Factors For Postoperative Complications Research Articles

Pathophysiology of risk factors for post operative complications

Postoperative complications lead to an increase in morbidity and mortality, increase in hospital length of stay and costs for health care. Understanding the pathophysiology of various risk factors causing post-operative complications, helps in better understanding of the subject and perioperative patient assessment. The risk factors selected for the purpose of the study include modifiable risk factors and includes results from various single centre and multi-centre cohort studies, and systematic reviews and data from various meta-analysis by various authors on different subjects. The importance of optimizing the modifiable risk factors like hypoalbuminemia, anemia, obesity and smoking can be understood from the above study. It is important to remember that morbidity is multifactorial and taking into account only a single risk factor will not improve the outcomes. This signifies the importance of multidisciplinary approach when treating the patient.

Immediate free flap reconstruction following the resection of benign jaw lesions: A 15-year perspective

ObjectivesTo report on outcomes of immediate free flap reconstruction following the resection of extensive benign jaw lesions. MethodsThis is a retrospective study on all patients who required free flap reconstruction after the ablation of benign jaw lesions and who were operated on by the Oral and Maxillofacial Surgery department in a tertiary care centre in Hong Kong from 2004 to 2019. The primary outcome assessed is flap success. The secondary outcomes assessed are recipient site, donor site and other complications, number of days on nasogastric tube and dental rehabilitation. Results45 patients were treated. Primary ameloblastoma was treated in 26 patients and recurrent ameloblastoma in five patients. 41 out of 45 cases were successful. The most common complication was local infection, experienced by 11.1 % of patients. On average, each patient spent 8.8 days on nasogastric tube feeding post-operatively. There was a significant difference in the number of days the patient was kept on nasogastric tube between the group which experienced recipient site complications and the group which did not (p = 0.0218). Dental rehabilitation with implants or dentures was possible in two-thirds of the patients. ConclusionImmediate free flap reconstruction is feasible for the reconstructing defects resulting from the resection of benign pathology, demonstrating high success and the option of dental rehabilitation. Age is not a significant factor in post-operative complications. Preventing recipient site complications may promote earlier resumption of oral feeding.

Periappendiceal fluid collection on preoperative computed tomography can be an indication for interval appendectomy: a retrospective study

BackgroundThe treatment strategies for acute appendicitis, such as emergency appendectomy (EA), interval appendectomy (IA), and repeating nonoperative management (NOM), are controversial. In this study, we examined the preoperative factors that can be used to distinguish which patients should undergo IA.MethodsWe retrospectively identified 902 patients who underwent surgery for appendicitis in our hospital from January 2010 to December 2021. Of these patients, 776 were included in this study. The patients were divided into two groups: those with a periappendiceal fluid collection (PAFC) on preoperative computed tomography (PAFC-positive group, n = 170) and those without a PAFC (PAFC-negative group, n = 606). In each group, we compared patients who underwent EA and IA.ResultsIn the PAFC-positive group, patients who underwent EA had a significantly higher postoperative complication rate than those who underwent IA (40.5% vs. 24.0%, p = 0.037). In the multivariate analysis, only the presence of PAFC was significantly associated with an increased risk of postoperative complications (odds ratio, 7.11; 95% confidence interval, 2.73–18.60; p < 0.001). The presence of PAFC alone was not significantly associated with an increased risk of IA or NOM failure (odds ratio, 1.48; 95% confidence interval, 0.19–11.7; p = 0.71). The rate of neoplasia on pathologic examination was significantly higher in the PAFC-positive than PAFC-negative group (7.6% vs. 1.5%, p < 0.001); the rate of carcinoma was also higher in the PAFC-positive group (2.4% vs. 0.17%, p = 0.02).ConclusionsThe presence of PAFC on preoperative computed tomography was found to be a risk factor for postoperative complications but not IA or NOM failure. It was also correlated with neoplasia as the etiology of appendicitis. Therefore, PAFC positivity is useful as an indication for IA.

