Early Detection Of Postoperative Complications Research Articles

Early Postoperative Prediction of Complications and Readmission After Colorectal Cancer Surgery Using an Artificial Neural Network.

Early predictors of postoperative complications can risk-stratify patients undergoing colorectal cancer surgery. However, conventional regression models have limited power to identify complex nonlinear relationships among a large set of variables. We developed artificial neural network models to optimize the prediction of major postoperative complications and risk of readmission in patients undergoing colorectal cancer surgery. The aim of this study was to develop an artificial neural network model to predict postoperative complications using postoperative laboratory values, and compare these models' accuracy to standard regression methods. This retrospective study included patients who underwent elective colorectal cancer resection between January 1, 2016, and July 31, 2021. Clinical data, cancer stage, and laboratory data from postoperative day 1 to 3 were collected. Models of complications and readmission risk were created using multivariable logistic regression and single-layer neural networks. National Cancer Institute-Designated Comprehensive Cancer Center. Adult colorectal cancer patients. Accuracy of predicting postoperative major complication, readmission and anastomotic leak using the area under the receiver-operating characteristic curve. Neural networks had larger areas under the curve for predicting major complications compared to regression models (neural network 0.811; regression model 0.724, p < 0.001). Neural networks also showed an advantage in predicting anastomotic leak (p = 0.036) and readmission using postoperative day 1-2 values (p = 0.014). Single-center, retrospective design limited to cancer operations. In this study, we generated a set of models for early prediction of complications after colorectal surgery. The neural network models provided greater discrimination than the models based on traditional logistic regression. These models may allow for early detection of postoperative complications as soon as postoperative day 2. See Video Abstract.

A Pilot Study Using Machine Learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery.

To evaluate whether a machine learning algorithm (i.e. the "NightSignal" algorithm) can be used for the detection of postoperative complications prior to symptom onset after cardiothoracic surgery. Methods that enable the early detection of postoperative complications after cardiothoracic surgery are needed. This was a prospective observational cohort study conducted from July 2021 to February 2023 at a single academic tertiary care hospital. Patients aged 18 years or older scheduled to undergo cardiothoracic surgery were recruited. Study participants wore a Fitbit watch continuously for at least 1 week preoperatively and up to 90-days postoperatively. The ability of the NightSignal algorithm-which was previously developed for the early detection of Covid-19-to detect postoperative complications was evaluated. The primary outcomes were algorithm sensitivity and specificity for postoperative event detection. A total of 56 patients undergoing cardiothoracic surgery met inclusion criteria, of which 24 (42.9%) underwent thoracic operations and 32 (57.1%) underwent cardiac operations. The median age was 62 (IQR: 51-68) years and 30 (53.6%) patients were female. The NightSignal algorithm detected 17 of the 21 postoperative events a median of 2 (IQR: 1-3) days prior to symptom onset, representing a sensitivity of 81%. The specificity, negative predictive value, and positive predictive value of the algorithm for the detection of postoperative events were 75%, 97%, and 28%, respectively. Machine learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications-prior to symptom onset-after cardiothoracic surgery.

Circulating metabolic markers after surgery identify patients at risk for severe postoperative complications: a prospective cohort study in colorectal cancer.

Early detection of postoperative complications after colorectal cancer (CRC) surgery is associated with improved outcomes. The aim was to investigate early metabolomics signatures capable to detect patients at risk for severe postoperative complications after CRC surgery. Prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before and after surgery, and analyzed by mass spectrometry obtaining 188 metabolites and 21 ratios. Postoperative complications were registered with Clavien-Dindo Classification and Comprehensive Complication Index. One hundred forty-six patients were included. Surgery substantially modified metabolome and metabolic changes after surgery were quantitatively associated with the severity of postoperative complications. The strongest positive relationship with both Clavien-Dindo and Comprehensive Complication Index (β=4.09 and 63.05, P <0.001) corresponded to kynurenine/tryptophan, against an inverse relationship with lysophosphatidylcholines (LPCs) and phosphatidylcholines (PCs). Patients with LPC18:2/PCa36:2 below the cut-off 0.084µM/µM resulted in a sevenfold higher risk of major complications (OR=7.38, 95% CI: 2.82-21.25, P <0.001), while kynurenine/tryptophan above 0.067µM/µM a ninefold (OR=9.35, 95% CI: 3.03-32.66, P <0.001). Hexadecanoylcarnitine below 0.093µM displayed a 12-fold higher risk of anastomotic leakage-related complications (OR=11.99, 95% CI: 2.62-80.79, P =0.004). Surgery-induced phospholipids and amino acid dysregulation is associated with the severity of postoperative complications after CRC surgery, including anastomotic leakage-related outcomes. The authors provide quantitative insight on metabolic markers, measuring vulnerability to postoperative morbidity that might help guide early decision-making and improve surgical outcomes.

