High Risk Of Perioperative Complications Research Articles

Outcomes of partial nephrectomy for non-metastatic cT2 renal tumors: Results from a Canadian multi-institutional collaborative.

690 Background: The role of partial nephrectomy (PN) is not well defined for cT2 renal cell carcinoma (RCC) as compared to radical nephrectomy (RN). The aim of this study was to examine oncological outcomes of PN as compared to RN for non-metastatic cT2 RCC. Methods: The Canadian Kidney Cancer information system was used to define patients who underwent surgery for non-metastatic cT2 RCC from January 2011 to October 2022. Patients with clear-cell, papillary, and chromophobe RCC were included. Other histology, multiple tumours, and hereditary RCC syndrome patients were excluded. Each PN patient was individually matched to RN up to 1:4 depending on availability of patients based on tumor size (+/- 1cm), histology, grade (clear cell and papillary), and necrosis (clear cell). Matched patients were analyzed as clusters. Results: A total of 1523 patients were identified, and 50 PN patients met study criteria who were then matched to 185 RN patients. Both groups had similar age, gender, smoking status, BMI, Charlson comorbidity index score, symptoms at presentation, baseline eGFR, hemoglobin and pathological characteristics. PN patients had smaller tumors (7.6 cm [IQR 2] vs 8.4 [IQR 2.4], p=0.05), had higher likelihood of undergoing open surgery (72.9% vs 31.8%, p<0.0001) and less likely received adrenalectomy (2% vs 24.3%, p=0.0004). Positive surgical margin rates were similar in both groups (8.2% in PN vs 3.4% in RN, p=0.2). Median follow up was not significantly different in either group (3.6 yrs [IQR 4.7] in PN vs 3.3 [4.7] yrs in RN, p=0.9). During the follow up period, PN patients had higher risk of local recurrence (HR 3.0, 95%CI 1.08-8.37), lower risk of distant metastasis (HR 0.36, 95%CI 0.15-0.88), better cancer specific survival (HR 0.56, 95%CI 0.18-1.78) and overall survival (HR 0.36, 95%CI 0.11-1.19) and as compared to RN. At 6 months and beyond after surgery, PN patients had less decline in eGFR than RN patients (-16.6 [SD 21.1] vs -24.4[SD 16.2], p=0.0002). Complications rates between PN and RN were (18% vs 9%, p=0.057). Conclusions: In this multi-institutional Canadian cohort of patients with non-metastatic cT2 RCC undergoing surgery, PN compared to RN was associated with slightly higher risk of peri-operative complications, better preservation of renal function, and higher risk of local recurrence. The lower risk of distant metastasis and death was likely from residual confounding unaccounted for in the individual patient match. [Table: see text]

Strategy for endovascular treatment of a patient with combined coronary and carotid artery atherosclerosis: a case report

Treatment of patients with combined coronary and carotid artery atherosclerosis is a difficult task due to the increased risk of surgical intervention in this cohort of patients. Lack of timely treatment can lead to a decrease in the quality of life of patients, as well as to death. In some cases with combined coronary and carotid artery atherosclerosis, the choice of surgical intervention may depend on vascular bed involvement. In a case report, open surgery was associated with a very high risk of perioperative complications; so the only way of myocardial revascularization was minimally invasive endovascular surgery. The article presents a case of the treatment of a patient with a combined multivessel coronary and bilateral carotid artery atherosclerosis.

Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh.

Surgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs. We performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status. The 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%). Total resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.

Outcome in 38 dogs surgically treated for hepatic abscessation.

To report outcomes following surgical treatment of hepatic abscessation in dogs. Retrospective. Thirty-eight dogs. Records from 6 institutions were evaluated for dogs undergoing surgical treatment for hepatic abscessation between 2010 and 2020. Signalment, clinical signs, medical therapy, surgical treatment, and postoperative outcome was obtained from medical records. Long-term outcome was recorded when possible. Median survival time was assessed using the Kaplan-Meier product-limit method. Peritoneal effusion was documented in 32/38 dogs preoperatively, with septic peritonitis confirmed in 21/23 samples. Liver lobectomy was the most common surgery (27 dogs). A single organism was cultured in 24/35 dogs, most commonly Escherichia coli. Hepatic neoplasia was identified in 11/36 dogs. Dogs were hospitalized for a median of 5 days (range, 3-17) with complications recorded in 21 dogs (regurgitation, aspiration pneumonia, and pancreatitis most commonly). Two dogs died intraoperatively, and 6 dogs died prior to discharge. Median survival time for dogs surviving to discharge was 638 days. Of these, 19 were lost to follow up a median of 301 (range, 3-1418) days postoperatively and 11 died a median of 291 (range, 7-1292) days postoperatively. No abscess recurrence was noted. Septic peritonitis was a common sequela to hepatic abscessation. Perioperative complications were recorded in approximately one-third of dogs. In dogs surviving the postoperative period, long-term prognosis was good. Dogs treated surgically for hepatic abscessation have a high risk of perioperative complications but favorable long-term prognosis and apparent low risk of recurrence.