Multiple cannulated screw fixation of femoral neck fractures with comminution in young- and middle-aged patients

ObjectiveTo investigate the distribution and influence of comminution in femoral neck fracture (FNF) patients after cannulated screw fixation (CSF).MethodsFrom January 2019 to June 2020, a total of 473 patients aged 23–65 years with FNF treated by CSF were included in the present study. Based on location of the cortical comminution, FNF patients were assigned to two groups: the comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) or the without comminution group. The incidence of postoperative complications, quality of life and functional outcomes was recorded at 1-year follow-up.ResultsComminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), and the rate of comminution was closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P < 0.05). The incidence of osteonecrosis of the femoral head (ONFH, 11.3% vs 2.9%, P < 0.05), nonunion (7.5% vs 1.7%, P < 0.05), femoral neck shortening (21.6% vs 13.4%, P < 0.05) and internal fixation failure (11.8% vs 2.9%, P < 0.05) was significantly higher in FNF patients with comminutions, especially with multiple comminutions, than those without. Furthermore, there was a significant difference in the Harris hip score (HHS, 85.6 ± 15.6 vs 91.3 ± 10.8, P < 0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85 ± 0.17 vs 0.91 ± 0.18, P < 0.05) between FNF patients with comminution and those without. There was no significant difference in Visual analogue scale scores (VAS, 1.46 ± 2.49 vs 1.13 ± 1.80, P > 0.05) between two groups at 1 year post-surgery.ConclusionComminution is a risk factor for postoperative complications in young- and middle-aged patients with displaced and Pauwels type III FNF who undergo CSF. This can influence the recovery of hip function, thereby impacting quality of life. Further evaluation with a more comprehensive study design, larger sample and long-term follow-up is needed.

Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator

BackgroundAlthough the risk calculator of the National Clinical Database (RC-NCD) has been widely used to predict the occurrence of mortality and major morbidity in Japan, it has not been demonstrated whether a correlation between the calculated RC-NCD risk score and the actual occurrence of mortality and severe morbidity exists.MethodsThe clinical data of 585 patients who underwent pulmonary resection for non-small cell lung cancer were collected, and the risk factors for postoperative morbidity were analyzed to verify the validity of the RC-NCD.ResultsThe coexistence of asthma (p = 0.02), nutrition lymphocyte ratio (p = 0.04), and pulmonary lobe (p < 0.01) were significant risk factors for postoperative morbidity in the present study, and the percent-predicted vital capacity (p < 0.01), pulmonary lobe (p = 0.03), and type of operative procedure (p = 0.01) were significant risk factors for severe postoperative morbidity. Furthermore, in patients received lobectomy, coexistence of asthma (p = 0.01) and pulmonary lobe (p < 0.01) were identified as significant risk factors for postoperative morbidity. Meanwhile, male sex (p = 0.01), high BMI (p < 0.01), low vital capacity (p = 0.04), and pulmonary lobe (p = 0.03) were identified as significant risk factors for severe postoperative morbidity.ConclusionsGiven that the pulmonary lobe was a significant risk factor for postoperative morbidity in patients received pulmonary resection and for severe postoperative morbidity in patients received lobectomy, the RC-NCD for postoperative morbidity needs to be modified according to high-risk lobes.Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.

Risk factors for postoperative ileus after diverting loop ileostomy closure

BackgroundPostoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.MethodsThis was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus [POI (+)] and patients who did not [POI (−)] after ileostomy closure were compared.ResultsSixty-eight patients were evaluated and were divided into two groups: POI (+) (n = 11) and POI (−) (n = 57), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery were significantly higher in the POI (+) group.ConclusionsThe incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery may increase the risk of postoperative ileus after ileostomy closure.

Does Dosage or Duration of Concurrent Oral Corticosteroid Influence Elevated Risk of Postoperative Complications After Total Joint Arthroplasty?

