Difference In Major Postoperative Complications Research Articles

Analysis of comorbidity and anesthesia technique in patients undergoing bariatric surgery at the University Clinical Center of Serbia

Introduction/Objective. Altered physiology and metabolism of obese patients represents a big challenge for the anesthesiologist. The objectives of the study are to investigate numbers of comorbidities, choice of anesthesia techniques, intraoperative and postoperative complications between bariatric and non-bariatric patients. Methods. This retrospective study included 469 patients. The study group of patients included obese patients with Body Mass Index ? 30. The control group included patients in whom elective laparoscopic cholecystectomy was performed, on the same day as bariatric surgery in the control group. Results. The study group included 235 patients who underwent bariatric surgery, while control group included 234 patients. More patients in study group had comorbidities compared with the control group (84.4% vs. 63.2%, p < 0.001). In the study group, total intravenous anesthesia and target control anesthesia were statistically significant more delivered than in the control group (74% vs. 0.9%, p < 0.001; 7.2% vs. 1.7, p < 0.001, respectively). Difficult intubation was statistically significant more in the control group (5.6% vs. 0.9%, p = 0.004). There was a statistically significant difference in the incidence of intraoperative desaturation and hypotension during induction of anesthesia between the study and the control group (9.8% vs. 2.1%, p < 0.001; 14.5% vs. 2.1, p < 0.001, respectively). There was statistically significant difference between the study and control group in minor complication according Clivian-Dindo classification, (20.8% vs. 5.1%, p < 0.001). Conclusion. Obesity is associated with higher number of comorbidities and intraoperative complications. There was no statistically difference in major postoperative complications between bariatric and non-bariatric patients.

Post-operative complications following dose adaptation of intra-operative electron beam radiation therapy in locally advanced or recurrent rectal cancer.

The benefit of intra-operative radiotherapy (IORT) in the treatment of locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) lie in its ability to provide high-dose of radiation to limited at-risk volume, thereby eliminating microscopic disease and decreasing toxicity. A comparative study between high-dose-rate (HDR) brachytherapy, named intra-operative brachytherapy (IOBT), and intra-operative electron radiotherapy (IOERT) was performed showing favorable LRFS after IOBT, possibly due to a higher surface dose that is inherent in IOBT technique. The IOERT technique in Catharina Hospital Eindhoven was adapted to increase the surface dose, aiming to improve local control. Post-operative complications due to an increased radiation dose remain the matter of concern. This retrospective study was performed to compare complication rates before and after adapted IOERT dose. All patients undergoing surgery with IOERT for LARC or LRRC from September 2019 until July 2023, were considered. Patients selected until August 31, 2021 were included in control cohort (n = 108), and those chosen from September 1, 2021 onwards were included in intervention cohort (n = 92). Perioperative and (major) post-operative complications were classified retrospectively, during admission, at 30 days, and at 90 days. In LARC patients, a decrease in post-operative complications was observed (p = 0.009). 19% of LARC patients experienced major post-operative surgical complications, i.e., Clavien-Dindo grade 3b-5, regardless of treatment group. No difference in major 90-day complications was noted (p = 0.142). In LRRC patients, the use of induction chemotherapy decreased from 78% to 29% (p < 0.001), which complicated comparison. However, no difference in major post-operative complications was observed at 30 days (p = 0.222) or 90 days (p = 0.977) after surgery. Increased surface dose of IOERT does not seem to lead to an increase in post-operative complications. Further research is needed to evaluate the efficacy of dose adaptation in IOERT to improve local oncological control rates. Routine evaluation of CTCAE scores in follow-up will help uncover possible long-term radiation-induced toxicity.

Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs.

The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.

Preoperative nutritional support in patients undergoing pancreatic surgery affects PREPARE score accuracy.

