Association Of Postoperative Complications Research Articles

ASSOCIATION BETWEEN BODY HEIGHT AND DOUBLE J STENT INTRAVESICAL POSITION AND ITS RELATION WITH THE INDONESIAN VERSION OF URETERAL STENT SYMPTOM QUESTIONNAIRE (USSQ)

Objective: This study aims to determine the relationship between the patient’s body height with the intravesical double J stent position and whether its position is related to the ureteral stent symptom questionnaire (USSQ). Material & Methods: A cohort study with a study population of patients inserted with double J stent size 4.7 Fr and length 26 cm was carried out at the Department of Urology Hasan Sadikin Academic Medical Center from July 2021 to July 2022. We assess the patient’s demographic features and different body heights into two categories, below and above average. Then we evaluate its stent position using a plain abdominal X-ray and the USSQ score. Results: Ninety samples were included in this study; 30 of them had a midline intravesical double J stent position, 30 pieces of contralateral, and 30 samples of ipsilateral. Only body height correlated to the stent’s position (p<0.05). The results of comparative statistical tests or the association of postoperative complications between 7 days and 30 days in the position of the double J stent midline, contralateral and ipsilateral had significant results (p<0.05). Stent with ipsilateral position showed a lower USSQ score. Conclusion: Men and women above the average height have a lower risk for migration stent to the contralateral side and are also associated with lower USSQ scores. Keywords: Double J stent, USSQ score, double J stent position.

The Association of Postoperative Complications and Hospital Costs Following Distal Pancreatectomy.

BackgroundUnderstanding the financial implications associated with the complications post-distal pancreatectomy (DP) may be beneficial for the future optimisation of postoperative care pathways and improved cost-efficiency. The primary outcome of this retrospective study was the characterisation of the additional cost associated with postoperative complications following DP. The secondary outcome was the estimation of the prevalence, type and severity of complications post-DP and the determination of which complications were associated with higher costs.MethodsPostoperative complications were retrospectively examined for 62 adult patients undergoing distal pancreatectomy at an Australian university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo (CVD) classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology and was reported in US dollars at 2021 rates. Regression modelling was used to investigate the relationships among selected perioperative variables, complications and costs.Results45 patients (72.6%) experienced one or more postoperative complications. The median (IQR) hospital cost in US dollars was 31.6% greater in patients who experienced complications compared to those who experienced no complications ($40,717.8 [27,358.0–59,834.3] vs. $30,946.9 [23,910.8–46,828.1]). Costs for patients with four or more complications were 43.5% higher than for those with three or fewer complications (p = 0.015). Compared to patients with no complications, the median hospital costs increased by 17.1% in patients with minor complications (CVD grade I/II) and by 252% in patients who developed major complication (i.e., CVD grade III/IV) complications.ConclusionPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following distal pancreatectomy with number and severity of postoperative complications being associated with increased hospital costs. (Registered in the Australian New Zealand Clinical Trials Registry [No. ACTRN12622000202763]).

Association of postoperative complications with persistent post-surgical pain: a multicentre prospective cohort study

BackgroundPersistent post-surgical pain is an important and under-recognised problem that is difficult to treat. Postoperative complications have been identified as possible risk factors for persistent post-surgical pain. We conducted a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) cohort study to characterise the association of major postoperative complications with post-surgical pain at 30 days and 1 yr after major surgery. MethodsThe analysis included 1313 participants (≥40 yr old) who had inpatient noncardiac surgery and survived for 1 yr. The co-primary outcomes were 30-day post-surgical pain and 1-yr post-surgical pain. Post-surgical pain was defined as pain or discomfort that was of moderate or severe intensity (EuroQoL-5D [EQ-5D] instrument) and unimproved compared with preoperative pain or discomfort. The principal exposure was major in-hospital complications (moderate or severe by modified Clavien–Dindo criteria). Multivariable logistic regression modelling was used to characterise the adjusted association of major complications with outcomes. ResultsOf the cohort, 12% (n=163) experienced major complications, 51% (n=674) reported 30-day post-surgical pain, and 42% (n=545) reported 1-yr post-surgical pain. Major complications were associated with 30-day post-surgical pain (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.05–2.23) and possibly 1-yr post-surgical pain (aOR=1.42; 95% CI, 0.98–2.06). When analyses were repeated after multiple imputation of missing covariate and outcome data, complications were associated with both 30-day and 1-yr post-surgical pain. ConclusionsPatients who developed major complications were more likely to report pain at 30 days and possibly 1 yr after surgery. Research is necessary to validate these findings and delineate underlying mechanisms.

Association of postoperative complications and outcomes following coronary artery bypass grafting

The long-term effects of postoperative complications following coronary artery bypass grafting (CABG) are unknown. Medicare-linked records from the Society of Thoracic Surgeons Adult Cardiac Surgery Database were queried for isolated CABG records from 2007 through 2012. Unadjusted and adjusted associations between individual postoperative complications and both mortality and all-cause rehospitalization were evaluated to 7 years using Cox proportional-hazards models and cumulative incidence functions. Because of nonproportional hazards, associations are presented as early (0 to 90 days) and late (90 days to 7 years). Of the 294,533 isolated CABG patients who had records linked to Medicare for long-term follow-up (median age, 73 years; 30% female), 120,721 (41%) experienced at least 1 of the complications of interest, including new-onset atrial fibrillation (30.0%), prolonged ventilation (12.3%), renal failure (4.5%), reoperation (3.5%), stroke (1.9%), and sternal wound infection (0.4%). Each of the 6 postoperative complications was associated with a significantly increased risk of mortality and rehospitalization to 7 years despite adjustment for baseline characteristics and the presence of multiple complications. Although the predominant effect of postoperative complications was observed in the first 90 days, the increased risk-adjusted hazard for death and rehospitalization continued through 7 years. Postoperative complications are associated with an increased risk of both early and late mortality and all-cause rehospitalization, particularly during the "value" window within 90 days of CABG. These findings underscore the need to develop avoidance strategies as well as cost-adjustment methods for each of these complications.

