Early Postoperative Mortality Research Articles

Sex difference in early mortality after abdominal aortic aneurysm repair

ObjectiveAlthough female patients have a lower prevalence of abdominal aortic aneurysm (AAA), they seem to have a worse treatment outcome compared with male patients. Both maximum aneurysm diameter and aortic size index (ASI) are important indicators of the risk of AAA rupture, among which ASI has been shown capable of equalizing sex-related anatomical differences. Our study aimed to investigate whether sex is an independent risk factor for early postoperative mortality and how the diameter or ASI affects the association between sex and mortality. MethodsWe performed a retrospective analysis of patients who enrolled in the AAA registry of the German Society of Vascular Surgery from 2013 to 2019. The patients were treated by either open surgical repair (OSR) or endovascular aneurysm repair (EVAR). The association between sex and 30-day mortality was investigated using logistic regression analysis. The interaction and mediating effects of maximum aneurysm diameter and ASI were investigated to verify their roles in the effect of sex on mortality. The relationships between the diameter (or ASI) and the risk of 30-day mortality in different sexes were demonstrated by the restricted cubic spline. ResultsOverall, 23,275 cases were included in our analysis, with 20,130 male (86.5%) and 3139 female (13.5%) patients. Female patients had a smaller maximum aneurysm diameter (OSR, 55.23 ± 10.29 mm vs 58.05 ± 11.28 mm [P < .001]; EVAR, 54.06 ± 9.08 mm vs 56.11 ± 9.38 mm [P < .001]), but a higher ASI (OSR, 3.16 ± 0.71 vs 2.92 ± 0.69 [P < .001]; EVAR, 3.05 ± 0.66 vs 2.80 ± 0.59 [P < .001]) compared with male patients. The 30-day mortality rate was higher for female patients in both OSR (6.6% vs 4.2%; P = .002) and EVAR groups (1.8% vs 0.8%; P < .001). Logistic regression confirmed a significantly higher risk of 30-day mortality for female patients compared with male patients (odds ratio, 1.55; 95% confidence interval, 1.21-1.99; P = .001). No interaction was found between sex and diameter or ASI, but there were mediating effects for diameter and ASI in the effect of sex on 30-day mortality. For female patients, the risk of 30-day mortality linearly increased with the increase of diameter (PNonlinear = .089) or ASI (PNonlinear = .888), whereas the risk for male patients was U-shaped (for diameter, PNonlinear < .001; for ASI, PNonlinear = .020). ConclusionsSex is an independent risk factor for 30-day mortality after AAA repair. Both diameter and ASI are mediating factors for the effect of sex on 30-day mortality. The relationship between diameter or ASI and the risk of 30-day mortality is different for male and female patients.

Does COVID-19 infection significantly affect liver transplantation? Results of liver transplantation in the COVID-19 era at a single, high-volume centre

BackgroundLiver transplantation is a proven management method for end-stage cirrhosis and is estimated to have increased life expectancy by 15 years. The COVID-19 pandemic posed a challenge to patients who...

Carcinoembryonic Antigen CEA - Prognostic Value in Immediate Post-Operative Mortality in Colorectal Cancer.

This study investigates the prognostic significance of carcinoembryonic antigen (CEA) levels in predicting early postoperative mortality in patients who have undergone colorectal cancer surgery. Between 2017 and 2022, total of 325 patients were enrolled in the study, and their preoperative serum CEA levels were measured. Relevant clinical and operative data were extracted and correlations between CEA levels and postoperative mortality was analysed. Among the surgical cases, 180 patients (55.3%) exhibited elevated CEA levels. Within the early postoperative period of 30 days, 14 patients (4.3%) succumbed, comprising 8 cases (2.4%) of colon cancer and 6 cases (1.8%) of rectal cancer. Notably, only 3 cases (0.9%), consisting of 1 (0.3%) colon cancer and 2 (0.6%) rectal cancer cases, were associated with an elevated CEA level. However, no statistically significant correlations were observed between CEA levels and early postoperative mortality. Our findings indicate that increased CEA levels may not serve as a reliable non-invasive marker for identifying patients at high risk of early mortality in the context of colo-rectal cancer surgery.