This study aimed to validate the accuracy of the Preoperative Pancreatic Resection (PREPARE) risk score in pancreatic resection patients. This prospective study included 216 patients who underwent pancreatic resection between January 2015 and December 2018. All patients in our cohort with weight loss or lack of appetite received dietary advice and preoperative oral nutritional supplementation (600 kcal/day). Demographic, clinicopathological, operative, and postoperative data were collected prospectively. The PREPARE score and the predicted risk of major complications were computed for each patient. Differences in major postoperative complications were analyzed using a multivariate Cox proportional hazards regression model. The predicted and observed risks of major complications were tested using the C-statistic. The study included 216 patients [117 men (54.2%)] with a median age of 65.0 (30.0-83.0) years. The majority of patients were classified as American Society of Anesthesiologists (ASA)' Physical Status score II (N = 164/216; 75.9%) and as "low risk" PREPARE score (N = 185/216; 85.6%) before the surgery. Only 4 (1.9%) patients were malnourished, with albumin levels of less than 3.5 g/dl. The most common type of pancreatic resection was a pylorus-preserving pancreaticoduodenectomy (N = 122/216; 56.5%). Major morbidity and 30-day mortality rates were 11.1% and 1.9%, respectively. The type of surgical procedure (hazard ratio [HR]: 3.849; 95% confidence interval [CI]: 1.208-12.264) and ASA score (HR: 3.089; 95% CI: 1.067-8.947) were significantly associated with the incidence of major postoperative complications in multivariate analysis. The receiver operating characteristic curve was 0.657 for incremental values and 0.559 for risk categories, indicating a weak predictive model. The results of the present study suggest that the PREPARE risk score has low accuracy in predicting the risk of major complications in patients with consistent preoperative nutritional support. This limits the use of PREPARE risk score in future preoperative clinical routines.

Role of perigastric arcade removal in serous epithelial ovarian cancers.

Omentectomy is an essential part of cytoreductive surgery (CRS). However, removal of perigastric arcade (PGA) of the omentum is a controversial aspect of omentectomy in view of the fear of injury, vascular compromise and gastroparesis. Hence, we conducted a study to evaluate the necessity and effect of removal of PGA during omentectomy. The nature of the study was a prospective observational study. The study period was for 1 year between 1.3.2019 and 29.2.2020. Patients with stage III to IV serous epithelial ovarian cancers - chemo naive/post neoadjuvant chemotherapy, without macroscopic involvement of the PGA were included in the study. Patients were divided into two groups - those who had PGA removed (group 1) and those whose PGA was preserved (group 2). Pre, intra and postoperative factors between the two groups were compared using standard statistical methods. Micrometastasis to PGA was present in 36.4% of the patients in group 1. The predictors for this involvement included gross involvement and microscopic involvement of the mobile part of the omentum (p < 0.001), pre surgery Meyer's score (p < 0.05) and requirement of peritonectomy (p < 0.05) during the CRS implying that higher the peritoneal carcinomatosis, more are the chances of microscopic involvement of PGA. On comparing postoperative outcomes between the two groups, we noted a statistically significant difference in intra-operative time (p < 0.01), prolonged recovery time with increased intensive care unit and hospital stay (p < 0.001) in group 1, although all with small absolute difference. However, there was no significant difference in major post-operative complications or time taken to tolerate soft diet. Micrometastasis to PGA was noted in significant number of cases. Its removal is also a safe procedure with minimal morbidity and good postoperative outcomes especially in cases with significant peritoneal carcinomatosis. Hence, it should be considered, provided we are achieving a complete cytoreduction otherwise.

Effects of propofol and inhaled anesthetics on postoperative complications for the patients undergoing one lung ventilation: A meta-analysis.