This report seeks to clarify whether the dosage and duration of preoperative concurrent corticosteroid use influence postoperative complications after primary total joint arthroplasty (TJA). This retrospective single institutional study enrolled 1128 primary TJA cases, including 905 total hip arthroplasties and 223 total knee arthroplasties at a minimum 6 months of follow-up. Mean follow-up period was 51.9±34.1 months (range 6-146). Of all joints, 120 joints (10.6%) were associated with chronic concurrent oral corticosteroid use. Multivariate analysis was performed to identify whether chronic concurrent oral corticosteroid use elevated the risk of postoperative complications including surgical site infection/periprosthetic joint infection, delayed wound healing, periprosthetic fracture, and implant loosening. For chronic concurrent oral corticosteroid user, we determined whether the dosage and duration of preoperative concurrent corticosteroid use influenced postoperative complications and have an effective threshold for postoperative complications using receiver operating characteristic curve analysis. The multivariate analysis revealed that American Society of Anesthesiologist Physical Status 3 was an independent risk factor for postoperative complications, while concurrent oral corticosteroid use was not an independent risk factor. When we compared joints with (n= 13) and without (n= 107) postoperative complications in chronic concurrent oral corticosteroid user, there was no statistical difference in the dosage (P= .97) and duration (P= .69) between the 2 groups. Area under the curve values for the oral corticosteroid dosages and duration were 0.482 and 0.549, respectively. This study revealed that neither dosage nor duration of concurrent oral corticosteroid use was predictive of postoperative complications after TJA. American Society of Anesthesiologist Physical Status 3 is a major factor in postoperative complications after TJA.

Hydatid cysts of the liver opening in the biliary tracts: about 120 cases comparative study between radical and conservative treatment

Background. Hepatic hydatid disease is still common in Tunisia, is deemed benign disease but concerns its complications; the most frequent is the rupture in biliary ducts. The aim of the work was to study the results of surgical treatment of hydatid cysts of the open liver in the bile ducts and to deduce the predictive factors of postoperative complications. Methods. This was a retrospective study, done in the department of general surgery of Mongi Slim hospital, over a period of 11 years (from January 2000 to December 2013) and collecting 115 patients. Judging criteria were specific morbidity, length of postoperative stay and recurrence. Results. The median age was 43 years (62 women and 53 men). The clinic consisted of typical cholangitis episodes (6.95%), 6.95% of patients were asymptomatic. 50 radical interventions and 65 conservative interventions were performed, supplemented by treatment of the fistula as follows: Fistula blindness (43.47%), trans-fistulo-oddian drainage (3.4%), bipolar drainage (2.6%), PERDOMO (6.95%). The overall mortality was zero. The overall morbidity was 27.69% with an overall specific morality of 14.7% mainly represented by the suppuration of the CR and the external biliary fistulas. The median postoperative stay was 6 days; the recurrence rate was 1.7% with a delay of 30 months. The predictive factors of postoperative complications in bi variance were: The size of the cyst (p = 0.02), The location of a cyst in the hepatic dome (p = 0.002), Surgical treatment: radical or conservative (p = 0.02), The sex factor (p = 0.015). The multivariate study who found a significant association between sex only and postoperative complications. Conclusion. Advances in hepatobiliary surgery and anesthesia are changing the surgical attitude in favor of radical procedures with favorable consequences in terms of morbidity, length of stay and recurrence. It is believed that the surgeon’s experience is the most important factor in the success of surgical treatment. This helps to prevent complications.

Comparison of Clinical Data Between Patients With Complications and Without Complications After Spinal Tuberculosis Surgery: A Propensity Score Matching Analysis.