Open abdominal vacuum pack technique for the management of severe abdominal complications after cytoreductive surgery in ovarian cancer

IntroductionThe aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. MethodsRetrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh.The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). ResultsTwo percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used.Median hospital stay was 65 days (range: 18–153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. ConclusionVAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications.

Острый коронарный синдром у пациентов со стенозом клапана аорты

The purpose — to assess the acute coronary syndrome (ACS) clinical aspects in patients with aortic stenosis. Material and methods. This is a retrospective single-center study that included comparison of hospital and midterm outcomes of ACS and aortic stenosis (n = 95, divided into the following groups: group 1 — severe aortic stenosis + ACS (n = 39); group 2 — moderate aortic stenosis + ACS (n = 28); group 3 — ACS without aortic stenosis (the control group selected using «Propensity matching» method) (n = 28)). Results. Hospital mortality did not differ statistically between the groups. In group 1, there was a tendency to worse survival within 1 year. In groups with aortic malformation, ACS with ST segment elevation was less common — p = 0.0002 and p = 0.001, respectively. In group 1, 23.1% of patients had intact coronary arteries. Conclusions. Severe aortic valve stenosis in some cases «mimics» acute coronary syndrome, which is indicated by significantly more frequent detection of intact coronary arteries in this cohort. Aortic stenosis of varying degrees does not lead to an increase in the frequency of early postoperative complications and 30-day mortality after PCI.

Evaluation of Perioperative Complications and Mortality in Covid-19 Patients Who Had Emergency Surgery

Objective: The risk for adverse outcomes in COVID-19 patients necessitates further scrutiny in Covid 19 patients in providing appropriate surgical indications and perioperative surgical safety precautions. In this study, we aimed to contribute to elective surgery resumption about infection with early and late postoperative complications and mortality in patients with RT-PCR (+) and clinically suspicious COVID-19 who underwent emergency surgery in our hospital. Methods: A total of 86 patients who have been operated on in our institution for emergency surgery over the age of 18 who were diagnosed with SARS-CoV-2 infection seven days before or 30 days after surgery were enrolled in the study. In this retrospective study, the primary outcome has been established as mortality factors and survival within postoperative 30 days. Results: Regarding the primary outcome as 30-day survival, every 1-year increase in age increased the risk of death by two folds. Patients with one or more comorbidities have an increased risk of death 13 times and those with two or more have an increased risk of death 23 times. Patients in intensive care units increase the risk of death by 8.5 times compared to those who are not hospitalized. On the contrary, an increase in hemoglobin level was shown to reduce the risk of death by 0.8 times. Conclusion: The need for intensive care and mortality is high, especially after emergency surgery, in patients with COVID19 symptoms and more than one comorbidity. Surgical indications of such patients should be well investigated.

Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative Evolution in Patients with Aortic Regurgitation Undergoing Aortic Valve Replacement.

Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern (LVDFP) compared with LV systolic performance in patients with severe aortic regurgitation (AR) undergoing aortic valve replacement (AVR) and to define the independent echographic predictors for the immediate and long-term prognoses. Materials and Methods: We performed a prospective study enrolling 332 AR patients undergoing AVR, divided into two groups: Group A—201 pts with normal LV systolic function, divided into two subgroups (A1: 129 pts with a nonrestrictive LVDFP and A2: 72 pts with restrictive LVDFP), and Group B—131 pts with LV systolic dysfunction (LV ejection fraction LVEF < 50%), divided into two subgroups (B1: 83 pts with a nonrestrictive LVDFP and B2: 48 pts with restrictive LVDFP). Results: The early postoperative mortality rate was higher in patients with a restrictive LVDFP (11.12% in A2 and 12.5% in B2) compared with normal LV filling (2.32% in A1 and 7.63% in B1, p < 0.0001), regardless of the LVEF. The restrictive LVDFP—defined by at least one of the following echographic parameters: an E/A > 2 with an E wave deceleration time (EDt) < 100 ms; an isovolumetric relaxation time (IVRT) < 60 ms; or an S/D ratio < 1 in the pulmonary vein flow—was an independent predictor for early postoperative mortality, increasing the relative risk by 8.2-fold. Other independent factors associated with early poor prognosis were an LV end-systolic diameter (LVESD) > 58 mm, an age > 75 years, and the presence of comorbidities (chronic obstructive pulmonary disease-COPD or diabetes mellitus). On a medium-term, an unfavorable evolution was associated with: an age > 75 years (RR = 8.1), an LV end-systolic volume (LVESV) > 95 cm3 (RR = 6.7), a restrictive LVDFP (RR = 9.8, p < 0.0002), and pulmonary hypertension (RR = 8.2). Conclusions: The presence of a restrictive LVDFP in patients with AR undergoing AVR is associated with both increased early and medium-term mortality rates. The LV diastolic function is a more reliable parameter for prognosis than LV systolic performance (RR 9.2 versus 2.1). Other independent predictors for increased early postoperative mortality rate were: an age > 75 years, an LVESD > 58 mm, and comorbidities (diabetes mellitus, COPD), and for unfavorable evolution at 2 years postoperatively: an age > 75 years, an LVESV > 95 cm3, and severe pulmonary hypertension.