Laser speckle contrast analysis (LASCA): a new device in the diagnosis and monitoring of surgical treatment of hidradenitis suppurativa.

Laser speckle contrast analysis (LASCA) is a quite new and unique device which can find applications in multiple diagnostic approaches in dermatology and dermatosurgery. LASCA can be used in multiple approaches. We would like to make the world's first presentation of LASCA usefulness in hidradenitis suppurativa (HS) surgery based on a case series. To evaluate the usefulness of LASCA in the surgical treatment of HS. In HS surgical treatment at the Centre for Burns Treatment in Siemianowice Śląskie, Poland in 2019-2022, we performed standard preoperative, intraoperative and postoperative speckle laser examinations to assess the vascular perfusion of the surgical sites. The device used was Laser Speckle Contrast Analysis (Perimed AG). This study included 18 patients treated surgically at the Centre for Burns Treatment in Siemianowice Śląskie with specific LASCA findings. As a result of the LASCA examination, we found 1) ischemia of the flap, and 2) local foci of HS, and we could also assess the healing process. LASCA is a great device with which we can evaluate wound healing after surgical procedures (STSG and skin local flaps). LASCA allows for early detection of post-operative complications like ischemia of the local skin flap.

Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery.

Simple SummarySurgery remains the mainstay treatment for oral cavity squamous cell carcinoma (OSCC). Up to 40% of patients with OSCC experience postoperative complications, most within the first 30 days since surgery. The early detection of postoperative complications is challenging. Sarcopenia has been shown to be a negative predictor of the surgical and oncological outcomes of patients with OSCC. The effect of sarcopenia associated with immediate complications and impaired survival after surgery for OSCC is still unknown. This study comprehensively investigated the clinical risk factors and biomarkers associated with 30-day postoperative complications and 5- and 8-year survival of patients with OSCC. Sarcopenia was an independent risk factor associated with 30-day complications, increased reoperation rate, and reduced short- and long-term overall and disease-free survival. Sarcopenia should be assessed before surgery to identify high-risk patients who require a more intensive approach to minimize complications and may be clinically helpful in tailoring treatment strategies for patients with OSCC.Sarcopenia negatively affects oncologic outcomes. However, studies have yet to reveal whether it is associated with postoperative complications and survival among patients with oral cavity squamous cell carcinoma (OSCC). This study retrospectively enrolled 592 patients undergoing primary OSCC surgery with available computed tomography (CT) images of their third cervical vertebrae (C3) within 30 days before surgery between January 2011 and December 2020. Preoperative sarcopenia, nutritional and frailty status, tumor characteristics, comorbidities, and inflammatory markers were assessed. The outcome variables included 30-day complications based on the Buzby and Dindo classification, reoperation, 5- and 8-year overall survival, and disease-free survival. A total of 318 (53.7%) had sarcopenia; of these patients, 217 (68.2%) presented with postoperative complications, and 48 (15.1%) underwent reoperations. Sarcopenia and higher systemic immune-inflammatory index were independently associated with local to systemic 30-day complications. Sarcopenia, advanced-stage disease, and extracapsular spread were correlated with 5- and 8-year survival. The presence of sarcopenia is associated with the 30-day complications and short- and long-term survival of patients who had OSCC and underwent surgery.

Usefulness of measuring temporal changes in physical activity levels using an accelerometer for prediction and early detection of postoperative complications after hepatectomy.

This research aimed to determine whether patterns of temporal changes in activity levels can indicate postoperative complications following hepatectomy. Between December 2016 and December 2019, 147 patients wore an accelerometer to measure their physical activity levels after hepatectomy until postoperative day 7. Patterns of changes in activity levels were categorized as follows: upward slope type (n=88), wherein activity levels gradually increased; bell curve type (n=13), wherein activity levels initially increased but subsequently decreased; and flat type (n=46), wherein there was no apparent increase in activity levels. Patient characteristics and postoperative complications were compared for each group. Postoperative complications occurred in 4.5% of patients in the upward slope group, in 76.9% in the bell curve group, and in 65.2% in the flat group (p<0.001). Surgical site infections (SSI), refractory pleural effusion, and ascites were more common in the bell curve group, while pneumonia was only observed in the flat group. SSI, pleural effusion, and ascites should be considered when previously increasing activity levels decline during the postoperative period. In addition, there is a high risk of SSI and pneumonia when activity levels do not increase at all after surgery.

