Complicated Postoperative Course Research Articles

Prevalence and early surgical outcome of congenital diaphragmatic hernia in the Netherlands: a population-based cohort study from the European Pediatric Surgical Audit

BackgroundCongenital diaphragmatic hernia (CDH) is a rare birth defect with substantial mortality. This study aims to generate a population-based overview of CDH care and outcomes in the Netherlands. Moreover, it...

Use of Densitometric Indicators Free DICOM-Viewer’s and Digital Data Processing Programs in Surgical Treatment of Patients with Pulmonary Tuberculosis

Objective — to determine the potential of using freely distributed specialised digital data processing programs and free DICOM-viewers for assessing densitometric indicators obtained from computed tomogra­phy of the thoracic organs. This aims to facilitate the planning of surgical treatment for patients with pulmonary tuberculosis and to substantiate methods for preventing pulmonary-pleural complications. Materials and methods. A retrospective analysis was conducted on the examination and treatment results of 103 patients with specific tuberculous lesions of the lungs. Histological examination of the resected material determined the degree of the specific inflammatory process in the affected tissue, based on which patients were categorised into groups. Group I included 32 patients with low activity of the specific inflammatory process, Group II comprised 37 patients with moderate activity and Group III included 34 patients with high activity. Using five common digital processing programs, densitometric indicators of the thoracic organs' structures were obtained. The accuracy of density indicators displayed by these programs was analysed in comparison with the results of histological examinations. Results and discussion. According to our data, the densitometric indicators obtained using free DICOM-viewers and digital data processing programs show a strong correlation with the reference standard and among themselves. The determined density indicators have a strong association with histological findings of emphysema and fibrosis of the lung parenchyma. These indicators are reliably identified both in cases of high activity of specific inflammation in the lung parenchyma and in inactive processes, allowing for patient stratification. It was found that the average density values of the mediastinal lymph nodes in cases of inactive specific inflammatory processes in 80 % of cases were (54.4 ± 17.8) HU. Values of (15.0 ± 2.5) HU characteri­sed high activity of specific inflammatory processes and the progressive phase of the disease. Clinically, 89 (86.4 %) of the patients with significant deviations in the densitometric density indicators of the lung parenchyma from the norm experienced prolonged air leakage in the postoperative period. In 96 (93.2 %) patients with altered density of mediastinal lymph nodes, prolonged postoperative exudation through pleural drains was noted. Patients with altered densitometric indicators had complicated intraoperative and postoperative courses. Changes in the density of the lung parenchyma detected on computed tomography of the thoracic organs were confirmed in 96.1 % of cases by histological examination of the resected material. These changes were reliably detected by all the programs studied. Conclusions. Densitometric indicators obtained using DICOM-viewers and digital data processing programs enable the planning of surgical treatment for patients with pulmonary tuberculosis and the reasoned application of methods to prevent pulmonary-pleural complications.

"Comparison of Outcomes After Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer vs. Abdominally Based Free Flaps".

Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared to implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to non-microsurgeons. This study aims to compare the two procedures concerning their clinical and patient-reported outcomes one year postoperatively. We conducted a retrospective review of LIFTs and Ab-FFs performed between March 2017 and August 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Abdomen, Back, Psychosocial Well-being, Physical Well-being: Chest, Abdomen, Back, and Sexual Well-being. Of the 281 included patients (408 breasts), 211 received Ab-FF, and 70 received LIFT. One-year follow-up (median [IQR]: 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. In addition, obesity predicted dehiscence, while bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by one year postoperatively. Although Ab-FF is the gold-standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may subsequently be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can also be utilized by more plastic surgeons who are either not microsurgically trained or do not have an environment that fosters Ab-FF.

Nesidioblastosis with delayed diagnosis and post-operative complications in a patient with complex psychiatric history.