Preoperative heart disease and risk for postoperative complications after pancreatoduodenectomy.

Comorbidities increase the risk for postoperative complications after pancreatoduodenectomy. The importance of different categories of heart disease on postoperative outcomes has not been thoroughly studied. Patients aged ≥18 years undergoing pancreatoduodenectomy between 2008 and 2019at Karolinska University Hospital, Sweden were included. Heart disease was defined as a preoperatively established diagnosis, and subcategorized into ischaemic, valvular, heart failure and atrial fibrillation. Postoperative outcome was analysed by multivariable regression. Out of 971 patients, 225 (23.3%) had heart disease. Heart disease was associated with an increased risk for complications; Clavien-Dindo score≥IIIa (Odds Ratio [OR] 1.53, 95% confidence interval [CI] 1.07-2.18; p=0.019), intensive care unit admissions (OR 3.20, 95% CI 1.81-5.66; p<0.001) and longer hospitalizations (median 14 vs. 11 days; p<0.001). Although heart disease was not associated with 90-day mortality, it conferred a shorter median overall survival (22 vs. 32 months; p<0.001). Atrial fibrillation and heart failure were each associated with increased risk for postoperative complications, whereas ischaemic and valvular heart disease were not. Atrial fibrillation and heart failure were independently associated with increased risk for postoperative complications. Despite no association with early postoperative mortality, heart disease negatively affected long-term survival.

Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis.

Patients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS). Between 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality. Twenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified "PMV > 24 hrs" (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke's R2 0.38). Our data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.

The presentation and the outcome of penetrating abdominal bullet injuries – Iraqi hospital based study

Background: In Iraq penetrating injuries to the abdomen caused by firearm are more common than stab wounds with remarkable mortality and morbidity. Early recognition of the injuries and immediate treatment are mandatory in saving the lives of many of those patients. Objective: To review the presentation and evaluate the early post-operative morbidity and mortality of abdominal bullet injuries in Baghdad teaching hospital. Patients and Methods: This prospective study was conducted on 132 patients admitted to second surgical unit in Baghdad teaching hospital after sustaining bullet injury to the abdomen during the time period of one year from October 2013 to September 2014. Results: The most vulnerable age group involved, between 21-30 years comprised 71.2% of total. Male to female ratio was 43:1(male comprised 97.73%). It was observed that the majority of the injured patients were military personnel (83%), associated with high velocity missiles (81%). It was seen that 96.6% of patients had positive findings during laparotomy; small intestine was involved in the majority of the patients 42.6% followed by large intestine in 35.65%, then liver in 20.86%. Majority of the patients had involvement of two organs (42%), followed by one organ in (28%). The major postoperative complications were wound infection (28.6%), followed by chest infection in (24.4%). The major cause of death was septicaemia in 80%. Conclusion: Explorative laparotomy continues to be the most accurate method used to diagnose the presence of penetrating intra-abdominal injuries with a negative laparotomy rate of 3.4%. The mortality rate tended to be related to the number of intra-abdominal organs injuries; high rates of surgical site and chest infections were found and septicaemia was the chief cause of death after 48 hours. Hospital stays in our study were prolonged in comparison to other developed countries.

