfunction after OPCAB, which may be associated further with an increased rate of 30-day postoperative mortality and complications. This study highlights: (1) the importance of personalized assessment for potential advantages and disadvantages in prognosis of severe ACAS patients undergoing OPCAB with carotid endarterectomy; (2) the role of multi-organ parameters, especially cardio-cerebral factors, should be emphasized during the process of severe ACAS management.

Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction

Background and study aim: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as a potential treatment option for malignant gastric outlet obstruction (mGOO), with a relatively long duration of patency and low rate of reintervention. Its intrinsic risk for serious adverse events and high procedure cost mandates careful patient selection beyond the common safety profiles. This study aimed to assess for predictors of early post-EUS-GE mortality. Patients and methods: We conducted a retrospective analysis of all patients with unresectable mGOO who underwent EUS-GE. Predictive factors for postoperative 30-day mortality with crude and adjusted hazard ratios were examined using univariate and multivariate penalized likelihood Firth logistic regression analyses. Results: Technical and clinical success was achieved in 96.7% and 93.1% of the patients, respectively. The 30-day mortality rate after the procedure was 11.7%, and no procedural complications were observed. The 30-day mortality group had a significantly low rate of initial clinical success (66.7% vs. 96.2%, p=0.007). Univariate analysis identified significantly higher postoperative 30-day mortality in patients with poor baseline ECOG performance status scale (≥2) and ascites. The presence of grade 2 ascites was confirmed as an independent predictive factor in the multivariate analysis (adjusted hazard ratio 52.41, 95% confidence interval 1.55 to 1775.64, p=0.024). Conclusion: EUS-GE should be carefully considered for patients with ascites which was an independent predictor for early mortality after procedure in mGOO, especially those with grade 2 or higher level of ascites.

Risk Factors and Clinical Outcomes of Perioperative Hypotension in the Neck of Femur Fracture Surgery: A Case-Control and Cohort Analysis.

Introduction Neck-of-femur (NOF) fractures have high prevalence rates and require prompt surgical intervention for better outcomes. Perioperative hypotension (POH) in the geriatric population has poor outcomes with several contributing factors. The study intends to explore these risk factors and their correlation with patient outcomes. Methodology We studied a total of 276 patients who underwent surgical fixation of the NOF fracture at St Peter's Hospital, Surrey, from June 1, 2022, to June 1, 2023. Patients with POH were identified; the risk factors and one-year outcome were studied to obtain the results. We used odds ratio (OR), relative risk (RR), and multivariate regression to analyse the statistical association within the data. Results The incidence of POH was 68% (188/276) which included preoperative hypotension (9.78%), intraoperative hypotension (48.55%), and postoperative hypotension with a mean arterial pressure (MAP) of <65 mmHg (24.63%) and fall of systolic blood pressure to less than 80% (34.42%). Statistically significant risk factors were hypertension (OR: 1.330), heart disease (OR: 2.768), and hemoglobin (Hg) drop (OR: 1.42). The outcomes we studied were all statistically significant, with an RR of more than one. It includes postoperative delirium (RR: 2.037), postoperative 30-day morbidity (RR: 4.008), postoperative 30-day mortality (RR: 6.12), 365-day mortality (RR: 2.224), postoperative delay in mobilisation (RR: 1.329), and prolonged length of stay (RR: 1.273). Conclusion The study shows a clear association between POH and increased postoperative complications, highlighting the need for prompt intervention. This case-control study identified hypertension, history of heart disease, and perioperative blood loss as significant risk factors for developing POH. Also, this study demonstrates that POH is significantly associated with adverse outcomes, including the increased risk of delirium, prolonged hospital stays, and elevated 30-day morbidity in elderly patients undergoing hip fracture surgery.The findings also indicated that the duration of hypotension did not directly influence the outcomes; its occurrence alone is a significant factor in developing these complications.

Analysis of surgical treatment outcomes for renal cell carcinoma with inferior vena cava tumor thrombosis: a singlecenter experience

The purpose of the study was to analyze surgical treatment outcomes for renal cell carcinoma (RCC) with inferior vena cava tumor thrombosis (IVC-TT) on the basis of one cancer center.Material and Methods. A retrospective analysis of treatment outcomes of 25 patients with locally advanced and metastatic RCC with IVC-TT, who underwent surgery from 01.2021 to 12.2022, was carried out. The median follow-up was 21 months (95 % CI 14.3–33 months). The patients were divided into groups according to the Mayo IVC-TT classifcation: Type I: 8 patients, type II: 8 patients, and type III: 9 patients.Results. Tangential IVC resection was done in 20 (80 %) cases, circular-in 3 (12 %) cases, and IVC extirpation was done in 2 (8 %) cases. The median intraoperative blood loss was 600 ml (from 250 to 1700 ml). The incidence of postoperative complications was 28 %, distribution by Clavien–Dindo classes was: III – 4, IV – 2, V – 1, an increase in the incidence of complications of class III–IV was revealed in patients with Mayo type III, however, no statistically signifcant differences were found (p=0.153). The most common complication was acute kidney injury. Two (8 %) patients required repeated surgical intervention. One patient died due to sepsis. Statistically signifcant differences were obtained in blood loss (p=0.003), the number of erythrocyte suspension blood transfusions (p=0.006), and the time of surgery (p=0.014) and prevailed in the group with the Mayo III level. However, the median length of hospital stay did not differ in the subgroups (p=0.978) and amounted to 6 bed days in the range from 4 to 20 days in the general group. The 30-day postoperative mortality rate was 4 %.Conclusion. Our experience has shown that surgical treatment of RCC with IVC-TT is feasible and provides acceptable surgical and oncological outcomes. However, the complication rate and postoperative mortality are higher in patients with Mayo III thrombus levels, requiring careful patient selection.