Nesidioblastosis is a rare condition of organic persistent hyperinsulinaemic hypoglycaemia, with fewer than 100 cases since it was first recorded. However, an increasing prevalence suggests previous underdiagnosis due to poor knowledge and awareness. This case describes the presentation, clinical decision-making and unique challenges in diagnosis and care of a 21-year-old female with nesidioblastosis and extensive psychiatric comorbidities. She was repeatedly misdiagnosed until 2021, despite having presented to emergency departments with hypoglycaemic symptoms for over 7 years. Her symptoms were often misattributed to behaviours secondary to restrictive anorexia nervosa and borderline personality disorder. Even after appropriate diagnosis and management, she suffered a complicated post-operative course. Patients with psychiatric comorbidities are at higher risk of distress, communication difficulties and inadequate social support, all of which could be better managed with increased multidisciplinary collaboration between endocrine, surgery, psychiatry, pain management and social work. This study highlights the importance of well-rounded patient care that addresses all facets of patient health. This approach not only improves quality of care, but also reduces overall readmissions, revisions, morbidity and mortality.

Intracranial Empyema in Children: A Single-center Retrospective Case Series.

We conducted a retrospective, observational study of 42 children with intracranial empyema admitted to a pediatric neurosurgical center over a 9-year period. Intracranial empyema is rare, but causes significant morbidity and mortality. Twenty-eight cases had neurosurgical source control, more commonly for subdural collections. Streptococcus anginosus group bacteria are important pathogens in subdural empyema, whose isolation predicts more complicated postoperative courses.

Rinosinusitida jako komplikace FESS: je prospěšná antibiotická profylaxe?

Introduction: One of the most common complications of functional endoscopic sinus surgery (FESS) is purulent rhinosinusitis, which often requires antibiotic (ATB) therapy. The aim of our study was to determine whether complications requiring ATB administration are so frequent and severe that antibiotic prophylaxis would be beneficial. Our next question is whether a complicated postoperative course with ATB therapy leads to early recurrence and thus reoperation. Material and methods: This is a retrospective study of 370 patients undergoing FESS at the Department of Otorhinolaryngology, University Hospital Královské Vinohrady, 3rd Faculty of Medicine, Charles University, between 2012 and 2018 for chronic rhinosinusitis with nasal polyps (CRSwNP). We investigated the incidence of postoperative complications, the reason for postoperative ATB therapy and the rate of revision FESS within 3 years in patients with complicated and uncomplicated healing. In the study cohort, we observed complications in 35 cases (9.5%); the most common complication was postoperative purulent rhinosinusitis, which was observed in 23 patients (6.2%). ATB therapy was indicated in 37 (10%) patients, most often because of postoperative purulent rhinosinusitis. Results: We did not show that patients with complicated healing reached revision surgery more often (P = 0.3883). Our findings are consistent with data from the available literature, according to which patients do not benefit significantly from the administration of ATB prophylaxis. Conclusion: ATB prophylaxis is not universally indicated in FESS. Postoperative suppurative inflammation is not associated with early recurrence requiring revision surgery. Keywords: Antibiotic prophylaxis – rhinosinusitis – FESS complications – revision procedure

Impact of external beam radiation on total shoulder arthroplasty outcomes: a propensity-matched cohort study.

External beam radiation therapy has a number of deleterious effects on the body, and a number of post-operative complications have been reported for several surgeries including total knee arthroplasty. However, few studies have investigated the impact of external beam radiation therapy for total shoulder arthroplasty (TSA). Our study aimed to assess the systemic and joint complications associated with TSA in patients with prior radiation exposures, as well as evaluate the surgical outcomes of radiation patients compared to non-radiation TSA patients. A retrospective cohort analysis was conducted using the TriNetX Analytics Network. A 1:1 propensity score matching function was utilized to create two cohorts with matched baseline characteristics within the TriNetX network. Comparisons of the primary and secondary outcomes between the two cohorts were made using odds ratios. A p value of < 0.05 was determined to be significant. A total of 75,510 patients that received TSA were identified with 1505 having a history of radiation therapy (RT) and 73,605 with no radiation therapy (non-RT). After propensity matching, both groups contained 1484 patients. RT patients were at higher risk for developing prosthetic joint infection, acute renal failure, altered mental state, cerebrovascular event, DVT, PE, pneumonia, respiratory failure, and UTI compared to non-RT patients at different time points (p < 0.5). Patients with prior history of external beam radiation undergoing TSA had a higher risk of systemic complications and prosthetic joint infection compared to patients without a prior history. These complications suggest a more complicated post-operative management course for these patients.