Postoperative Intensive Care Management of Aortic Repair.

Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.

P32. Impact of controlled vs uncontrolled mFI-5 frailty on perioperative complications following adult spinal deformity surgery

<h3>BACKGROUND CONTEXT</h3> Preoperative risk assessment is crucial before adult spinal deformity, due to its relatively high surgical invasiveness and likelihood of complications. Frailty has been found across multiple surgical subspecialties to be associated with risk of complications. However, the current frailty measures do not account for whether certain points refer to a controlled or uncontrolled condition. <h3>PURPOSE</h3> The goal of this study was to sub-stratify the mFI-5 frailty index into controlled or uncontrolled and assess the relationship to perioperative complications. We hypothesize that patients with uncontrolled frailty have a higher risk for perioperative complications following adult spinal deformity (ASD) surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> ASD patients with fusion of=5 vertebral levels were identified. <h3>OUTCOME MEASURES</h3> The primary outcome of this study was perioperative complication rates. <h3>METHODS</h3> Frailty was calculated using mFI-5. Uncontrolled frailty was defined as having any of the following mFI-5 components: 1) blood pressure >140/90, 2) HbA1C > 7%, or 3) COPD exacerbation, while on medication. Patients were then divided into three cohorts: nonfrail, controlled frail and uncontrolled frail. Bivariate analysis was first performed. Multivariable analysis assessed the relationship between frailty state and perioperative complication. <h3>RESULTS</h3> A total of 178 ASD patients were identified. There were 97 nonfrail, 54 controlled frail and 27 uncontrolled frail patients. Patients with uncontrolled frailty were more likely to be >60 years old (84% vs 24%), have hyperlipidemia (42% vs 20%), ODI >42 (84% vs 52%) (p 60 years old (41% vs 24%), hyperlipidemia (52% vs 20%) (p 42, and age >65. Uncontrolled frailty was associated with 4.24x greater odds of any major complication and 9.47x odds of any wound complication. Controlled frailty was not associated with increased risk of perioperative complications (p>0.05 for all). <h3>CONCLUSIONS</h3> The results of this study suggest that patients with uncontrolled frailty have higher risk of perioperative complications compared to those with controlled frailty. Furthermore, components of uncontrolled frailty, that did not exist in the current mFI-5 frailty index, represent new modifiable risk factors that can be targeted for preoperative optimization in ASD patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Detection of residual pulmonary alterations with lung ultrasound and effects on postoperative pulmonary complications for patients with asymptomatic SARS-CoV-2 infection undergoing surgeries

