Frequency Of Postoperative Complications Research Articles

Abstract PR014: Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer

Abstract INTRODUCTION The physical separation of residential housing based on race and income, otherwise known as racialized economic residential segregation, has been associated with more aggressive tumor pathology and higher mortality in patients with breast cancer. The purpose of this study is to evaluate the impact of racialized economic segregation on post-operative complications (POC) in surgical patients with triple negative breast cancer (TNBC). METHODS Women aged 18+ diagnosed with stage I-III TNBC between 1/1/12-12/31/20 who underwent surgery were identified in the cancer registry and electronic medical record at a comprehensive cancer center. Racial (ICE-race) and racialized economic (ICE-race-income) polarization were operationalized using the Index of Concentration at the Extremes (ICE) at the census tract level. Metrics were divided into quartiles where higher quartiles represented greater polarization. Postoperative complications (POC) included technical, infectious, respiratory, urinary, and cardiovascular complications within 30 days of surgery. Crude and adjusted logistic regression generalized estimating equations (GEE) assessed the association between greater racial (ICE-race) and racialized economic (ICE-race-income) segregation as exposures and POC as the outcome, while accounting for clustering effects. Models were adjusted for age, race, ethnicity, health insurance, marital status, history of alcohol and smoking use, molecular subtype, clinical stage, receipt of chemotherapy, breast and axillary surgery type, and surgical reconstruction. RESULTS 626 patients were included in the study, of whom 509 (81.4%) identified as White, 97 (15.5%) Black, and 20 (3.2%) other. Median age was 59 (IQR 49.0, 67.0) years. Average overall frequency of POC was 8.2%, with increased odds in patients living in neighborhoods with greater racial segregation (ICE-race: Q1 4.0% vs. Q4 12.3%, P=0.02) and racialized economic segregation (ICE-race-income: Q1 3.2% vs. Q4 13.4%, P=0.001). Patients with TNBC living in neighborhoods with greater racialized economic segregation had a 2.52 (95% CI: 1.22 – 5.22) adjusted odds of POC compared to patients residing in less segregated neighborhoods. A one-quartile increase in racial segregation was associated with 41% increased odds of POC (aOR 1.41, 95% CI: 1.00 – 1.98). Similarly, a one-quartile increase in racialized economic polarization was associated with 45% increased odds of POC (aOR 1.45, 95% CI: 1.05 - 2.01). CONCLUSIONS Patients with TNBC breast cancer residing in areas with greater racial segregation or racialized economic segregation are more likely to experience postoperative complications than their counterparts in less segregated areas. Future studies need to examine the mechanistic pathways between neighborhood contextual factors and poor postoperative outcomes. Citation Format: J.C. Chen, Mohamed I. Elsaid, Jesse J. Plascak, Daniel G. Stover, William E. Carson, Timothy M. Pawlik, Samilia Obeng-Gyasi. Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR014.

Frequency of Maternal Complications in Obese and Non Obese Pregnant Patients

Objective: To compare the frequency of maternal complications in obese and non obese pregnant patients. Subject and Methods: This study comprises 82 pregnant patients during their 1st trimester of pregnancy, which were further divided into 2 groups as obese and non obese as per their body mass index BMI. Mean and standard deviation was calculated for BMI and gestational age. Frequency of post operative complications and outcomes like preeclampsia and eclampsia, gestational diabetes mellitus GDM , pre-term delivery and mode of delivery were noted. Results: The majority of patients were in age group of 26 to 35 years. Mean BMI was 33.19 ± 1.837 in obese group, while in non obese group it was 22.49 ± 1.186. No significant difference was found in terms of gestational age among both groups. There was significant difference in occurrence of postoperative complications in obese group as compared to non obese group. Conclusion: An increased BMI increases the chances of preeclampsia, eclampsia, GDM, preterm delivery and C section mode of delivery. Key Words: Body Mass Index, Maternal Obesity, Gestational Diabetes Mellitus, Preeclampsia, Pre term Delivery