A study of serum albumin as an indicator for complications in patients undergoing abdominal surgery

ABSTRACT Introduction: Albumin is the major protein of human plasma produced by the liver and is conversely, downregulated by inflammatory signals. It is widely used as a nutritional marker and shows immediate response to surgical stress and could therefore qualify to measure surgical stress and to predict a complicated postoperative course. Aims and Objects: To study the level of acute phase protein albumin as an indicator for adverse outcome/morbidity in patients undergoing abdominal surgeries. Materials and Methods: A total of 121 patients undergoing abdominal surgery in the Department of General Surgery, Regional Institute of Medical Sciences, Imphal from August 2019 to July 2021 were included in this study. Patients who are immunosuppressed, pregnant, and those &lt;18 years and &gt;65 years were excluded. Results: There was a significant difference in the reduction in albumin level from pre- to postoperative day 5 among the three groups (no complications, Clavien–Dindo Grade I and Clavien–Dindo Grade II and above). There was a significant difference between those with no complication group with either Grade I or Grade II and above groups. Conclusion: Lower preoperative albumin level usually results in higher complication rate, and longer hospital stay. Out of those having postoperative complications, majority (52.1%) had Grade I complications. The most common complication was surgical site infection which was successfully managed conservatively.

Association of Postoperative Delirium and Parkinson Disease After Common United States Surgical Procedures

IntroductionTo determine the association of Parkinson disease (PD) and postoperative delirium following common surgical procedures. MethodsWe performed a retrospective database analysis of the National Inpatient Sample. We used a matched sample of patients with and without PD who underwent any of ten common surgical procedures in the US, 2005-2014. Primary outcome measure was postoperative delirium for patients with and without PD. Secondary measures included disposition, length of stay, and hospital costs. ResultsThere were 3,235,866 patients receiving any of the ten most common operative procedures, 2005-2014. There were 35,743 patients with and without PD matched based on age, sex, elective admission status, Charlson Comorbidity index, and presence of dementia. Median age was 77 y (interquartile range 72-82), median Charlson Comorbidity index was 1 (standard deviation 0-2), 46.6% were female, and 46.8% were admitted electively. The three most common operative procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%). Postoperative delirium was present in 1519 patients with PD compared to 828 matched patients without PD (4.2% versus 2.3%; P < 0.001). The adjusted odds ratio of postoperative delirium for PD compared to the matched cohort without PD was 1.88 (95% confidence interval 1.73-2.05). Those undergoing spinal fusion (adjusted odds ratio 2.99, 95% confidence interval 2.06-4.38) had the greatest odds of delirium. For patients with PD, adjusted length of stay, adjusted hospital costs, and adjusted odds of postacute care facility discharge were greater compared to the matched cohort without PD. ConclusionsPatients with PD are more likely to develop postoperative delirium and have a more complicated postoperative course with longer length of stay and greater hospitalization costs.

A rare clinical case of syringomyelia progression in the presence of Chiari I malformation following the surgery

Today, an Arnold-Chiari malformation is defined as a developmental pathology of the craniovertebral junction manifested by a discrepancy between the volume and contents of the posterior cranial fossa, which in turn leads to compression of neurological structures and changes in the cerebrospinal fluid circulation. There are several theories of the correlation between Chiari malformation and syringomyelia, but the exact mechanism of syringomyelia development remains unclear.This article describes a clinical case of treatment of a child with Chiari I malformation and syringomyelia within the cervical and thoracic segments of the spinal cord; after complete posterior fossa decompression, syringomyelia progressed in the early postoperative period with the development of a severe neurological deficiency. Since there is no standard treatment of such postoperative complications, a decision was made on the expectant management of the patient. From the twentieth day of the postoperative period, the patient showed complete regression of the neurological deficiency and positive MRI dynamics of syringomyelia.The presented clinical case raises such issues as not only the pathophysiology of syringomyelia progression after complete posterior fossa decompression, but also the determination of patient management tactics in case of a complicated postoperative course of the disease.The presented clinical case is of interest due to the rarely described aggravation of syringomyelia with enhancing neurological symptoms in the early postoperative period after complete posterior fossa decompression. Our observation suggests that the expectant management of the patient, despite syringomyelia progression with neurological deficiency aggravation after posterior fossa decompression, allowed a favorable long-term outcome of Chiari I malformation.