BackgroundFor patients with a clinical course of active SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, there may be a higher risk of perioperative complications. Our main objective is to detect the residual pulmonary alterations in asymptomatic patients after SARS-CoV-2 infection undergoing surgery and determine their relationship with the clinical course of SARS-CoV-2 infection. The secondary aim is to investigate whether the presence of residual pulmonary alterations have any affects on the severity of postoperative pulmonary complications.MethodsAfter approval by the Hospital’s Ethical Committee, this prospective observational study included consecutive patients (n=103) undergoing various surgical procedures and anesthetic techniques with a history of past SARS-CoV-2 infection. On the day of surgery these patients remained asymptomatic and the polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. The history, physical findings, and clinical course of SARS-CoV-2 infection were recorded. Lung ultrasound was performed before surgery to evaluate the possible residual pulmonary alterations (≥ 3 B-lines and pleural thickening), along with determitation of pulmonary static compliance values during surgery. Postoperative pulmonary complications were collected during hospital stay.Results24.27% (n=25) patients presented ≥ 3 B-lines, and 28% (n=29) patients presented pleural thickening. For 15 patients (21.7%) the pulmonary compliance was < 40 mL/cm H2O. Patients with pleural thickening had a higher incidence of pneumonia, acute respiratory syndrome distress, a need for vasoactive drugs and required more days of hospitalization during SARS-CoV-2 infection (p= 0.004, 0.001, 0.03, 0.00 respectively). Patients with ≥ 3 B-lines needed more days in an intensive care unit and vasoactive drugs during SARS-CoV2 infection (p= 0.04, 0.004 respectively). Postoperative pulmonary complications were observed in 5.8% (n=6) of the patients, and were more frequent in the presence of both, ≥ 3 B-lines and pleural thickening (p= 0.01).ConclusionsIn asymptomatic post-COVID-19 patients, pathological findings detected by lung ultrasound before surgery are associated with the severity of the SARS-CoV2 infection and resulted in more postoperative pulmonary complications. In these patients, the incidence of postoperative pulmonary complications appears similar to that described in the surgical population before the pandemic.Trial registrationclinicaltrials.gov (NCT04922931). June 21, 2021. “Retrospectively registered”

MP11-05 FACTORS ASSOCIATED WITH PERIOPERATIVE COMPLICATIONS FOLLOWING AUGMENTATION CYSTOPLASTY: A CONTEMPORARY POPULATION-BASED ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP11-05 FACTORS ASSOCIATED WITH PERIOPERATIVE COMPLICATIONS FOLLOWING AUGMENTATION CYSTOPLASTY: A CONTEMPORARY POPULATION-BASED ANALYSIS Hriday Bhambhvani, Kritika Sharma, and Kunj Sheth Hriday BhambhvaniHriday Bhambhvani More articles by this author , Kritika SharmaKritika Sharma More articles by this author , and Kunj ShethKunj Sheth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Augmentation cystoplasty (AC) is a major urologic operation, and previous data suggest a high perioperative complication rate of approximately 30%; however, more contemporary data are lacking. We assessed clinical characteristics of patients undergoing AC as well as perioperative complication rates using a national database. METHODS: The Pediatric Health Information System (2004-2021) was queried to identify children (≤21 years of age) who underwent AC using the appropriate International Classification of Diseases procedure code. Likewise, indication for AC, type of AC, and perioperative complications were identified. Multivariable logistic regression identified factors associated with the presence of at least one perioperative complication. RESULTS: 2596 patients were included. Baseline characteristics are detailed in Table 1. The most common indication for AC was spina bifida (50.9%). Small bowel cystoplasty was utilized in 56.7% of ACs, and a catheterizable stoma was created in 53.9% of ACs. 22.2% of patients had at least one perioperative complication; individual complication rates are given in Table 1. In multivariable regression, a primary indication of lower urinary tract obstruction (LUTO) was associated with a higher risk of complication (OR 2.18, 95% CI 1.20-3.87, p = 0.009) as compared to spina bifida. Performance of small bowel cystoplasty (OR 1.29, 95% CI 1.04-1.60, p = 0.02) or large bowel cystoplasty (OR 1.40, 95% CI 1.00-1.95, p = 0.047) was associated with increased risk of perioperative complications, as compared to the absence of each respective procedure. Lastly, AC’s with catheterizable stoma creation were associated with a higher risk of perioperative complications (OR 1.26, 95% CI 1.04-1.53, p = 0.02) as compared to AC’s without catheterizable stoma creation. Age, sex, race, year of AC, and ureterocystoplasty were unassociated with perioperative complications (p >0.05). CONCLUSIONS: This population-level study provides contemporary data on the perioperative complication rate of AC and identifies LUTO as well as enterocystoplasty and concomitant channel creation as risk factors for perioperative complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e158 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hriday Bhambhvani More articles by this author Kritika Sharma More articles by this author Kunj Sheth More articles by this author Expand All Advertisement PDF DownloadLoading ...

Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction.

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical candidates. After publication of EORTC 55971, the first randomized trial demonstrating non-inferiority of NACT followed by interval debulking surgery, NACT was considered in a wider breadth of patients. Since EORTC 55971, 3 randomized trials—CHORUS, JCOG0602, and SCORPION—have studied NACT versus PDS. While CHORUS supported EORTC 55971, JCOG0602 failed to demonstrate non-inferiority and SCORPION failed to demonstrate superiority of NACT. Despite conflicting data, a subset of patients would benefit from NACT while preserving survival including poor surgical candidates and inoperable disease. Further randomized trials are needed to assess the role of NACT.