IntroductionWith the widespread use of one-lung ventilation (OLV) in thoracic surgery, it is unclear whether maintenance anesthetics such as propofol and inhaled anesthetics are associated with postoperative complications. The purpose of this study was to compare the effects of propofol and inhaled anesthetics on postoperative complications in OLV patients.MethodsPubMed, EMBASE, Medline, and Cochrane Library were searched for relevant randomized controlled trials until 09/2021. All randomized controlled trials comparing the effect of propofol versus inhaled anesthetics on postoperative complications in OLV patients were included. All randomized controlled trials comparing:(a) major complications (b) postoperative pulmonary complications (c) postoperative cognitive function (MMSE score) (d) length of hospital stay (e) 30-day mortality, were included.ResultsThirteen randomized controlled trials involving 2522 patients were included in the analysis. Overall, there was no significant difference in major postoperative complications between the inhaled anesthetic and propofol groups (OR 0.78, 95%CI 0.54 to 1.13, p = 0.19; I2 = 0%). However, more PPCs were detected in the propofol group compared to the inhalation anesthesia group (OR 0.62, 95%CI 0.44 to 0.87, p = 0.005; I2 = 37%). Both postoperative MMSE score (SMD -1.94, 95%CI -4.87 to 0.99, p = 0.19; I2 = 100%) and hospital stay (SMD 0.05, 95%CI -0.29 to 0.39, p = 0.76; I2 = 73%) were similar between the two groups. The 30-day mortality rate was also not significantly different between groups (OR 0.79, 95%CI 0.03 to 18, p = 0.88; I2 = 63%).ConclusionsIn patients undergoing OLV, general anesthesia with inhaled anesthetics reduced PPC compared to propofol, but did not provide clear benefits on other major complications, cognitive function, length of hospital stay, or mortality.

Single Lung Transplant Remains a Viable Alternative to Double Lung Transplantation for the Patients with Severe Secondary Pulmonary Hypertension

<h3>Purpose</h3> Whereas double lung transplantation (LTx) is a preferred surgical option for the patients with secondary pulmonary arterial hypertension (SPH: defined as a mean pulmonary artery pressure (mPAP) above 25 mmHg), our institutional experiences have demonstrated the unique values of single LTx for SPH. Here, we review our experiences prioritizing single LTx for SPH in an attempt to optimize their opportunities and decrease mortality while waiting. <h3>Methods</h3> A retrospective review of the LTx database was used to identify patients who underwent single LTx. SPH patients were stratified into mild SPH (mPAP: 25-40 mmHg) and severe SPH (mPAP > 40 mmHg). Recipients without PH transplanted over the same time period were used as controls. Data are reported as severe SPH vs. mild SPH vs. controls. <h3>Results</h3> Three hundred eighteen patients received single LTx between January 2017 and December 2019. There were 217 patients with mild SPH (mPAP of 32 mmHg), 59 patients with severe SPH (mPAP of 46 mmHg) and 42 patients without PH (controls). There were no significant differences among the groups in their patients' characteristics except higher pulmonary vascular resistance noted in severe SPH group and morbid obesity noted in mild and severe SPH groups. While severe SPH group required more intraoperative cardiopulmonary support (37.3% vs. 11.1% vs. 5.0%, <i>p</i> < 0.05), there were no significant differences in major postoperative complications including postoperative duration mechanical ventilation and incidences of severe primary graft dysfunction. Actual survival at 1 year was not significantly different among the groups (93.2% vs. 88.9% vs. 92.9%, <i>p</i> = 0.683). <h3>Conclusion</h3> Our experience supports the option of single LTx for the patients with even severe SPH by utilizing appropriate mechanical circulatory support intraoperatively. In light of the ongoing donor lung shortage, this strategy should be considered for optimizing organ utilization and decreasing waitlist mortality.

30 Years of Heart Transplant: Outcomes After Mechanical Circulatory Support From a Single Center

BackgroundSurvival after bridge to transplantation with mechanical circulatory support (MCS) has yielded varying outcomes on the basis of device type and baseline characteristics. Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved waitlist mortality, but recent changes to the transplantation listing criteria have dramatically altered the use of MCS for bridge to transplantation. MethodsOrthotopic heart transplantations from 1988 to 2019 at our institution (Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO) were retrospectively reviewed and stratified by pretransplantation MCS status into CF-LVAD (n = 224), pulsatile LVAD (n = 49), temporary MCS (n = 71), and primary transplantation (n = 463) groups. Patients who underwent heart transplantation after the approval of CF-LVAD for bridge to transplantation and before the 2018 allocation policy changes underwent subgroup analysis to evaluate predictors of survival and complications in a contemporary cohort. ResultsRates of primary transplantation declined from 88% to 14% over the course of the study. No significant difference in survival was detected in the cohort stratified by MCS status (P = .18). In the modern era, survival of patients treated with CF-LVADs and temporary MCS was noninferior to that seen with primary transplantation (P = .22). Notable predictors of long-term mortality included lower body mass index, peripheral vascular disease, previous coronary artery bypass graft, ABO nonidentical transplant, and increased donor age (all P ≤ .02). There were no differences in major postoperative complications. ConclusionsCF-LVAD has grown to account for the majority of transplantations at our center in the last decade, with no adverse effect on survival or postoperative complications. Temporary MCS increased after the 2018 listing criteria change, with acceptable early outcomes.