Let’s Get That Bread Clip: Mechanical or Malignant Large Bowel Obstruction?

A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.

Introduction: Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. Research Question: This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. Design: This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. Outcome Measures Included: 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. Results: Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. Conclusion: An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.

The 5-factor frailty index for radical nephrectomy: Simplifying personalized preoperative risk-stratification.

Radical nephrectomy is the gold standard treatment for large renal cell carcinoma. Given the rising incidence of renal cell carcinoma and higher prevalence of geriatric patients in the population, readily identifying patients preoperatively that are at risk for a more complicated postoperative course is critical. The 5-factor modified frailty index (5-IFi) is a scoring system that assigns 1 point for each of the following comorbidities: dependent functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. Patients with higher 5-IFi scores have been shown to be at significant risk for increased postoperative morbidity and mortality in many cohorts, including patients that undergo radical nephrectomy. This simplified comorbidity index with only 5 components is much more clinically pragmatic than its predecessors. As we encounter an increasing volume of patients with renal cell carcinoma and geriatric surgical candidates, readily risk stratifying patients on a personalized basis may be informative for shared clinical and surgical-decision making.

ANXIETY-DEPRESSIVE SPECTRUM DISORDERS IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN THE LONG TERM AFTER SURGERY

HighlightsThe article presents the analysis of anxiety and depressive disorders in patients who were followed as outpatients after surgery for chronic thromboembolic pulmonary hypertension in the long term, taking into account the study during the COVID–19 pandemic.The prevalence of clinically pronounced anxiety disorders in the group was 10.9%, depression - 18.6%, a combination of anxiety-depressive disorders was noted in 10.3% of cases.Multifactorial analysis revealed that the development of severe anxiety disorders in patients with chronic thromboembolic pulmonary hypertension in the long term is associated with a complicated postoperative course. Independent risk factors for clinically pronounced depressive disorders in these patients were older age, a history of cerebral circulation disorders, as well as pronounced post-COVID-19 functional disorders. Aim. To study the frequency and severity of anxiety-depressive disorders in patients with chronic thromboembolic pulmonary hypertension (CTEPH) in the long term after pulmonary thromboendarterectomy and to identify factors affecting their development.Methods. 156 patients with CTEPH were examined in the long term after surgery using the generalized anxiety disorder (GAD) questionnaire GAD-7 and the Beck`s Depression Inventory. In patients who suffered COVID-19, a “Post-COVID-19 Functional Status scale” (PCFS) was used to measure functional status over time after COVID-19. Logistic regression analysis was used to identify predictors of clinically pronounced GAD and depression in the long-term period after surgery.Results. In patients with CTEPH, clinically significant GAD and depression in the long term after surgery were observed in 10.9 and 18.6% of cases, respectively. A combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of GAD was associated with cardiopulmonary insufficiency in the early postoperative period (ОR 3,1; CI 1,2–13,8; p = 0,009). Clinically pronounced depression was associated with older age (ОR 1,3; CI 1,04–2,0; p = 0,02), chronic cerebral circulatory insufficiency (ОR 7,6; CI 1,8–17,5; p = 0,02) and pronounced post-COVID-19 functional neurological disorders according to the PCFS scale (ОR 6,7; CI 1,9–14,5; p = 0,007). The combination of clinically expressed anxiety and depression was correlated with older age (ОR 1,1; CI 1,02–1,3; p = 0,04).Conclusion. The prevalence of clinically pronounced GAD in the group was 10.9%, depression was 18.6%, and a combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of clinically significant GAD is associated with a complicated course of cardiac surgery. Independent risk factors for clinically significant depression were older age, a history of cerebral circulatory disorders and pronounced post-COVID-19 functional neurological disorders.