Oncoplastic reconstruction of a large chest wall defect using dual fasciocutaneous flaps: A case report.

Introduction and importanceLarge chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy.Case presentationA 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well.Clinical discussionFasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury.ConclusionsOncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation.

Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis

IntroductionNeonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. Material and methodsData from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients’ characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. ResultsOverall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients’ characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6–16.4]% and 1.8% [95% CI 1.1–2.9] of cases, respectively. DiscussionAlthough the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.

Actual Sarcopenia Reflects Poor Prognosis in Patients with Esophageal Cancer.

Minimally invasive esophagectomy (MIE) for esophageal cancer patients with sarcopenia is associated with a high risk of perioperative complications; however, the relationship between sarcopenia and the survival of esophageal cancer patients remains controversial. In this study, we aimed to develop a stratifying marker for sarcopenia to precisely predict patients' prognosis. We retrospectively studied 135 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital from 2011 to 2015 and who were preoperatively diagnosed with or without sarcopenia based on the Asian Working Group for Sarcopenia index. Creatinine levels and albumin as measures of skeletal muscle volume and nutritional status, respectively, were used to develop a marker to be used for stratifying sarcopenic patients based on prognosis. Of the 135 patients, 35 were diagnosed with sarcopenia and 100 were not. We combined the creatinine and albumin levels (Cr×Alb) as a stratifying marker for sarcopenia, and extracted sarcopenic patients with values below the Cr×Alb cut-off as the actual sarcopenic group. The 5-year overall survival (OS) rates of the actual and non-actual sarcopenic groups were 28.9% and 58.9%, respectively (p=0.0005), and the 5-year disease-free survival rate of the actual sarcopenic group was 34.1%, and 62.8% (p=0.0106) for the non-actual sarcopenic group. This stratified sarcopenia model was an independent prognostic factor and was superior to sarcopenia alone for OS. In patients undergoing MIE, preoperative measurement of Cr×Alb may be a prognostic stratification marker for patients with sarcopenia.

Simultaneous surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava and ischemic heart disease own research and literature review.

&lt;b&gt; Introduction:&lt;/b&gt; Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Tumor penetration into the inferior vena cava/right atrium is rare, as it occurs only in 34% of HCC patients. There are no clear guidelines for the management of this stage of disease. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; This is a case report of a patient with HCC and tumor thrombus in the inferior vena cava and with advanced coronary artery disease. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Materials and methods:&lt;/b&gt; The patient was qualified for a simultaneous cardiac surgery and liver resection with removal of the tumor thrombus from the inferior vena cava due to a high risk of sudden cardiac death. The first stage involved aortocoronary bypass followed by a right-sided hemihepatectomy with removal of the tumor thrombus from the inferior vena cava (this part of the operation was performed by extracorporeal circulation). The postoperative period was uneventful. Surgical treatment is one of the therapeutic options that offers a chance to radically remove the tumor and extend the patient&apos;s life. From a standpoint, these operations are extremely difficult and carry a high risk of perioperative complications (up to 40%). At the same time, the patient is at risk of complications due to cancer, such as pulmonary embolism, tricuspid stenosis, and congestive heart failure, which should be considered when choosing a treatment method. A significant number of patients also suffer from chronic conditions that worsen the prognosis. Cardiac diseases combined with tumor thrombus in the inferior vena cava may cause sudden cardiac death. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Surgical treatment should be considered in patients with HCC and tumor thrombus in the inferior vena cava, especially in patients with cardiovascular disease burden, as it is not only a chance to prolong life, but also to protect them against life-threatening cardiac complications.

Metabolic syndrome as a predictor of perioperative outcomes in primary bariatric surgery, a MBSAQIP survey.