PurposeThis study used a propensity score matching (PSM) analysis to explore the risk factors of post-operative complications and compared the differences in clinical data between them following spinal tuberculosis surgery.MethodsThe clinical data of patients with spinal tuberculosis were collected in our hospital from June 2012 to June 2021, including general information, laboratory results, surgical information, and hospitalization costs. The data were divided into two groups: complication and without complication groups. The baseline data of the two groups were obtained using the PSM analysis. Univariate and multivariate logistic analyses were used to analyze the differences between the two groups.ResultsA total of 292 patients were included in the PSM analysis: 146 patients with complications and 146 patients without complications. The operation time, incision length, hospital stay, and albumin quantity in the complications group were 162 ± 74.1, 11.2 ± 4.76, 14.7 ± 9.34, and 1.71 ± 2.82, respectively, and those in the without complication group were 138 ± 60.5, 10.2 ± 3.56, 11.7 ± 7.44, and 0.740 ± 2.44, respectively. The laboratory costs, examination costs, guardianship costs, oxygen costs, and total costs in the complications group were higher than those in the without complication group. A significant difference was observed in the albumin quantity by logistic regression analysis (P < 0.05).ConclusionSeveral costs in the complication group were higher than in the without complication group. The albumin quantity may be an independent factor to predict post-operative complications of spinal tuberculosis by logistic regression analysis.

Predictive value of matrix metalloprotease 9 on surgical outcomes after pericardiectomy

BackgroundThe effects of matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) expressions on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the associations of MMPs and TIMPs expressions with postoperative outcomes in these patients.MethodsPericardial specimens were obtained during pericardiectomy from the patients with constrictive pericarditis. The levels of MMP1, MMP2, MMP9 and TIMP1 in pericardium were analyzed by quantitative real-time polymerase chain reaction. The enrolled patients were divided into two groups according to the optimal cutoff value of gene expression predicting postoperative complications. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the degree of contribution of gene expression on postoperative outcomes.ResultsA total of 22 patients and their pericardial specimens were included. The level of MMP9 was significantly associated with postoperative complications and the optimal cutoff value predicting postoperative complications was 3.67. The patients with low level of MMP9 (< 3.67) had lower incidence of postoperative complications (P = 0.002), shorter postoperative intensive care unit (P = 0.040) and hospital stay (P = 0.043) in comparison to those with high level of MMP9 (≥ 3.67). Binary logistic regression analysis showed that high level of MMP9 increased the risk of postoperative complications (OR 27.096, 95% CI 1.166–629.886, P = 0.040).ConclusionsHigh level of MMP9 in the pericardium was associated with poor postoperative outcomes and was the independent risk factor of postoperative complications. The level of MMP9 could be used as a potential marker for prediction of surgical outcomes.

Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection

Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.&#x0D; The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.&#x0D; Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05.&#x0D; Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively.&#x0D; Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.

Systemic Inflammatory Markers as Predictors of Postoperative Complications and Survival in Patients With Advanced Head and Neck Squamous Cell Carcinoma Undergoing Free-Flap Reconstruction