The impact of postoperative complications on oncological outcomes of liver transplantation for hepatocellular carcinoma: A competing risk analysis

ObjectiveTo investigate the influence of postoperative complications on tumor-related (TRD), disease-free survival (DFS) and overall survival (OS) in patients undergoing liver transplant (LT) for hepatocellular carcinoma (HCC). MethodsWe retrospectively evaluated 425 LTs for HCC from 2010 to 2019. Postoperative complications were classified according to Comprehensive Complication Index (CCI) and the posttransplant risk of TRD assessed through Metroticket 2.0 calculator. The population was stratified into high-risk and low-risk cohorts based on the predicted TRD risk of 80%. In a second step, we re-evaluated TRD, DFS and OS of both cohorts according to a further stratification based on 47.3 points of CCI cut-off. ResultsIn the low-risk cohort, we observed a significantly better DFS (84% vs. 46%, p<0.001), TRD (3% vs. 26%, p<0.001) and OS (89% vs. 62%, p<0.001) in the group with CCI < 47.3. In the high-risk cohort, patients with CCI < 47.3 had significantly better DFS (50% vs. 23%, p = 0.003) and OS (68% vs. 42%, p = 0.02) and a comparable TRD (22% vs. 31%, p = 0.142). ConclusionsA complicated postoperative course negatively influenced long-term survival. This poorer oncological outcome associated with in-hospital postoperative complications suggests that every effort should be made to improve the early posttransplant course in HCC patients, including a careful donor-to recipient match and use of new perfusion technologies.

Developing nonlinear k-nearest neighbors classification algorithms to identify patients at high risk of increased length of hospital stay following spine surgery.

Spondylolisthesis is a common operative disease in the United States, but robust predictive models for patient outcomes remain limited. The development of models that accurately predict postoperative outcomes would be useful to help identify patients at risk of complicated postoperative courses and determine appropriate healthcare and resource utilization for patients. As such, the purpose of this study was to develop k-nearest neighbors (KNN) classification algorithms to identify patients at increased risk for extended hospital length of stay (LOS) following neurosurgical intervention for spondylolisthesis. The Quality Outcomes Database (QOD) spondylolisthesis data set was queried for patients receiving either decompression alone or decompression plus fusion for degenerative spondylolisthesis. Preoperative and perioperative variables were queried, and Mann-Whitney U-tests were performed to identify which variables would be included in the machine learning models. Two KNN models were implemented (k = 25) with a standard training set of 60%, validation set of 20%, and testing set of 20%, one with arthrodesis status (model 1) and the other without (model 2). Feature scaling was implemented during the preprocessing stage to standardize the independent features. Of 608 enrolled patients, 544 met prespecified inclusion criteria. The mean age of all patients was 61.9 ± 12.1 years (± SD), and 309 (56.8%) patients were female. The model 1 KNN had an overall accuracy of 98.1%, sensitivity of 100%, specificity of 84.6%, positive predictive value (PPV) of 97.9%, and negative predictive value (NPV) of 100%. Additionally, a receiver operating characteristic (ROC) curve was plotted for model 1, showing an overall area under the curve (AUC) of 0.998. Model 2 had an overall accuracy of 99.1%, sensitivity of 100%, specificity of 92.3%, PPV of 99.0%, and NPV of 100%, with the same ROC AUC of 0.998. Overall, these findings demonstrate that nonlinear KNN machine learning models have incredibly high predictive value for LOS. Important predictor variables include diabetes, osteoporosis, socioeconomic quartile, duration of surgery, estimated blood loss during surgery, patient educational status, American Society of Anesthesiologists grade, BMI, insurance status, smoking status, sex, and age. These models may be considered for external validation by spine surgeons to aid in patient selection and management, resource utilization, and preoperative surgical planning.