The Effect of Obesity on Operative Time and Postoperative Complications for Peritrochanteric Femur Fractures.

IntroductionThe high prevalence of obesity among adults in the United States presents significant challenges to orthopedic surgeons. Obesity has been shown to increase operative time and complications in both elective and nonelective orthopedic surgeries. Despite this, there is a lack of literature evaluating the effect obesity has on operative time and postoperative complications following peritrochanteric fracture surgery.Methods and MaterialsWe performed a retrospective review of patients who underwent isolated operative stabilization of a peritrochanteric femur fracture at our urban level one trauma center between 2010 and 2018. Patients were divided into an obese group, as defined by a body mass index (BMI) equal to or greater than 30 kg/m2, and a nonobese group, as defined by a BMI less than 30 kg/m2. Operative timing variables including time to surgery, operative time, total operating room (OR) time, anesthesia time, and fluoroscopy time were collected. Postoperative variables evaluated including the presence of a major postoperative complication within 90 days of surgery, the need for repeat surgery within 90 days, and the need for surgery due to an infection within 90 days were collected.ResultsA total of 175 patients were included in this retrospective review. Thirty-seven patients were included in the obese group, and 138 were included in the nonobese group. Obesity was associated with a significantly (p = 0.002) longer operative time, total OR time (p = 0.0001), anesthesia time (p = 0.00006), and fluoroscopy time (p = 0.0001). There was no significant difference (p > 0.05) in postoperative variables between the obese and nonobese group. The 90-day major postoperative complication rate was 10.8% in the obese group and 10.9% in the nonobese group. Both repeat surgery and surgery for infection within 90 days were 2.7% in the obese group and 1.4% in the nonobese group.ConclusionThe treatment of peritrochanteric femur fractures in obese patients is associated with a significantly longer operative time, total OR time, anesthesia time, and fluoroscopy time, but no difference in major postoperative complications when compared to nonobese patients.

Video-assisted thoracoscopic bullectomy with pleurectomy versus pleural abrasion in the treatment of primary spontaneous pneumothorax

Background Comparative study between partial pleurectomy and mechanical pleural abrasion in the treatment of primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopy (VATS) to show its efficacy and safety. Patients and methods Between August 2014 and January 2018, 120 patients with PSP underwent VATS pleural abrasion and partial pleurectomy with bullectomy for both groups in the Security Force Hospital, Riyadh, KSA. All patients were reviewed retrospectively according to medical records. Results Partial pleurectomy was performed in 60 (50%) patients while other 60 patients underwent pleural abrasion. There is no significant differences in sex, age, weight, or history of smoking at the time of surgery. There was longer operative duration in the pleurectomy group (90±12.4 min) versus the pleural abrasion group (40±7.55 min) but with more blood loss in the latter one (P&lt;0.001). There was no significant differences between studied groups regarding number, site, and size of bullae (P&gt;0.05). There was no significant difference in major postoperative complications (P=0.132). Nine (7.5%) patients developed pneumothorax after surgery with mechanical pleurodesis. The incidence of recurrent pneumothorax in patients who underwent pleural abrasion was higher than in patients who underwent pleurectomy (13.3 vs. 1.7%, P=0.045). Conclusion In our study, VATS pleurectomy is more effective in the treatment of PSP than pleural abrasion. The recurrent rate of pneumothorax is significantly lower in the pleurectomy group than in the pleural abrasion group. So, VATS pleurectomy is the procedure of choose in the management of PSP.