The aim of this study was to determine the prognostic value of systemic inflammatory indices as factors for postoperative complications and survival in patients with advanced stages of p16-negative head and neck squamous cell carcinoma undergoing free-flap reconstruction. This was a retrospective cohort study. The primary predictor variables were inflammatory markers such as neutrophil, lymphocyte, monocyte, and platelet count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, lymphocyte-monocyte ratio, derived NLR, systemic immune-inflammatory index, and systemic inflammatory marker index (SIM). Multivariate regression analyses were used to measure the associations between systemic inflammatory indices and overall and disease-free survival as a primary outcome and occurrence of postoperative complications as a secondary outcome measure. The sample was composed of 69 male (76.67%) and 21 female (23.33%) patients, with an average age of 61.15±9.79years. The median follow-up time was 24months, and 73 of 91 (66.43%) patients were alive during the median follow-up. Overall disease survival correlated with systemic immune-inflammation (P=.022, cutoff >1,005.3, sensitivity 67.1%, and specificity 70.6%) and SIM (P=.0001, cutoff >4.05, sensitivity 90.4%, and specificity 41.2%), preoperative platelets (P=.036, cutoff <194, sensitivity 28.8%, and specificity 94.1%), and postoperative lymphocytes (P=.012, cutoff <0.6, sensitivity 38%, and specificity 76.5%), whereas increased SIM (P=.042, cutoff >4.05, sensitivity 91.3%, and specificity 38.1%), NLR (P=.031, cutoff >13.2, sensitivity 56.9%, and specificity 60%), and preoperative platelets (P=.006, cutoff <244, sensitivity 52.3%, and specificity 76%) were associated with adverse disease-free survival. The cumulative postoperative complication rate was 34.5%, of which 13.3% accounted for major complications, whereas derived NLR (P=.013, degrees of freedom 1, χ2 test 6.161, cutoff >2.3) and postoperative lymphocytes (P=.009, DF 1, χ2 test 6.756, cutoff <1) correlated with occurrence of complications. Inflammatory indices as measures of inflammation-related systemic dysfunction may be associated with adverse survival in patients with head and neck squamous cell carcinoma and occurrence of postoperative complications and with specific cutoff values.

Postoperative Reduction in Serum Albumin Predicts Complications after Rectal Cancer Surgery

Background The serum albumin (Alb) level often decreases early in the postoperative period. However, it is unclear whether a decline in the serum albumin level (ΔAlb) is a predictor of postoperative complications. We aimed to determine the relationship between the ΔAlb and complications following surgery for rectal cancer (RC). Methods We retrospectively collected the records of patients aged ≥ 18 years who underwent RC surgery between January 2015 and August 2018. We determined the cut-off value of the ΔAlb using subject working characteristic curve analysis and analyzed complications above grade II according to the Clavien-Dindo classifcation. Single and multifactor analyses of the risk factors for postoperative complications were performed. Results A total of 430 RC patients were included in this study. The area under the ΔAlb curve was 0.786, with a critical value of 22%. We selected 20% as the critical point for grouping patients. The total postoperative complication rate was signifcantly higher in patients who had a ≥ 20% serum Alb decline than those had a &lt; 20% serum Alb decline (&lt; 20% ∆Alb group); with rates of 51.5% and 16%, respectively (P &lt; 0.001). A multifactorial logistic regression analysis revealed that the ∆Alb (odds ratio [OR] = 4.95, 95% CI = 3.126-7.838 P &lt; 0.001), surgical approach (OR = 2.374, 95% CI = 1.335-4.224 P = 0.003), and blood loss (&gt; 200 ml) (OR = 1.684, 95% CI = 1.043-2.716 P = 0.033) were independent risk factors for postoperative complications follow RC surgery. Conclusions The ∆Alb predicted the incidence of postoperative complications in patients after RC surgery. This could help identify patients at risk of complications early during the perioperative period, thereby helping to more effectively manage high-risk patients.

The role of factor XIII in surgery for advanced stage of epithelial ovarian cancer.

Hereditary factor (F) XIII-deficiency is a known risk factor for postoperative complications, but data of acquired FXIII-deficiency in malignancies are limited. Therefore, we evaluated the role of acquired FXIII-deficiency in surgery for advanced epithelial ovarian cancer (EOC). We performed a retrospective analysis of patients with known serum FXIII status and treatment between 2011 and 2018 at our center. We defined cohorts according to FXIII with values > 75% as normal (group A), 55-75% as reduced (group B) and < 55% as low (group C). Complications were classified according to the Clavien-Dindo Classification, class III-V complications were defined as severe. 347 patients with EOC were identified. 180 patients (51.2%) were in group A, 82 patients (23.6%) in group B, and 85 patients (24.4%) in group C. Lower levels of FXIII were associated with higher amount of ascites, FIGO IV, high grade serous histology, low albumin, and higher CA-125 levels. Regarding intraoperative variables, low FXIII was associated with longer duration of surgery, higher blood loss, higher surgical complexity score/number of bowel anastomosis and a higher probability for macroscopic residual disease. The risk of severe complications in group A was 12.2%, 24.4% in group B, and 31.8% in group C. In a multivariate model, low FXIII (OR 2.8), > 1 bowel anastomosis (OR 2.7), age-adjusted Charlson comorbidity index ≥ 4 (OR 3.6) and a longer duration of surgery (> 285min.) were significant predictive factors for severe complications. FXIII is associated with tumor and treatment burden. A low level of FXIII is associated with postoperative complications. The knowledge about the presurgical serum FXIII-level might be helpful to plan the treatment strategy.

Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

PurposeSkeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3).MethodsRetrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3).ResultsPCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027).ConclusionMeasuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.

The association between preoperative 25-OH vitamin D levels and postoperative complications in patients undergoing colorectal cancer surgery

BackgroundDetermining the modifiable risk factors for postoperative complications is particularly significant in patients undergoing colorectal surgery since those are associated with worse long-term outcomes.MethodsConsecutive newly diagnosed 104 colorectal cancer patients were prospectively included in this single-center observational study. Preoperative serum 25-OH vitamin D levels were measured and analyzed for infectious and postoperative complications.ResultsSerum 25-OH vitamin D levels were found to be < 20 ng/ml in 74 patients (71.2%) and ≥ 20 ng/ml in 30 patients (28.8%); and the mean serum 25-OH vitamin D level was 15.95 (± 9.08) ng/ml. In patients with surgical site infection and infectious complications, 25-OH vitamin D levels were significantly lower than patients without complications (p = 0.036 and p = 0.026). However, no significant difference was demonstrated in 25-OH vitamin D levels according to overall postoperative complications.ConclusionsOur results suggest that vitamin D levels might be a potential risk factor for infectious complications in patients undergoing colorectal cancer surgery.

Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung

BackgroundThe purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients.MethodsWe retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019.ResultsOf 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL.ConclusionIn conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.

Effect of neoadjuvant treatment combined with radical gastrectomy on postoperative complications and prognosis of gastric cancer patients

Objective To investigate the occurrence of postoperative complications in and factors influencing the prognosis of patients undergoing radical gastrectomy after neoadjuvant chemotherapy. Methods A total of 238 patients with gastric cancer were enrolled in this study. There were 194 patients who underwent neoadjuvant chemotherapy before surgery and 44 patients who underwent concurrent radiochemotherapy before surgery. The clinical data of patients and the incidence of postoperative complications were collected. Postoperative complications were graded based on the Clavien-Dindo classification. The impact of postoperative complications on the prognosis of patients was analysed. Results (1) The overall incidence of postoperative complications was 17.2% (41/238) among all patients. A total of 49 patients experienced postoperative complications, including 12 cases of grade I, 15 cases of grade II, seven cases of grade IIIa, three cases of grade IIIb, seven cases of grade IV, and four cases of grade V complications. A total of 21 patients experienced severe complications. Multivariate analysis indicated that age, body mass index (BMI), and scope of gastrectomy were independent risk factors for postoperative complications (p < .05). (2) The five-year survival rate for the entire group of patients was 58.4%. The five-year survival rate for the complication group and non-complication group were 31.7% and 51.7%, respectively, with a significant difference between the two groups (χ2=15.41p = .000). Based on the severity of complications, the subgroup analysis indicated that the five-year survival rate for patients with severe postoperative complications was 21.1% and that for patients with non-severe complications was 40.9%; the difference was significant (χ2=21.70, p = .000). (3) Multivariate analysis indicated that age, pathological tumour, node, and metastasis (ypTNM) stages II-III, operation time >3.5 h, total gastrectomy, and postoperative complications were independent risk factors affecting the prognosis of patients undergoing radical gastrectomy after neoadjuvant chemotherapy. Postoperative adjuvant therapy was an independent protective factor for patient prognosis (p < .05). Conclusion The incidence of complications in patients undergoing radical gastrectomy after neoadjuvant chemotherapy is closely correlated with patient age and the scope of surgical resection, and the occurrence of severe complications has a significant adverse effect on patient prognosis.