The presentation and the outcome of penetrating abdominal bullet injuries – Iraqi hospital based study

Background: In Iraq penetrating injuries to the abdomen caused by firearm are more common than stab wounds with remarkable mortality and morbidity. Early recognition of the injuries and immediate treatment are mandatory in saving the lives of many of those patients.&#x0D; Objective: To review the presentation and evaluate the early post-operative morbidity and mortality of abdominal bullet injuries in Baghdad teaching hospital.&#x0D; Patients and Methods: This prospective study was conducted on 132 patients admitted to second surgical unit in Baghdad teaching hospital after sustaining bullet injury to the abdomen during the time period of one year from October 2013 to September 2014.&#x0D; Results: The most vulnerable age group involved, between 21-30 years comprised 71.2% of total. Male to female ratio was 43:1(male comprised 97.73%). It was observed that the majority of the injured patients were military personnel (83%), associated with high velocity missiles (81%). It was seen that 96.6% of patients had positive findings during laparotomy; small intestine was involved in the majority of the patients 42.6% followed by large intestine in 35.65%, then liver in 20.86%. Majority of the patients had involvement of two organs (42%), followed by one organ in (28%). The major postoperative complications were wound infection (28.6%), followed by chest infection in (24.4%). The major cause of death was septicaemia in 80%. &#x0D; Conclusion: Explorative laparotomy continues to be the most accurate method used to diagnose the presence of penetrating intra-abdominal injuries with a negative laparotomy rate of 3.4%. The mortality rate tended to be related to the number of intra-abdominal organs injuries; high rates of surgical site and chest infections were found and septicaemia was the chief cause of death after 48 hours. Hospital stays in our study were prolonged in comparison to other developed countries.

Early Postoperative Complications in Patients with Acute Myocardial Infarction During Emergency Coronary Bypassing

Despite the success results of interventional cardiology, the indications for coronary artery bypass grafting in acute myocardial infarction, according to the recommendations, are quite limited. In recent years, the optimization of perioperative management of patients, including myocardial protection, has helped to improve the effects of treatment by emergency surgical revascularization in patients with cardiogenic shock. Thus, it is important to learn the results of emergency surgical myocardial revascularization in patients with acute myocardial infarction (AMI), which were previously considered incurable or in cases where interventional cardiology is ineffective. Therefore, the aim of the study was to conduct a prospective analysis of the immediate clinical results of the early postoperative period to determine the factors of early mortality in emergency coronary artery bypass grafting. Research methods. The research is based on the prospective investigation of 129 patients who were hospitalized in Kyiv “Heart Center” through the period from 2011 to 2015. At 100,0% the ST-elevated myocardial infarction (STEMI) of them it was verified, at 29,0 patients non- ST-elevated myocardial infarction (NSTEMI) was set. In early postoperative period, we have analyzed such events like inotropic support duration, necessity of intra-aortic balloon pump, the episodes of the development kidney injury and respiratory failure, complete atrioventricular blockade, supraventricular tachyarrhythmia episodes, encephalopathy, rethoracotomy needs. Also early postoperative mortality endpoints were evaluated. Research results. It has been proven that in the presence of STEMI type of acute myocardial injury compared with NSTEMI type, there is a higher risk of acute left ventricular failure (p &lt;0.05) followed by intra-aortic balloon pulsation (IABP)- procedure (p &lt;0,05) and inotropic support (p &lt;0,05) in the early postoperative period. In patients of the STEMI group, acute kidney injury was recorded more often with reliable indexes of absolute and relative risks (p &lt;0,05). All cases of transient atrioventricular block after emergency coronary artery bypass grafting (CABG) were registered in patients with STEMI injury with significant changes of odds ratio (p &lt;0.05). It was established that the main structure of respiratory complications was due to prolonged mechanical ventilation, but the difference in the relative risk and odds ratio between the STEMI and NSTEMI groups is insignificant (p&gt; 0.05), however the likelihood of supraventricular arrhythmia and encephalopathy in the NSTEMI group was reliably higher (p &lt;0.05). Estimates of the level of early postoperative mortality (12.4%) proved the probable relative risk (p &lt;0.05) and the odds ratio (p &lt;0.05) of mortality in the STEMI group, which was confirmed by the analysis of cumulative survival by Kaplan-Meyer method (Criterion log-rank 2,74; p = 0,006). Mortality in the STEMI group was associated with previously diagnosed acute heart failure (56,2%), the onset of cardiogenic shock (31,3%) and the development of acute mitral regurgitation (12.5%). Conclusions. STEMI type of acute myocardial damage installed reliably higher absolute and relative risk of acute left ventricle failure (p&lt;0,05) with following intra-aortic balloon pump (p&lt;0,05), inotropic support (p&lt;0,05) and acute kidney injury with glomerular rate reduction (p&lt;0,05) in the early postoperative period. The higher absolute and relative risks of encephalopathy, as well as the possibility of supraventricular arrhythmia presented at NSTEMI patients (p&lt;0,05). All cases of transient atrioventricular blockade and early hospital mortality with reliable odds ratio, absolute and relative risks changes registered at STEMI patients (p&lt;0,05). Prospects for further research are long-term prospective observation, analysis of long-term clinical results of coronary artery bypass grafting in patients with acute myocardial infarction, as well as assessment of risk factors for long-term mortality.