The effect of restrictive blood transfusion policy on patients undergoing major liver surgery

Presenter: Jonathan DeLong MD | University of California, San Diego Background: Unrestricted transfusion practices expose patients to potentially harmful complications and are major cost drivers in critically ill patients. Our institution adopted a restrictive transfusion policy driven by education, a point of service BestPractice Advisory (BPA), and enhancements to the electronic order entry process starting Q3 2014, completed by Q2 2015, with additional electronic functionality and education completed by Q2 2017. We investigated whether these interventions altered transfusion practices following complex liver surgery, and whether restrictive transfusion practices affected outcomes. Methods: A retrospective review was performed of patients at an academic medical center undergoing major liver surgery at over a six-year period from 2013 to 2018. All patients undergoing total lobectomy, trisegmentectomy, and partial hepatectomy were included. There were 272 total liver resection cases in the entire cohort. Preintervention, transition period, and postintervention periods were considered. Results: Overall blood transfusion decreased from 42.4% preintervention to 21.7% during the intervention to 7.1% postintervention (p < 0.001). Adherence to best practice recommendations improved from 34.6% preintervention to 68.8% during the intervention period to 100% postintervention (p < 0.001). Absolute RBC transfusions were also decreased in the post intervention group (p = 0.006). There was no difference in liver resection type (lobectomy, trisegementectomy, partial lobectomy) between the groups (p = 0.095). There was no difference in major complications (defined as death, cardiac arrest, MI, CVA, and progressive renal failure requiring dialysis) between the three periods (p = 0.863). Infectious complications (defined as surgical site infections, urinary tract infection, or pneumonia) were not significantly different between the groups (p = 0.849). Similarly, there was no difference in bile leak and progression to liver failure (p = 0.251 and p = 0.480 respectively). Surgical take backs readmission rates were not statistically different between the 3 groups (p = 0.229 and p = 0.372). Conclusion: Implementing the institutional policy for restrictive blood transfusion reduced the rate of perioperative blood transfusion for major liver surgery by 35.3%. Adherence to best practice guidelines for blood transfusion improved by 65.4%. Restricting transfusion of RBCs did not result in a statistically significant difference in major post-operative complications, post-operative infections, bile leak, or progression to liver failure. Surgical take backs and readmissions were also unchanged. We conclude that restrictive RBC transfusion practices can safely be adopted in patients undergoing major liver surgery without increasing post-operative complications or exposing patients to unnecessary transfusion risks.

VATS Partial Pleurectomy Versus VATS Pleural Abrasion: Significant Reduction in Pneumothorax Recurrence Rates After Pleurectomy

IntroductionSurgical treatment of primary spontaneous pneumothorax (PSP) usually consists of bullectomy and any form of pleurodesis to reduce risk of disease recurrence. Whether pleurectomy is superior to pleural abrasion is still a matter of debate with recurrence rates especially high when performed with a video-assisted thoracoscopic (VATS) approach. Aim of this study was to compare the efficacy of the two methods in prevention of recurrence of pneumothorax in a minimally invasive setting.Materials and methodsBetween 01/2005 and 12/2015, 107 patients younger than 40 years with PSP underwent VATS bullectomy and either partial pleurectomy or pleural abrasion. Medical records of patients were reviewed retrospectively.ResultsPleural abrasion was performed in 34/107 patients, 73/107 patients underwent partial pleurectomy. There were no statistically significant differences in age, sex, body mass index or smoking history at time of surgery. There was no significant difference in major postoperative complications (p = 0.3022). Nine (8.4%) patients had a recurrence of pneumothorax during follow-up. Incidence of recurrence in those undergoing pleural abrasion was significantly higher than those undergoing apical pleurectomy (8/34 vs. 1/73, p < 0.001). Surgical technique was the only factor associated with a recurrence of PSP after surgical intervention.DiscussionIn our analysis, a VATS partial pleurectomy proved to be effective for prevention of recurrent PSP. Recurrence rates were low despite a minimally invasive approach and significantly lower than in the pleural abrasion group. According to these findings, VATS pleurectomy might be considered as the primary choice for surgical pleurodesis in patients with PSP.