Among bariatric surgery patients, body mass index (BMI) does not fully capture the severity of obesity and it may be complicated to stratify patients at higher risk of peri-operative complications. In our study, we surveyed the MBSAQIP database to determine whether bariatric patients with metabolic syndrome (MetS) are at higher risk for peri-operative complications. MBSAQIP database was used to investigate the correlation between MetS and perioperative outcomes. All patients between 2015 and 2018, ≥ 18years old, who underwent primary bariatric surgery were included. Patients were excluded if they underwent natural orifice transluminal endoscopic surgery or had surgery performed by gastroenterologist or interventional radiologist. We modified the International Diabetes Federation definition of MetS for our study to select patients with BMI > 30 in addition to two or more of the following comorbidities: hypertension, hyperlipidemia, or diabetes. The primary outcome was perioperative mortality. Secondary outcomes included post-operative surgical site infections (SSI), perioperative MI, stroke, acute renal failure, transfusion requirement, readmission, conversion to open and reoperation. Between 2015 and 2018, 760,076 bariatric operations were performed. 670,935 met criteria for analysis. 190,239 patients were identified to have MetS. Patients with MetS were found to have higher odds of death (OR 2.32; 95% CI 1.97-2.72), SSI (OR 1.39; 95% CI 1.31-1.48), perioperative MI (OR 4.70; 95% CI 3.42-6.45), stroke (OR 3.30; 95% CI 2.08-5.24), acute renal failure (OR 3.04; 95% CI 2.48-3.72), and transfusion requirement (OR 1.30; 95% CI 1.33-1.39). Patients with metabolic syndrome are at increased odds of peri-operative complications after bariatric surgery.

Deciphering excess healthcare burden in head and neck cancer patients with cardiovascular comorbidity.

This study aimed to determine the perioperative surgical outcomes for head and neck cancer patients with cardiovascular diseases (CVDs). A cross-sectional analysis was performed using data from the Nationwide Readmissions Database between 2010 and 2014. Logistic regression analysis by enter and backward stepwise methods were used. A total of 8346 patients met the inclusion criteria. Patients with concomitant CVD had a higher frequency of complications (57.6%) compared with those without (47.4%) (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23-1.48, p < 0.001). Patients with CVD comorbidities were prone to experience in-patient mortality at both admission (OR = 2.4, 95% CI = 1.42-4.05) andreadmission (OR = 2.55, 95% CI = 1.10-5.87). CVD patients have prolonged hospital admission (OR = 1.14, 95% CI = 1.02-1.27, p = 0.020)and higher cost (OR = 1.28, 95% CI = 1.15-1.43, p < 0.001). Patients with congestive heart failure were prone to 30 days readmission (OR = 1.67, 95% CI = 1.10-2.53, p = 0.019) and 90 days (OR = 1.65, 95% CI = 1.14-2.39, p = 0.010). This is the first study identifying factors predicting higher risk of perioperative complications of surgical management of head and neck cancer. Those with CVD had higher risk of adverse events.

Mortality and complication rates in nonagenarians and octogenarians undergoing total hip and knee arthroplasty: a systematic review and meta-analysis.

Advancing age is a significant risk factor for the development of perioperative complications and mortality in patients undergoing total hip or knee arthroplasty (THA or TKA) due to their compromised health status and the associated medical comorbidities. The purpose of this review is to identify if nonagenarians having a THA or TKA are associated with a higher incidence of mortality and morbidity compared to octogenarians. Medline, Scopus, and the Cochrane library were searched for relevant studies. The primary outcome of the review was the incidence of mortality. The secondary outcomes were the 30-day readmission, the perioperative complications, and the length of hospital stay (LOS). Six studies with 479,630 patients were included in the review. No difference between nonagenarians and octogenarians was detected regarding the in-hospital mortality, the 30-day readmission rate, and the LOS. However, nonagenarians were associated with a greater 1-year mortality rate (OR: 2.4; 95% CI 1.91-3.01, P < 0.001; I2 = 0%) and increased odds of perioperative complications (OR: 1.6; 95% CI 1.48-1.72, P < 0.001; I2 = 0%). This finding was unchanged after adjusting for baseline characteristics (ORadj: 1.68; 95% CI 1.53-1.84, P < 0.001; I2 = 0%). Although nonagenarians undergoing TKA or THA can achieve the same clinical benefit as octogenarians, they have a higher risk of perioperative complications and 1-year mortality. Therefore, meticulous preoperative screening, proper patient selection and optimization of comorbidities are essential to minimize any postoperative side effects in patients over 90years of age.