Is it worthwhile to perform surgical aortic valve replacement in elderly patients with symptomatic aortic valve disease and malignancy: a short and long-term study in 2,500 patients

Abstract Introduction Malignancy (all types) can be considered as limiting factor for the outcome of surgical aortic valve replacement (SAVR). Purpose How does the referral pattern evolve over time for patients with previously malignancy, referred for SAVR What is their early and long-term outcome after SAVR? Patients and methods This is a retrospective file study of 2,500 patients referred for SAVR with a biological prosthesis between 1987 and 2017. Mechanical valves and valve prosthesis in another position were excluded. A chi-square analysis was used to compare patients with and without cancer with respect to age, gender, era of referral (2008, the year of introduction of transcatheter aortic valve implantation, TAVI), preoperative cardiovascular (parameters for ventricular function, severity of valve disease, coronary disease, arrhythmias and conduction defects) and non-cardiac (pulmonary, renal, diabetes, cerebral) comorbid conditions, operative variables (bypass time, associated CABG and mitral valve repair), need for resources (blood products, stay on ICU) and early postoperative mortality, cardiac and non-cardiac events. A Kaplan-Meier (log-rank) analysis was used to evaluate the effect of malignancy on long-term outcome. Results Of the 2,500 patients, 388 (15.5%) patients had a documented prior malignancy There was a total of 18.917 patient-years for follow-up. For cancer patients, this was 2,489 patient-years. The referral of patients increased after 2008 (from 9.1% to 17.7%, p=0.006). Cancer patients had more chronic pulmonary (14.6% vs. 17.9%, p=0.044) and kidney (15.5% vs. 21.5%, p=0.009) disease, more prior CVA (14.8% vs. 19.8%, p=0.038) and permanent pacemaker implant (14.9% vs. 24/19%, p=0.044). Obesity was less present (18.4% vs. 14.2%). Cardiovascular and operative parameters were comparable for both groups. Postoperative cardiac and non-cardiac adverse events, need for resources and especially mortality (5.0% vs. 6.9%, p=0.105) were comparable. Long-term survival was significantly reduced in patients with malignancy (p&amp;lt;0.001), but this was acceptable: a mean survival time of 105 (98–113) months vs. 121 (118–125) months. Five-year survival was 70.0±2.4% vs. 76.6±0.9% Ten-year survival was 38.6%±1.3% vs. 48.9±2.9% Fifteen-year survival was 14.1±2.7% vs. 20±1.3% In a Cox' proportional hazard analysis, malignancy ranks 8th of 10 independent predictors for mortality (odds ratio 1.26). Conclusion Even after the introduction of TAVI, the number of valve patients with prior malignancy referred for SAVR increased significantly. Nevertheless, only non-cardiac preoperative factors differed significantly. Operative variables, use of resources and early outcome did not differ significantly. Malignancy reduces long-term survival in a significant but acceptable degree. Funding Acknowledgement Type of funding sources: None.