Incidence of Perioperative Complications Following Resection of Adrenocortical Carcinoma and Its Association with Long-Term Survival.

The association of postoperative complications with long-term oncologic outcomes remains unclear. We sought to determine the incidence of complications among patients who underwent surgery for adrenocortical carcinoma (ACC) and define the relationship of morbidity with long-term survival. Patients who underwent surgery for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the US ACC group study. The incidence and type of the postoperative complications, the factors associated with them as well their association with long-term survival were analyzed. A total of 265 patients with median age of 52 years (IQR 44-63) were identified; at surgery, the majority of patients underwent an open abdominal procedure (n = 169, 66.8%). A postoperative complication occurred in 99 patients for a morbidity of 37.4%; five patients (1.9%) died in hospital. Factors associated with morbidity included a thoraco-abdominal operative approach (reference: open abdominal; OR 2.85, 95% CI 1.00-8.18), and a hormonally functional tumor (OR 3.56, 95% CI 1.65-7.69) (all P < 0.05). Presence of any complication was associated with a worse long-term outcome (median survival: no complication, 58.9 months vs. any complication, 25.1 months; P = 0.009). In multivariate analysis, after adjusting for patient- and disease-related factors postoperative infectious complications independently predicted shorter overall survival (hazard ratio (HR) 5.56, 95% CI 2.24-13.80; P < 0.001). Postoperative complications were independently associated with decreased long-term survival after resection for ACC. The prevention of complications may be important from an oncologic perspective.

Abstract 17406: Association of Post-operative Complications with Clinical Outcomes and Hospital Costs following the Norwood Operation

Introduction: Patients undergoing the Norwood operation consume considerable healthcare resources. However, data are limited regarding factors impacting hospitalization costs for these patients. We evaluated the association of post-operative complications with hospital costs. Methods: We utilized a unique dataset consisting of prospectively collected clinical outcomes and complications data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for hospitals (n=10) participating in the Children’s Hospital Association administrative databases during the trial period. Probabilistic matching of indirect identifiers was used to link records. Cost-to-charge ratios were used to estimate costs, which were adjusted for regional differences and inflation. The relationship between complications and cost was modeled using linear regression, accounting for the skewed distribution of cost, and adjusting for within-center clustering and patient characteristics. Results: A total of 334 eligible Norwood records (95%) were matched between datasets. Overall, 82% suffered at least one complication (median 2; range 0-33). The most common complications associated with increased hospital costs included: cardiopulmonary resuscitation (22%), arrhythmia (22%), sepsis (15%), and extracorporeal membrane oxygenation (11%). Those with complications had longer post-operative length of stay (25d vs. 12d, p&lt;0.0001), more total ventilator days (7d vs. 5d, p&lt;0.0001), and higher in-hospital mortality (17.6% vs. 3.4%, p&lt;0.01). Adjusted hospital costs in those with a complication were $113,505 (95% CI $99,326 - $129,707) vs. $71,453 (95% CI $59,200 - $86,243) in those without a complication, p=0.0001, and costs increased with the number of complications (1-2 complications = $117,137 vs. 3-4 complications = $155,500 [p&lt;0.01] vs. ≥5 complications $266,386 [p&lt; 0.0001]). Conclusions: This unique dataset of merged clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to both improved outcomes and cost savings.

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Centre.

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Centre.

Association of postoperative complications with hospital costs and length of stay in a tertiary care center

Association of postoperative complications with hospital costs and length of stay in a tertiary care center

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center

Postoperative complications are a significant source of morbidity and mortality. There are limited studies, however, assessing the impact of common postoperative complications on health care resource utilization. To assess the association of clinically important postoperative complications with total hospital costs and length of stay (LOS) in patients undergoing noncardiac surgery. We determined total hospital costs and LOS in all patients admitted to a single tertiary care center between July 1, 1996 and March 31, 1998 using a detailed administrative hospital discharge database. Total hospital costs and LOS were adjusted for preoperative and surgical characteristics. Of 7,457 patients who underwent noncardiac surgery, 6.9% developed at least 1 of the postoperative complications. These complications increased hospital costs by 78% (95% confidence interval [CI]: 68% to 90%) and LOS by 114% (95% CI: 100% to 130%) after adjustment for patient preoperative and surgical characteristics. Postoperative pneumonia was the most common complication (3%) and was associated with a 55% increase in hospital costs (95% CI: 42% to 69%) and an 89% increase in LOS (95% CI: 70% to 109%). Postoperative complications consume considerable health care resources. Initiatives targeting prevention of these events could significantly reduce overall costs of care and improve patient quality of care.

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Centre

Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Centre