Assessing the utility of deep neural networks in predicting postoperative surgical complications: a retrospective study

Early detection of postoperative complications, including organ failure, is pivotal in the initiation of targeted treatment strategies aimed at attenuating organ damage. In an era of increasing health-care costs and limited financial resources, identifying surgical patients at a high risk of postoperative complications and providing personalised precision medicine-based treatment strategies provides an obvious pathway for reducing patient morbidity and mortality. We aimed to leverage deep learning to create, through training on structured electronic health-care data, a multilabel deep neural network to predict surgical postoperative complications that would outperform available models in surgical risk prediction. In this retrospective study, we used data on 58 input features, including demographics, laboratory values, and 30-day postoperative complications, from the American College of Surgeons (ACS) National Surgical Quality Improvement Program database, which collects data from 722 hospitals from around 15 countries. We queried the entire adult (≥18 years) database for patients who had surgery between Jan 1, 2012, and Dec 31, 2018. We then identified all patients who were treated at a large midwestern US academic medical centre, excluded them from the base dataset, and reserved this independent group for final model testing. We then randomly created a training set and a validation set from the remaining cases. We developed three deep neural network models with increasing numbers of input variables and so increasing levels of complexity. Output variables comprised mortality and 18 different postoperative complications. Overall morbidity was defined as any of 16 postoperative complications. Model performance was evaluated on the test set using the area under the receiver operating characteristic curve (AUC) and compared with previous metrics from the ACS-Surgical Risk Calculator (ACS-SRC). We evaluated resistance to changes in the underlying patient population on a subset of the test set, comprising only patients who had emergency surgery. Results were also compared with the Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) calculator. 5 881 881 surgical patients, with 2941 unique Current Procedural Terminology codes, were included in this study, with 4 694 488 in the training set, 1 173 622 in the validation set, and 13 771 in the test set. The mean AUCs for the validation set were 0·864 (SD 0·053) for model 1, 0·871 (0·055) for model 2, and 0·882 (0·053) for model 3. The mean AUCs for the test set were 0·859 (SD 0·063) for model 1, 0·863 (0·064) for model 2, and 0·874 (0·061) for model 3. The mean AUCs of each model outperformed previously published performance metrics from the ACS-SRC, with a direct correlation between increasing model complexity and performance. Additionally, when tested on a subgroup of patients who had emergency surgery, our models outperformed previously published POTTER metrics. We have developed unified prediction models, based on deep neural networks, for predicting surgical postoperative complications. The models were generally superior to previously published surgical risk prediction tools and appeared robust to changes in the underlying patient population. Deep learning could offer superior approaches to surgical risk prediction in clinical practice. The Novo Nordisk Foundation.

Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons.

BackgroundPatients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging.ObjectiveThis study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy.MethodsSemistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome.ResultsThe majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy.ConclusionsCaregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

Enhanced Recovery in Surgery for Gastric Cancer

Aim. A summarising review of national and international practices in enhanced recovery after surgery (ERAS) for gastric cancer.Key points. Although ERAS is a routine protocol in colorectal surgery, little agreement exists on its effectiveness and safety in upper gastrointestinal surgery, particularly, for gastric cancer (GC). General recommendations are being widely followed in clinical practice, whilst the adherence to GC-specific measures is still limited. The review highlights the specific measures of perioperative nutrition, surgical approach, early postoperative diet, phase-out of routine nasogastric or nasojejunal tubes, audit of results. The GC-specific protocols include the early detection of postoperative complications, especially the oesophagojejunal anastomosis leakage, to facilitate the ERAS safety and early oral nutrition.Conclusion. Current evidence suggests a strong association of ERAS with improved outcomes and quality of life in the early postoperative period. The long-term impact of ERAS remains understudied but is expected to reduce complications and their severity in oncological surgery.