Comparative Risk Stratification for Prediction of Early Postoperative Morbidity and Mortality after Open Fixation of Periarticular Lower Extremity Fractures

Category: Trauma; Ankle; Hindfoot Introduction/Purpose: The standardized identification of patients who are at higher risk of early postoperative adverse events has implications for quality improvement, preoperative medical optimization, and cost reduction through bundled payments. The purpose of the present study was to develop points-based risk stratification systems for predicting 30-day adverse events (AEs) and mortality after open fixation of periarticular hip, knee, and ankle fractures. Methods: Query of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database yielded 65,529 patients who underwent periarticular hip, knee, and ankle fracture repair from 2010-2019. We collected patient demographics and preoperative risk factors. To generate our risk stratification systems, 60% of patients were randomly designated as the development cohort and analyzed with multivariable regression plus bootstrap modeling to identify independent risk factors for early AE and mortality. A nomogram analysis was then conducted to assign scores for each risk factor and generate two points-based risk stratification systems, for AE and mortality. To validate our models, the systems were applied to the remaining 40% of patients (the validation cohort) and tested for predictive ability. Results: In total, 13,212 patients (20.2%) experienced any AE and 3,613 patients (5.5%) mortality within 30 days of fracture fixation. Patients were assigned points for each of the following in both risk stratification systems: fracture type (+4 hip, +2 knee, +0 ankle), male gender (+1), age (&gt;=80 years +5, 60-79 years +3, 40-59 years +2), functionally dependent (+2), anemia (+2 for AE, +1 for mortality), pulmonary disease (+3 for AE, +1 for mortality), congestive heart failure (+3 for AE, +2 for mortality), and end- stage renal disease (+3 for AE, +1 for mortality). Corticosteroid use (+1), hypertension (+1), and insulin-dependent diabetes (+2) were additional predictors for only AEs. The AE and mortality models had maximum scores of 27 and 17 points, and Harrell C statistics of 0.66 and 0.75, respectively. The estimated risk of developing early AE ranged from 3.4-79.5% and mortality from 0.08- 54.4%. Conclusion: Fracture type, male gender, age &gt;=40 years, corticosteroid use, functional dependence, anemia, hypertension, insulin-dependent diabetes, pulmonary disease, congestive heart failure, and end-stage renal disease can be used in the prediction of early AE or mortality following open fixation of periarticular lower extremity fractures, with a marked disparity in estimated risks depending on the number of risk factors possessed by a patient.

Hyperthermic Intraperitoneal Chemotherapy After Cytoreductive Surgery; Experience and Short Term Outcomes

Purpose: Cytoreductive surgery + hyperthermic intraperitoneal chemotherapy is an important treatment option in patients with primary diagnosis of colorectal cancer, ovarian cancer, appendix cancer, gastric cancer (selected cases), malignant peritoneal mesothelioma and peritoneal pseudomyxoma in the presence of peritoneal involvement and resectable lesions limited to the abdomen. In this study, it is aimed to discuss cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) in the light of literature. Patients and methods: The data of patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy between June 2017 and September 2020 at Eskisehir Osmangazi University Medical Faculty Surgical Oncology and Gastroenterology Surgery Departments were analyzed. The study was designed retrospectively, and all patients who were discussed at the oncology council and decided on CRS + HIPEC were included in the study. Results: 31 patients were included in the study. Primary diagnoses of the patients were colorectal cancer in 15 (48%), ovarian cancer in 9 (29%), stomach cancer in 3 (10%), mesothelioma in 2 (7%), appendix cancer in 1 (3%), and also peritoneal pseudomyxoma in 1 (3%). Therapeutic HIPEC was performed in 30 patients, prophylactic HIPEC was performed in 1 patient. Cytoreduction score was 0 in all patients. The median peritoneal cancer index was 15 (7-29). the median number of resected organs was 3(1-6). Stoma formation was performed in 14 patients (45%). During the postoperative 30 days, mortality was observed in 1 patient (3%) and morbidity in 5 patients (16%). Conclusion: The early postoperative mortality and morbidity results which were reported in our study are compatible to those in the literature.