Increased Metabolic Benefit for Obese, Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients. Retrospective review was conducted of all patients age 60years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014. A total of 134 patients who underwent LSG (n=65) or LRYGB (n=69) were identified. Groups were similar with respect to age (64years, range 60-75years), BMI (44.0±6.1), and ASA score (91%≥ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p=0.75). Median follow-up was 39months (IQR 14-64months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p=0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36months was 26.9±9.0% in the LSG group and 23.9±9.3% in the LRYGB group, p=0.24. Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program

Surgical approaches to the correction of pelvic organ prolapse include abdominal, vaginal, and obliterative approaches. These approaches require vastly different anatomical dissections, surgical techniques, and operative times and are often selected by the patient and surgeon to match preoperative multimorbidity and ability of the patient to tolerate the stress of surgery. We sought to describe the occurrence of postoperative complications occurring after 3 different surgical approaches to treat pelvic organ prolapse: vaginal, abdominal, and obliterative. We conducted a secondary database analysis of the 2006 through 2014 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze patients undergoing procedures for pelvic organ prolapse based on Current Procedural Terminology codes. Women were categorized into 3 surgical approaches to prolapse: vaginal, abdominal, and obliterative. Concomitant hysterectomy and sling were also examined. The primary outcome was a composite of 30-day major postoperative complications. A total of 33,416 women were included in our final analysis: 24,928 vaginal procedures, 6834 abdominal (4461 minimally invasive) procedures, and 1654 obliterative procedures. Concomitant hysterectomies and slings were performed in 17,380 (52.0%) and 10,896 (32.6%) of prolapse procedures. The overall prevalence of composite 30-day major postoperative complications was 3.1% (n/N= 1028/33,416). There were 13 perioperative deaths (0.04%) with no difference in the surgical approaches (P= .55). There were no differences in major postoperative complications between vaginal and abdominal procedures (3.0% vs 3.0%; P = .71). Women undergoing obliterative procedures had an occurrence of major postoperative complications of 5.0% (n/N= 83/1654), P < .001. The occurrence of major postoperative complications after prolapse surgery is rare. We did not find a significant difference in major postoperative complications between vaginal and abdominal surgeries for pelvic organ prolapse. In this well-characterized cohort of patients who self-selected surgical approach, women undergoing obliterative surgery had more postoperative complications, likely attributed to increased age and multimorbidity.

Intraoperative Oxygen Consumption During Liver Transplantation

BackgroundThe aim of this study was to investigate the changes in oxygen consumption during liver transplantation and to examine the relationship between intraoperatively elevated systemic oxygen consumption and postoperative liver function. MethodsThis study was performed in 33 adult patients undergoing liver transplantation between September 2011 and March 2014. We measured intraoperative oxygen consumption through the use of indirect calorimetry, preoperative and intraoperative data, liver function tests, and postoperative complications and outcomes. ResultsThe mean age of patients was 52 ± 9.7 years; 14 (42%) of them were women. Average Model for End-Stage Liver Disease scores were 20 ± 8.9. Oxygen consumption significantly increased after reperfusion from 172 ± 30 mL/min during the anhepatic phase to 209 ± 30 mL/min (P < .0001). We divided patients into 2 groups according to the increase in oxygen consumption after reperfusion (oxygen consumption after reperfusion minus anhepatic phase oxygen consumption: 40 mL/min increase as cutoff). The higher consumption group had a longer cold ischemia time and higher postoperative aspartate aminotransferase and alanine aminotransferase levels as compared with the lower oxygen consumption group. There were no statistically significant differences in major postoperative complications, but the higher oxygen consumption group tended to have shorter hospital stays than the lower consumption group (58 versus 95 days). ConclusionsWe have demonstrated that oxygen consumption significantly increased after reperfusion. Furthermore, this increased oxygen consumption was associated with a longer cold ischemia time and shorter hospital stays.

Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study

Screening for abdominal aortic aneurysms (AAAs) substantially reduces aneurysm-related mortality in men and is increasing worldwide. This cohort study compares post-operative mortality and complications in men with screening-detected vs. non-screening-detected AAAs. Data were extracted from the Swedish National Registry for Vascular Surgery (Swedvasc) for all screening-detected men treated for AAA (n = 350) and age-matched controls treated for non-screening-detected AAA (n = 350). There were no differences in baseline characteristics besides age, which was lower in the screening-detected group than in the non-screening-detected group (median 66 vs. 68, p < .001). Open repair was used more frequently than endovascular aortic repair (EVAR) in patients with screening-detected AAAs than in non-screening-detected controls (56% vs. 45% p = .005). No differences in major post-operative complications at 30 days were observed between the groups. In patients treated with open repair there were no differences in 30-day, 90-day or 1-year mortality in screening-detected patients compared to non-screening-detected controls (1.0% vs. 3.2% p = .25, 2.1% vs. 4.5% p = .23, 4.1% vs. 5.8% p = .61). None of the patients treated with EVAR in either group died within 30 days. The 90-day mortality after EVAR was lower in patients with screening-detected AAA than in those with non-screening-detected AAAs (0.0% vs. 3.1%, p = .04). No difference in the 1-year mortality was detected in the EVAR-patients between the two groups (1.4% vs. 4.7%, p = .12). The contemporary post-operative mortality after AAA surgery was low in this national audit of patients with screening-detected AAAs and age-matched controls. Patients with screening-detected AAAs have the same frequency of complications at 30 days as patients with non-screening-detected AAA. This study gives further support to national screening programs for the detection of AAA in men.

Cardiac surgery in patients with liver cirrhosis: risk factors for predicting mortality.

To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality. We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and 2012. Child-Turcotte-Pugh (Child) classification and Model for End-Stage Liver Disease (MELD) score were used to assess the severity of liver cirrhosis. The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient. Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery. Multivariate Cox proportional hazard models were applied to estimate the hazard ratios (HR) of predictors for mortality. The Kaplan-Meier method was used to generate survival curves, and the survival rates between groups were compared using the log-rank test. There were 30 patients in Child class A, 20 in Child B, and five in Child C. The hospital mortality rate was 16.4%. The actuarial survival rates were 70%, 64%, 56%, and 44% at 1, 2, 3, and 5 years after surgery, respectively. There were no significant differences in major postoperative complications, and early and late mortality between patients with mild and advanced cirrhosis. Multivariate logistic regression showed preoperative serum bilirubin, the EuroSCORE and coronary artery bypass grafting (CABG) were associated with early and late mortality; however, Child class and MELD score were not. Cox regression analysis identified male gender (HR = 0.319; P = 0.009), preoperative serum bilirubin (HR = 1.244; P = 0.044), the EuroSCORE (HR = 1.415; P = 0.001), and CABG (HR = 3.344; P = 0.01) as independent risk factors for overall mortality. Advanced liver cirrhosis should not preclude patients from cardiac surgery. Preoperative serum bilirubin, the EuroSCORE, and CABG are major predictors of early and late mortality.

Quality of Life Following Component Separation Versus Standard Open Ventral Hernia Repair for Large Hernias

Component separation (CS) has become a viable alternative to repair large ventral defects when the fascia cannot be reapproximated. However, the impact of transecting the external oblique to facilitate closure of the abdomen on quality of life (QOL) has yet to be investigated. The study goal was to investigate QOL and outcomes after standard open ventral hernia repair (OVHR) versus CS for large ventral hernias. Prospective data for all CSs were reviewed and compared with matched OVHR controls. All defects were 100 to 1000 cm2 in size and repaired with mesh. Comorbidities, complications, outcomes, and Carolinas Comfort Scale (CCS) scores, were reviewed. Seventy-four CS patients were compared with 154 patients undergoing standard OVHR with similar defect sizes. Age (56.7±13.0 vs. 54.7 ± 12.3 years, P = .26), defect sizes (299 ± 160 vs. 304 ± 210 cm2, P = .87), and BMI (32.7 ± 6.9 vs. 34.2 ± 9.0 kg/m2, P = .26) were similar in both groups, respectively. There were no differences in major postoperative complications (P = .22), mesh infections (P = 1.00), wound infections (P = .07), or hernia recurrence (P = .09), but wound breakdown increased after CS (10% vs. 1%, P < .001) as did seroma interventions (15% vs. 4%, P = .005). Postoperative CCS scores were similar at 1 month (P = .82) and 1 year (P = .14). In the first comparative study of its kind, it is found that patient undergoing CS with mesh reinforcement had equal short- and long-term QOL outcomes compared with similar patients who underwent standard OVHR. Whereas wound breakdown and seroma formation are higher, the overall complication, mesh infection, and recurrence rates are similar.