Association of Diabetes Mellitus (DM) with Early Morbidity in Patients of Heart Disease (IHD) Undergoing Coronary Artery Bypass Surgery (CABG)

Objective: To find association of Diabetes Mellitus (DM) with early morbidity in patients of heart disease(IHD) undergoing coronary artery bypass surgery (CABG) Methodology: In this Prospective Cohort Study conducted at Deptt. of Cardiac Surgery / Punjab Institute of Cardiology(PIC), which is tertiary Cardiac Center in Punjab/Lahore, we enrolled 200 cases(100 exposed and 100 non-exposed) who were undergoing isolated CABG procedure, all cases taking or in need of anti-diabetic agents either pre-operative diagnosis or at admission were classified as DM. The preoperative variables were noted before undergoing surgical operation while operative, and postoperative variables (Renal Dysfunction, bleeding and usage of intra-aortic balloon pump) was collected prospectively recorded. Results: The frequency of post operative complications was recorded as 28%(n=28) in exposed and 10%(n=10) in non-exposed group, R.R was 2.80, p value was 0.002, bleeding in exposed group was 12%(n=12) and 9%(n=9) in non-exposed group, R.R was 1.33, p value was 0.49 whereas usage of intra aortic balloon pump was 16%(n=16) in exposed and 12%(n=12) in non-exposed group, R.R was 1.34, p value was 0.41. Conclusion: We concluded that there is a significant association of DM with early morbidity in patients of IHD undergoing CABG. Keywords: Ischemic heart disease, Diabetes Mellitus, Coronary Artery Bypass Surgery (CABG), early morbidity

Ondansetron for Prevention of Post-Operative Nausea and Vomiting (PONV) in General Surgery Patients

Aim: To determine the efficacy of single dose ondansetron in preventing PONV in patients.
 Methodology: In this cross sectional study 49 patients were given Ondansetron. Every patient was evaluated for PONV at 1, 2, 3, 6, 12 and 24 hours post operatively. This study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh.
 Results: A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), 35% male and 65% female was included in this study. In this study ondansetron was given (N=49) 4 mg I/V before induction. Regarding complications there was not significant (p ≤0.05) POVN was observed.
 Conclusion: Our study results showed in patients who received ondansetron regarding frequency of post operative complications (PONV) showed insignificant results as no p-value is found to be ≤0.05.It was concluded that a single dose of ondansetron is very effective in preventing PONV in general surgery patients.

Primary reconstructive plastic surgery in nodular form of III stage breast cancer

In this study there was evaluated the possibility to perform one-stage reconstructive and plastic operations (RPO) in III stage breast cancer (BC) cases. There were analyzed two similar groups of patients, depending on the volume of the operations: in the 1st (main) group there were carried out RPO of different kinds of simultaneously with radical mastectomies (RME), in the 2nd (control) RMEs with preservation of pectoral muscles. There were analyzed overall survival (OS), disease-free survival (DFS); the frequency ofpostoperative complications and aesthetic results of the treatment. 3-, 5- and 10-year OS and DFS in group statistically did not differed significantly (p > 0.05). The rate of postoperative complications was in the group of patients who undergone RPO by TRAM-flap accounted of 8.3%, in the RME group - 6.9% (p> 0.05). The aesthetic results of the treatment: satisfactory in RPO, unsatisfactory - in RME.

Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center

Laparoscopic colorectal surgery (LCRS) has several advantages over open surgery, but LCRS has been associated with a higher rate of postoperative complications (POCs) among obese patients [body mass index (BMI), ≥30 kg/m(2)]. The prevalence of obesity in Chile is increasing, up to 25.1% in 2010, suggesting that a higher percentage of patients undergoing LCRS will be obese. This study compared POC rates between obese and nonobese patients undergoing LCRS. This study included case and control patients in a prospectively maintained LCRS database who underwent LCRS between July 2007 and June 2012 at Clinica Las Condes, Santiago, Chile. Obese and nonobese (BMI <30 kg/m(2)) patients were paired by gender, age, American Society of Anesthesiologists class, preoperative diagnosis, and type of surgery. Intraoperative complications and POCs were documented up to 30 days. The severity of each POC was classified by Clavien-Dindo score. In this study, 449 patients who underwent LCRS during the study period were identified. The study paired 53 obese patients (mean BMI 33.1 kg/m(2)) with 53 nonobese patients (mean BMI 25.9 kg/m(2)). The median age was 55 years in the obese group and 57 years in the nonobese group, and 60% of the patients in both groups were men. The findings showed POCs in 13 obese (24.5%) and 15 nonobese (28.3%) patients (p = 0.66). Stratified by severity of POCs, the two groups were similar (p = 0.62). The two groups did not differ in terms of the median time to the first feeding (1 day each) or the hospital length of stay (4 days each). Similar percentages of patients in the two groups required reoperation (p = 0.4), intensive care unit (ICU) admission (p = 0.77), and readmission to the hospital (p = 0.65) because of POCs. The frequency of POCs after LCRS was no higher among the obese patients than among the nonobese patients.

Reconstruction methods after pancreaticoduodenectomy for pancreatic carcinoma: better method to prevent serious complications

Purposes The of aim of this study was to assess the safety of pancreatic anastomosis after pancreaticoduodenectomy (PD) and to compare the results of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) following PD in a prospective and randomized setting. Background Pancreatic fistula after PD represents a critical trigger of potentially life-threatening complications and is also associated with markedly prolonged hospitalization. The best method for dealing with the pancreatic stump after PD remains in question. Patients and methods The study included 50 patients, 33 (64%) men and 18 (36%) women with a mean age of 66.3 ± 4 years. All patients underwent clinical evaluation, laboratory assessment, and computed tomography or MRI examination. All patients undergoing PD with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). The postoperative follow-up ranged from 6 to 12 months. Results No mortality was recorded. The mean ICU stay duration was 2.4 ± 0.8 days. The duration of hospital and ICU stay was shorter in group PG ( P = 0.03). The mortality because of surgical causes was higher in group PJ ( P = 0.02). The frequency of postoperative complications - that is, pancreatic fistula ( P = 0.0343), intra-abdominal bleeding and collection ( P = 0.0376) - was higher in group PJ; however, there was no significance between both groups in the frequency of abdominal wall abscess and biliary leakage ( P = 0.39). The patients with intra-abdominal collection were treated well by conservative measures in group PG ( P = 0.023); however, patients who needed open drainage were less ( P = 0.0376) and there was no significance between both groups in computed tomography-guided drainage ( P = 0.56). Conclusion Pancreaticogastrostomy could be considered better as a reconstruction method; with shorter hospital stay, No Necrosis of pancreatic remnant, Less frequency of post operative complications & so Re-do with its complication is less.

Complete and partial hoof wall resection for keratoma removal: post operative complications and final outcome in 26 horses (1994-2004)

There are no data on the frequency of post operative complications following keratoma removal, such as recurrence, hoof wall instability and excessive granulation tissue formation, or their relation to the method of surgical removal. To identify important factors in the outcome for horses undergoing surgical removal of a keratoma and compare the post operative complications encountered following keratoma removal by complete hoof wall resection (CR) and partial hoof wall resection (PR). Horses undergoing PR would have fewer post operative complications and would return to work more quickly than those undergoing CR. A retrospective review of medical records from one equine hospital identified 26 horses that underwent removal of a keratoma by CR or PR. Clinical, radiological and surgical findings and outcome were analysed. Common clinical signs included lameness and the presence of a subsolar abscess. Fourteen horses underwent CR and 12 PR. The complication rate following CR (71%) was significantly lower than that following PR (25%) (P<0.01). Complications encountered included excess granulation tissue formation, hoof crack formation and keratoma recurrence at the surgical site. The time taken to return to full work post operatively was significantly shorter in horses undergoing PR compared to CR (P<0.01). All horses, except one, returned to their previous exercise level. PR resulted in fewer post operative complications and a more rapid return to athletic activity than CR. Although the overall complication rate for CR was higher than for PR, the overall prognosis for return to soundness and the previous performance level is very good.