Abstract 15892: Reliability of Focused Cardiac Ultrasound in the Post-Operative Assessment of Patients With Congenital Heart Disease: A Single Center Experience

Introduction: Early detection of postoperative complications in children with congenital heart disease (CHD) is crucial. The utility of focused cardiac ultrasound (FoCUS) in the assessment of post-operative congenital cardiac surgical patients is not known. Objective: To evaluate the reliability of FoCUS in the assessment of children with CHD in the early post-operative period. Methods: A prospective observational cross-sectional study was performed in a single pediatric center. All FoCUS studies were performed by one imager within two hours of the paired echocardiographic (ECHO) study performed by a different imager. FoCUS studies were obtained using Philips Lumify R and ECHO studies utilized a high-end ultrasound machine (Philips Affiniti R ). Qualitative ventricular (right and left) function, pericardial effusion, pleural effusion, and degree of mitral regurgitation (MR) and tricuspid regurgitation (TR) were compared. All FoCUS and ECHO studies were sent for review in a random and blinded fashion to two independent noninvasive imaging cardiologists. Weighted k statistics were used to determine the level of agreement between FoCUS and ECHO, and between observers. Results: Twenty-three FoCUS studies were performed in 12 patients with a mean age of 16.6 months (range 0-96 months) within two weeks postoperatively. There was inter-observer agreement for ECHO on all parameters and inter-observer agreement for FoCUS on all parameters except for TR. The intra-observer agreement between FoCUS and ECHO for the two cardiologists was fair to moderate for ventricular function (k= 0.470, p&lt; 0.05 and 0.340, p &lt; 0.05), substantial for pericardial effusion (k = 0.617, p&lt; 0.05 and 0.777, p&lt; 0.05), and fair for MR (0.400, p&lt; 0.05). There was no statistically significant agreement for TR and pleural effusion for both observers and MR for one observer. Conclusions: FoCUS demonstrated acceptable reliability in the assessment of ventricular function and presence of pericardial effusions, with a limited value in the assessment of atrioventricular valve regurgitation. This tool is valuable in the early post-operative evaluation of pediatric patients with congenital heart disease in the cardiac intensive care unit.

Intensified and Standardized Digital Communication with Cystectomy Patients as a Potentially Simple and Effective Modality for Early Detection of Postoperative Complications: Results from a Pilot Study

BackgroundPostoperative readmission rates following radical cystectomy remain significant. Early identification of emerging complications could potentially allow for immediate institution of therapy. ObjectiveTo intensify postoperative patient-physician communication via a cellphone-based health care application (CHA) and to evaluate its potential for early detection of complications. Design, setting, and participantsThis was a pilot study involving 18 radical cystectomy patients. During the first 30 d, patients received a push cellphone notification twice a week requesting data input into the CHA. This was reduced to once a week from day 31 to day 90. De-identified recorded data were reviewed by the surgeon involved. If deemed necessary, patients were contacted by the surgeon via telephone to obtain more detailed clinical information. Outcome measurements and statistical analysisDescriptive statistics were used. Results and limitationsOf the 18 patients enrolled, all completed the 90-d reporting period. On two occasions, interventions were necessary on the basis of data recorded on the CHA. One neobladder patient was given antibiotic therapy for pyelonephritis. Another patient reported weight loss and nausea with clinical suspicion of metabolic acidosis, and his sodium bicarbonate and fluid intake were increased. Limitations include the small number of cases from a single low-volume center. ConclusionsCHA-based monitoring of clinical parameters within the crucial 90-d postoperative period following radical cystectomy provides meaningful information. In this pilot study, two potential readmissions were possibly avoided on the basis of recorded basic vital signs and early intervention. Patient summaryBesides regular clinic follow-up visits after radical cystectomy, additional aids such as a cellphone-based health care application can provide treating physicians with relevant clinical information and may help to identify imminent deviations from normal postoperative recovery at an early stage.

Are the C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (NLR) novel inflammatory biomarkers in the early diagnosis of postoperative complications after laparoscopic sleeve gastrectomy?