Hemoglobin Trends in Isolated Coronary Artery Bypass Grafting Performed Off‐Pump and With Standard and Mini Circuits

The comparison of hemodilution at the end of surgery is of limited use as it represents only a snapshot of a dynamic phenomenon. This study was undertaken to compare the perioperative hemoglobin curves of isolated coronary artery bypass grafting performed with minimized extracorporeal circulation, traditional cardiopulmonary bypass, and off-pump technique. The propensity score method was used to select three groups of patients, homogenous regarding preoperative and operative data, who underwent isolated coronary artery bypass grafting. A generalized linear mixed model was used for estimating differences in perioperative hemoglobin trends among groups. The three groups were each composed of 50 patients with no differences in demographic data, preoperative risk profile, preoperative hemoglobin, or type of surgery. There was no significant difference in major postoperative complications. The pattern of the hemodilution curves was similar in patients operated with mini-circuit and off-pump technique (P > 005). Mini-circuit led to a 3.1 ± 11.9% hemoglobin reduction, which was similar to the off-pump group (1.6 ± 8.9%, P = 0.99 at ANOVA) and significantly different from the standard extracorporeal circuit group (16.0 ± 10.3%, P < 0.001 at ANOVA). The generalized linear mixed model determined that the standard circuit was the only independent predictor for increased hemodilution. Its effect on hemodilution was time-dependent and the slope of the hemoglobin curve was more pronounced between systemic heparinization and the end of surgery. Perioperative hemoglobin trends of patients who underwent myocardial revascularization with mini-circuit were similar to those of off-pump surgery and significantly less pronounced than those of standard extracorporeal circulation.

Outcomes of Laparoscopic Surgery for Colorectal Cancer in Elderly Patients

To evaluate the short-term outcomes of laparoscopic colorectal surgery for cancer in the elderly compared with younger patients. We retrospectively considered a consecutive unselected series of 159 patients who underwent elective laparoscopic procedures for colorectal cancer at our institution between January 2007 and December 2009. Of these patients, 101 (63.5%) were ≤ 70 years of age (Group A), and 58 (36.5%) were >70 (Group B). Operative steps and instrumentation were standardized. Demographics, disease-related, operative, and short-term data were analyzed for each group, and an appropriate statistical comparison was made. Comorbidity was quantified by using the Charlson Comorbidity Index. We reviewed right colectomies (29.5%), left colectomies (44.7%), rectal resections (19.5%), and other procedures (6.3%). There was no significant difference in sex ratio, body mass index, American Society of Anesthesiology score, type of surgical procedures, and tumor stage between Group A and Group B. A statistically higher comorbidity according to the Charlson index characterized Group B (2.2 vs 3.8; P=.034). Median operative time (228 ± 78.1min vs 224.3 ± 97.6min; NS), estimated blood loss (50.0 ± 94.8mL vs 31.2 ± 72.7mL; NS), conversion rate (2.0% vs 1.7%; NS), and timing to canalization (4.5 ± 1.7dd vs 4.4 ± 1.3dd; NS) were statistically comparable in both Groups. Group B was associated with a significantly longer length of hospital stay compared with Group A (8.1 ± 2.8dd vs 10.8 ± 6.6dd; P<.01) There was no statistically significant difference in major postoperative complications (3.8% vs 3.4%; NS), reoperations (0.9% vs 1.7%; NS), and 30-day mortality (0% vs 1.7%; NS). Laparoscopic colorectal surgery appears feasible and safe in elderly patients with increased comorbidity.