Comparative Analysis of Clavien-Dindo Grade and Risk Factors of Complications after Dual-Port Laparoscopic Distal Gastrectomy and Hand-Assisted Laparoscopic Gastrectomy.

Objective To compare the Clavien–Dindo grade and risk factors of complications after dual-port laparoscopic distal gastrectomy (DPLDG) and hand-assisted laparoscopic gastrectomy (HALG). Methods The clinical data of 775 patients who underwent DPLDG or HALG in our hospital from May 2016 to May 2019 were retrospectively reviewed, and the patients were divided into the DPLDG group (n = 386) and HALG group (n = 389) according to the surgical method to explore the risk factors of postoperative complications by grading their postoperative complications according to the Clavien–Dindo classification system and single-factor and multivariate analysis of the association between variables in clinical data and complications. Results Compared with the HALG group, the DPLDG group had significantly shorter surgical time, less intraoperative blood loss, and better postoperative exhaust time (p < 0.05), with no significant difference in other clinical indicators between the two groups (p > 0.05); the postoperative complication incidence rate of DPLDG group was significantly lower than that of the HALG group; it was shown in the single-factor analysis that the age, tumor length, intraoperative blood loss, pathological stages, and surgical method were related to the postoperative complications, and the results of multivariate analysis indicated that DPLDG was the protective factor for reducing postoperative complications, while age no less than 60 years old and intraoperative blood loss no less than 180 ml were the independent risk factors leading to complications; after surgery, the PNI level values at T1, T2, and T3 of DPLDG group were significantly higher than those of the HALG group (p < 0.05); and at 1 month after surgery, both groups obtained significantly higher GLQI scores than before, and the GLQI score of the DPLDG group was significantly higher in the between-group comparison (p < 0.05). Conclusion The DPLDG has lower postoperative complication incidence rate than the HALG, but age no less than 60 years old and intraoperative blood loss not less than 180 ml are the independent risk factors for postoperative complications, so advanced prevention measures shall be taken to lower the incidence of complications.

Current trends in diagnostic and treatment tactics in patients with strangulated ventral hernias

The aim of the work. To analyze the world achievements in modern diagnostic and treatment tactics in patients with strangulated ventral hernias, as well as to outline promising and pragmatic directions for further research. The literature review presents current trends and views on the choice of individual components of the integrated diagnostic approach in patients with strangulated ventral hernias, and focuses on various principles of therapeutic tactics. The need to further improve the examination methods of abdominal organs, anterior abdominal wall, hernia contents (polypositional roentgenoscopy or roentgenography, ultrasound, CT, MRI) is emphasized and prospects of allohernioplasty and videolaparoscopic technologies with an integrated approach in choosing the method for correction or reconstruction of abdominal wall depending on the prognostic risk factors of postoperative complications are substantiated. Comparison of individual priorities of planned hernia surgery provided the opportunity to define the main directions in terms of urgent medical treatment features for patients with strangulated ventral hernias, taking into account a phasal nature of the pathological process and the availability and applicability of various synthetic implants. The literature analysis allowed for enough critical evaluation of the current state of tension-free allohernioplasty – the main fundamental principle of modern urgent surgery for ventral hernias and determining the main pragmatic directions of a selective approach in choosing the therapeutic tactics for patients with infected surgical wound. Conclusions. Urgent surgery of strangulated ventral hernias requires adequate and timely provision of individual and differentiated approaches in choosing the volume and method of surgery. Improvement of methods for predicting and preventing complications in patients with strangulated ventral hernias will expand the indications for the use of advanced types of tension-free hernioplasty.