PurposeC-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are new generation inflammatory markers that have been investigated for use in determining disease prognosis or postoperative morbidity and mortality after many open surgeries. The aim of this study is to investigate the efficacy of CAR, NLR, and PLR on the early detection of postoperative complications (POC) after laparoscopic sleeve gastrectomy (LSG). Material-methodThe study included 448 patients, 16–65 years of age, who underwent LSG between 2015 and 2019. C-reactive protein (CRP) and albumin levels were measured on postoperative day 1 and 3 and CAR values were obtained. NLR and PLR values were evaluated preoperatively and on postoperative day 1 and 3. Statistical analyses were performed using the SPSS version 21.0 and MedCalc. ResultsA total of 326 patients with a mean age of 37 ± 11 years were analyzed. Both CAR1 and CAR3 values were correlated with the development of complications (r = 0.3, r = 0.3, respectively p < 0.001). Pre-op NLR value was found to be a significant risk factor on complication development (OR = 1.943, p = 0.043). The cut-off value for CAR1 and CAR3 were found as 0.78 and 1.25 mg/dL in ROC analysis (AUC = 0.808, AUC = 0.832, respectively). PLR3 value was diagnostic among other PLR values in the determination of POC (AUC = 0.703 Youden index = 0.36 p = 0.014). ConclusionThe most significant diagnostic value for the determination of POC was CAR3. It was followed by CAR1, CRP3, CRP1, and PLR3 values. Only preoperative NLR was found as a risk factor for the development of POC.

Usefulness of Abdominal Drain in Laparoscopic Roux-en-Y Gastric Bypass: A Randomized Controlled Trial

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common procedures to treat morbid obesity. Abdominal drains are often placed during the operation to detect complications earlier. The aim of this study was to assess the benefit of routine drain placement during laparoscopic RYGB. Materials and Methods: A consecutive series of patients undergoing laparoscopic RYGB between 2017 and 2018 was analyzed. The sample was randomized before the procedure into two groups: with abdominal drain (G1) and without abdominal drain placement (G2). Patients with intraoperative complications were excluded from the randomization. Postoperative complications and pain (visual analogue scale) were compared between groups. Results: A total of 84 patients were included; 45 belonged to G1 and 39 to G2. Mean age (G1 44 years versus G2 48 years) and body mass index (G1 43 kg/m2 versus G2 44 kg/m2) were similar in both groups. There were no significant differences between groups in preoperative comorbidities. Mean operative time was 92 minutes in both groups. Mean pain score at postoperative day 0 was similar in both groups (G1 3.2 versus G2 3.5, P = .58), but was higher in G1 at postoperative day 1 (G1 3.1, G2 1.1, P = .02). Postoperative Clavien-Dindo I-II complications were similar in both groups (G1 9% versus G2 1%, P = .37). No major complications, reoperations, or 30-day mortality occurred in the entire cohort. Conclusions: Drain placement in laparoscopic RYGB was associated with greater postoperative pain and did not show benefits in early detection of postoperative complications. Routine placement of abdominal drain in laparoscopic RYGB might not be recommended.

The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea.

BackgroundKorea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications.MethodsWe analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass.ResultsA majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound.ConclusionHere, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.

Complications of liver transplant.

Liver transplantation has become a definitive treatment for patients with end-stage liver disease and those meeting Milan criteria for hepatocellular carcinoma. The morbidity and mortality associated with liver transplantation continues to decrease thanks to refinements in surgical technique, immunosuppression, and imaging. In particular, imaging plays a vital role by facilitating early detection of post-operative complications and enabling prompt treatment. Post-operative complications that lead to graft failure and patient morbidity/mortality can be generally categorized as vascular, biliary, parenchymal, and malignant. Vascular complications include stenosis and thrombosis of the hepatic artery, portal vein, and inferior vena cava; hepatic artery pseudoaneurysm; arteriovenous fistula; and celiac stenosis. Biliary abnormalities include strictures, bile leak, obstruction, recurrent disease, and infection. While imaging is not primarily utilized to diagnose allograft rejection, it plays an important role in excluding mechanical causes of graft dysfunction that can mimic rejection. Ultrasound is routinely performed as the first-line imaging evaluation for the detection and follow-up of early and delayed complications. Cholangiography and magnetic resonance cholangiopancreatography are useful in detecting and characterizing biliary complications. Computed tomography is often used to further evaluate abnormal findings on ultrasound or for the characterization of post-operative fluid collections. The aim of this review is to discuss and illustrate the imaging findings of complications associated with liver transplantation and their role in facilitating treatment.