Impact of Pulmonary Hypertension on Mortality after Surgery for Aortic Stenosis.

Background and Objectives: The prognosis of patients with aortic stenosis (AS) adding pulmonary hypertension (PHT) is worse than in those with normal pulmonary artery pressure (PAP), and there are few results reported for the association between PHT and adverse outcomes of AS. We aimed to determine the predictive factors for the development of PHT in patients with surgical AS and to identify those factors that may predict the surgical prognosis. We aimed to identify the independent predictors for PHT regression at 2 years after surgery. Additionally, we tried to evaluate the involvement of PHT as an additional perioperative risk factor in patients with AS undergoing surgical aortic valve replacement (AVR). Materials and Methods: We carried out a two-year prospective study on 340 patients with AS undergoing surgical AVR. Results: The independent predictors for the occurrence of PHT in patients with surgical AS were: age > 75 years (RR = 6, p = 0.001), a restrictive left ventricle diastolic filling pattern (LVDFP) (RR = 9, p = 0.001) and associated moderate mitral regurgitation (MR) (RR = 9, p = 0.0001). The presence of severe PHT increased by 7.6 times the early postoperative risk of death, regardless of the presence of other parameters. The independent predictors for early postoperative mortality were: severe PHT, restrictive left ventricle diastolic pattern, age > 75 years, interventricular septum (IVS) thickness >18 mm and the presence of comorbidities. Conclusions: The presence of a severe PHT in patients with AS undergoing surgical AVR is associated with an early postoperative increased mortality rate. The mean PAP is a more reliable parameter for prognosis appreciation than the LV systolic function.

Robotic mitral valve replacement; results from the world’s largest series

BackgroundThis study evaluates the clinical outcome of patients with robotic mitral valve replacement (MVR).MethodsBetween January 2010 and April 2022, 117 consecutive patients underwent robotic MVR with or without additional cardiac procedures. All procedures were completed by a single surgical team with Da Vinci Robotic Systems. Perioperative variables and early clinical outcomes were recorded.ResultsMean age and EuroScore II of the patients were 57.1±12.9 and 5.1±5.7, respectively. Isolated MVR was performed in 55 (47.0%) patients and combined cardiac procedures were performed in 62 (53.0%) patients. Additional procedures included: ablation for atrial fibrillation, tricuspid valve replacement, tricuspid valve repair, left atrial appendix ligation, patent foramen ovale closure, left atrial thrombectomy and septal myectomy for hypertrophic obstructive cardiomyopathy. Mean cardiopulmonary bypass time and cross clamp time were 143±54 and 93±37 minutes, respectively. Mean intensive care unit stay time was 26.5±26.0 hours. Postoperative stroke was observed in one (0.9%) patient and new onset renal failure was observed in two (1.7%) patients. Perioperative and postoperative early mortality was observed in three (2.6%) patients, which was lower than expected.ConclusionsRobotic MVR is feasible and can be performed with good early postoperative outcomes. A majority of the patients require additional cardiac procedures.

Risk factors for evaluating early mortality after microvascular reconstruction of head and neck cancers.

Free tissue transfer reconstruction carries significant complication rates in surgical head and neck oncology. A registry-based approach offers a possibility to investigate the factors affecting increased morbidity and early mortality, that is, death within 6 months of treatment. A retrospective registry review was conducted on a series of 317 consecutive microvascular free tissue transfers in head and neck cancer patients performed during 2013-2017 at the Helsinki University Hospital (Helsinki, Finland). All surviving patients had a minimum follow-up of 2 years (range 24-84 months). Overall, 36 (11.4%) early deaths occurred in this series. In multivariable logistic regression analysis, patients aged 75 years and older (p = 0.019), Adult Comorbidity Evaluation-27 (ACE-27) score of 3 (p = 0.048), tumor class T3 (p = 0.005), lymph node class N2 (p = 0.014), or thrombocyte count of 360 (× 109 L) or more (p = 0.001) were more likely to die within 6 months of surgery. Of these 36 patients, 27 (75%) had a complication warranting hospital care and most (n = 22, 61%) had several complications. Early postoperative mortality most frequently affects patients aged 75 years and above, with a high ACE-27 score, advanced tumor stage, or high thrombocyte count. Therefore, preoperative assessment and patient selection should have a crucial role in this patient population.