Mitral Valve Repair in Advanced Age Groups: Does Cardiac Age Differ from Chronological Age?

Advanced age is a risk factor in cardiac surgery contributing significantly to a worse outcome. The reasons are frailty and multimorbidity. In this study, we asked: Is there an aging of the heart which differs from chronological age? Propensity score matching was performed between 115 seniors ≥ 80 years and 345 juniors < 80 years. After the patients were found to be comparable in terms of cardiac and noncardiac disease and risk profiles, they were further analyzed for cardiac parameters. In addition, the seniors and juniors were compared in terms of cardiac health and postoperative outcome. Furthermore, the patients were subdivided into several age groups (<60 years, 60-69 years, 70-79 years, and >80 years) and compared regarding outcome. The seniors demonstrated significantly lower tricuspid annular plane systolic excursion (TAPSE), significantly more frequent diastolic dysfunction, significantly higher plasma levels of NT-proBNP, and significantly larger left ventricular end-diastolic and end-systolic diameters and left atrial diameters (p < 0.001, respectively). Furthermore, in-hospital mortality and most postoperative complications were significantly higher in seniors compared with juniors. While old cardiac healthy patients showed better outcome than old cardiac aged patients, the outcome from young cardiac aged patients was better than old cardiac aged patients. The outcome and survival deteriorated with increasing life decades. The elderly suffer significantly more from cardiac deterioration, i.e., cardiac aging, and show higher multimorbidity. Mortality risk is significantly higher and they suffer more often from a complicated postoperative course compared to younger patients. Further approaches to prevention and treatment of cardiac aging are needed to address the needs of an aging society.

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

BackgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.MethodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.ResultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications.ConclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.Trial Registration: ClinicalTrial.gov NCT04995380.

Obesity and Kidney Transplant Candidates: An Outcome Analysis Based on Body Mass Index.

Background Obesity is a well-established risk factor for a decline in renal function and post-operative complications. Also, obese patients suffer worse outcomes such as higher rates of wound complications, longer hospital stays, and delayed graft function (DGF) when compared to nonobese patients. The correlation between having a high BMI and the postoperative outcomes of kidney transplantation has not been investigated yet in Saudi Arabia. There is scarce evidence that patients with obesity who have undergone kidney transplantation are devoid of any complications before, during, or after their procedure. Methodology A retrospective cross-sectional study was conducted using charts of nearly 142 patients in King Abdullah Specialist Children's Hospital in Riyadh, who had kidney transplant surgery in the organ transplantation department. All Obese patients with BMI >29.9 who underwent Kidney Transplant Surgery in King Abdulaziz Medical City from 2015 to 2022 were used. Details of hospital admissions were retrieved. Results A total of 142 patients fulfilling the inclusion criteria were included. There was a significant difference between patients regarding pre-surgical history where all cases(100%; 2) with class three obesity were hypertensive and on dialysis versus (77.8%; 21) and (70.4%; 19) of class two obesity and (86.7%; 98) and (78.8%; 89) of class one obesity cases, respectively (P = 0.041).Regarding medical history, hypertension was reported among 121 (85%), followed by dialysis (77%; 110), diabetes mellitus (DM) (52%; 74), dyslipidemia (24%; 35), endocrine diseases (15%; 22), and cardiovascular diseases (16%; 23). Considering post-transplant complications, 14.1% (20) of the study cases had DM(16.8% of obese class one, 3.7% of obese class two, and none of obese class three; P = 0.996) and urinary tract infection (UTI) among 7% (10) of the cases (6.2% of obese class one, 11.1% of obese class two, and none of obese class three; P = 0.996). All these differences according to patients' BMI were statistically insignificant. Conclusion Obese patients are more likely to experience difficult intraoperative management along with a complicated postoperative course due to numerous concomitant comorbidities. Post-transplant DM(PTDM) was the most prominent post-transplant complication followed by UTI. A remarkable reduction in serum creatinine and blood urea nitrogen (BUN) has been observed at the time of discharge and after six months compared to pre-transplant measurements.

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?