O181 SERUM C-REACTIVE PROTEIN CAN BE AN EARLY PREDICTOR OF LENGHT OF HOSPITAL STAY AFTER MINIMALLY INVASIVE OESOPHAGECTOMY

Abstract Aim Oesophagectomy is associated with a significant number of potential complications affecting the lenght of the post-operative recovery. Serum C-reactive protein (CRP) is an acute phase protein which has been linked to early detection of post-operative complications, including but not limited to anastomotic leak. The aim of this retrospective study was to investigate the value of CRP elevation in the early post-operative days as a predictor of lenght of Hospital stay after minimally invasive oesophagectomy for cancer. Background and Methods The study group included 88 patients undergoing minimally invasive oesophagectomy for cancer from September 2017 to April 2019. CRP values on post-operative day 1,3,5 and 7 were retrieved and correlated to overall lenght of stay. Post-operative morbidity and mortality were also recorded. Results The approach was fully minimally invasive in 65 patients (74%) and hybrid in the remaining 23 (26%). The median length of stay was 11 days (IQR, 6-105 days) with overall mortality of 3.4% (n=3). Gastro-intestinal complications occurred in 15 patients (17%). The overall surgical or endoscopic re-intervention rate was 13.6% (n=12). The median CRP value was 54.8, 167, 143 and 134 mg/L, respectively on day 1,3,5 and 7. There was a positive correlation between CRP and length of stay on day 1, 3 and 7. A cut-off value of 167 mg/L on day 3 appeared to be a significant predictor of increased lenght of stay (12.8 vs 23.3 days, p=0.008). Conclusion CRP levels above 167mg/L on post-operative day 3 were associated with a prolonged lenght of hospital stay in our group of patients. Elevated CRP in the early post-operative period could represent a useful tool to predict lenght of stay after minimally invasive oesophagectomy.

The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study

BackgroundComplications after laparoscopic gynecological surgery may increase patients’ morbidity and mortality; therefore, their timely diagnosis and early treatment would help clinicians to avoid life-threatening situations. We aimed to evaluate the predictive role of fibrinogen for diagnosing complications after laparoscopic gynecologic surgery for benign and malignant conditions.Patients and methodsAll patients who underwent elective laparoscopic gynecologic surgery between June 2013 and December 2017 at the Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, were prospectively included. Post-operative complications were assessed and graded according to the Clavien-Dindo classification. Fibrinogen and white blood cell level were determined preoperatively, on the first post-operative day and at the appearance of symptoms indicative of an irregular post-operative course or at the time of re-hospitalization for persistent symptoms. The postoperative changes (calculated from the first postoperative day) were correlated with the occurrence and severity of complications and their predictive role was assessed.ResultsWe enrolled 1016 patients: 36% underwent surgery for benign pathologies (mainly voluminous fibromatous uteri and severe deep endometriosis) and 64% for gynecologic malignancies. The overall complication rate was of 3.45%, the rate of major postoperative complications was 2.85%. A postoperative fibrinogen increase ≥ 20% had a high diagnostic accuracy to identify postoperative complications early (AUC 0.931, sensitivity 89%, and specificity 99%). The magnitude of postoperative fibrinogen change was associated with complication severity.ConclusionsOur findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results.

A Review of the Use of Telemedicine in Dermatologic Surgery.

Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery. To provide a review of the applications of telemedicine within dermatologic surgery. A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology. The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care. For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.

Serum procalcitonin concentration within 2 days postoperatively accurately predicts outcome after liver resection

Introduction: Relatively high mortality and morbidity rates are reported after liver resection (LR). However, the early predictors of complications after LR are not clear. Serum procalcitonin (PCT) is reportedly useful for prediction of postoperative complications in various types of surgery. The purpose of this study was to clarify the usefulness of PCT for the early detection of postoperative complications after elective LR. Methods: This observational study included 72 consecutive patients who underwent elective LR from December 2015 to March 2017. Patients were categorized into two groups: those with and without postoperative complications. The values of postoperative inflammatory markers [white blood cell (WBC) count, C-reactive protein (CRP), and PCT] were compared between the two groups. Results: CRP and PCT were significantly higher in patients with than without complications; however, the WBC count showed no difference within 5 days postoperatively. The PCT level peaked within 2 days postoperatively in 61 patients (85%). The maximum PCT level within 2 days postoperatively (PCT1-2) was significantly higher in patients with than without complications (0.52 vs. 0.19 ng/ml, p < 0.001). A cut-off PCT1-2 level of 0.35 ng/ml achieved 80% sensitivity and 83% specificity. PCT1-2 was superior to CRP level within 2 days postoperatively (CRP1-2) for correct diagnosis of complications after LR (p = 0.006). In the patients without complications, there was no difference in PCT1-2, even if the surgical procedure was different (p = 0.935). Conclusions: PCT1-2 is an early prediction maker after LR and can be similarly used regardless of surgical procedure of LR.

Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study.

BackgroundThe growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis.ObjectiveThe aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value.MethodsA multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis.ResultsEncounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care.ConclusionsDigital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.