Off-pump or on-pump coronary artery bypass at 30 days: A propensity matched analysis.

IntroductionThis study was to determine whether coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG, OPCAB) could reduce early postoperative mortality and major complications compared with conventional coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG, ONCAB) by experienced surgeons.Material and methodsFrom January 2016 to June 2020, isolated CABG was performed in 1200 patients (ONCAB 429, OPCAB 771) in Wuhan Union Hospital. The propensity score matching was used to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. After 1:1 matching, 404 pairs for each group were selected to compare outcomes within 30 days after surgery. All the operations were completed by experienced surgeons that had completed more than 500 on-pump and 200 off-pump CABG, respectively.ResultsAfter propensity matching, the two groups were comparable in terms of preoperative characteristics. The OPCAB group had less vein graft (2.5 ± 1.0 vs. 2.7 ± 0.9; P < 0.001) and a higher rate of incomplete revascularization (12.4 vs. 8.2%; P < 0.049) than the ONCAB group. There was no significant difference in early postoperative mortality between ONCAB and OPCAB groups (2.2 vs. 2.2%; P = 1.00). However, patients in the OPCAB group had a lower risk of postoperative stroke (1.5 vs. 4.7%; P = 0.008), new-onset renal insufficiency (8.9 vs. 18.8%; P < 0.001), respiratory failure (2.2 vs. 7.2%; P = 0.001), reoperation for bleeding (0.5 vs. 2.7%; P = 0.001), and required less ventilator assistance time (33.4 ± 37.9 h vs. 51.0 ± 66.1 h; P < 0.001) and intensive care unit (ICU) time (3.7 ± 2.7 days vs. 4.8 ± 4.3 days; P < 0.001).ConclusionsIn our study, patients undergoing OPCAB had fewer postoperative complications and a faster recovery. It is a feasible and safe surgical approach to achieve revascularization when performed by experienced surgeons.

Factors of Early Recurrence After Resection for Intrahepatic Cholangiocarcinoma.

Two-thirds of patients undergoing liver resection for intrahepatic cholangiocarcinoma experience recurrence after surgery. Our aim was to identify factors associated with early recurrence after resection for intrahepatic cholangiocarcinoma. Patients with intrahepatic cholangiocarcinoma undergoing curative intent resection (complete resection and lymphadenectomy) were included in two centers between 2005 and 2021 and were divided into three groups: early recurrence (< 12months after resection), delayed recurrence (> 12months), and no recurrence. Patients experiencing early (< 90days) postoperative mortality were excluded. Among 120 included patients, 44 (36.7%) experienced early recurrence, 24 (20.0%) experienced delayed recurrence, and 52 (43.3%) did not experience recurrence after a median follow-up of 59months (IQR: 26-113). The median recurrence-free survival was 16months (95% CI: 9.6-22.4). Median overall survival was 55months (95% CI: 45.7-64.3), while it was 25months for patients with early recurrence (p < 0.001). Patients with early recurrence had significantly larger tumors (59.1% of tumors > 70mm in early vs. 58.3% in delayed vs. 26.9% in no recurrence group, p = 0.002), multiple lesions (65.9% vs. 29.2% vs. 11.5%, p < 0.001), and positive lymph nodes (N +) (38.6% vs. 37.5% vs. 11.5%, p = 0.005). In multivariable analysis, presence of multiple lesions (OR: 9.324; 95% CI: 3.051-28.489; p < 0.001) and positive lymph nodes (OR: 3.307. 95% CI: 1.001-11.011. p = 0.05) were associated with early recurrence. Early recurrence after curative resection of intrahepatic cholangiocarcinoma is frequent and is associated with the presence of multiple lesions and positive lymph nodes, raising the question of surgery's futility in this context.