Modified radical mastectomy under paravertebral block in a patient diagnosed with active pulmonary tuberculosis with moderate restriction of pulmonary function

Mastectomy is mostly performed as definitive management for resectable breast cancer (BC). Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics and malnourished individuals will eliminate the risks and complications of general anaesthesia (GA). Although thoracic paravertebral block is an established technique as post-operative pain management for breast surgery, there is no conclusive evidence on its use as a sole anaesthetic for modified radical mastectomy (MRM). In this case report, we present a 45-year-old woman who underwent a successful MRM for Stage IIIb BC associated with pulmonary tuberculosis with moderately restricted pulmonary function test under paravertebral nerve block. We believe that paravertebral nerve block can be used as an alternative anaesthetic technique for MRM in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under GA.

Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Introduction: Modified radical mastectomy (MRM) or breast conservative surgery (BCS) done under general anaesthesia (GA) in high-risk patients may be associated with significant morbidity, Intensive Care Unit stay and increased hospital stay leading to cost issues. In this case-series, we describe our experience with regional anesthesia for MRM or BCS and sentinel / complete axillary clearance in 61 patients with breast carcinoma who were high risk for perioperative complications in view of their co-morbidities. None required ICU or increased hospital stay postoperatively. Material &amp; Methods: Sixty-one ASA III/IV patients operated under regional anaesthesia for carcinoma of the breast were included. Multiple level USG guided thoracic paravertebral block (PVB), PECS block (1/2), Pecto-intercostal fascial block (PIFB), Serratus-anterior plane block (SAPB), brachial plexus block, Superficial cervical plexus blocks (SCPB), Erector spinae block (ESB) were given in different combinations. Result: There were 60 female patients (Age: 30-97 years) and 1 male patient (59 years) (Left side -27 patients, right side- 34 patients). Of the total 61 patients, 23 patients underwent BCS with axillary dissection, 36 patients underwent MRM with axillary dissection, 2 patients had MRM with Pectoralis Major muscle resection. Patients received different combinations of blocks PVB or ESB, PECS1/2 and SAPB. 43 patients received the PVB, 61 got the PECS1/2, 12 patients received ESP, 32 patients required SCPB, 1 infra-clavicular block and 35 patients got PIFB. All procedures were completed under regional anaesthesia with 51 patients getting intravenous midazolam (0.01-0.02mg/kg), 59 patients were given IV fentanyl (1-3ug/kg , 43 patients were given IV propofol (1-2mg/kg), These were given in small aliquots during the duration of the procedure. 2 patients had IV ketamine (0.5mg/kg) and 1 patient had IV dexmeditomidine (0.2-0.3ug/kg/hr). IV paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) ie. Inj Diclofenac Sodium IV in the dose of 1mg/kg (max 75mg) were given when not contraindicated. There was single case of axillary hematoma with no other complications. No patient required ICU care postoperatively and were discharged as routine. Conclusion: A combination of blocks may be an option for surgical anaesthesia for breast surgeries in high risk patients. Careful planning, patient counseling and attention to toxic dose of local anaesthetics must always be considered. Keywords: Paravertebral block, Thoracic wall blocks, PECS block, Serratus Anterior plane block, Pecto-intercorstal fascial block, Superficial cervical plexus, Modified radical mastectomy, Breast conservative surgery.

Intraoperative protective lung ventilation strategies in patients with morbid obesity.

ABSTRACTPostoperative pulmonary complications (PPCs) occur frequently and are associated with a prolonged hospital stay, increased mortality, and high costs. Patients with morbid obesity are at higher risk of perioperative complications, in particular associated with those related to respiratory function. One of the most prominent concerns of the anesthesiologists while taking care of the patient with obesity in the perioperative setting should be the status of the lung and delivery of mechanical ventilation as its strategy affects clinical outcomes. Negative effects of mechanical ventilation on the respiratory system known as ventilator-induced lung injury include barotrauma, volutrauma, and atelectrauma. However, the optimal regimen of mechanical ventilation still remains a matter of debate. While low tidal volume (VT) strategy has become a widely accepted standard of care, the protective role of PEEP and recruitment maneuvers is less clear. This review focuses on the pathophysiology of respiratory function in patients with morbid obesity, the effects of mechanical ventilation on the lungs, and optimal intraoperative strategy based on the current state of knowledge.

Compliance with Enhanced Recovery After Surgery (ERAS) protocol recommendations for bariatric surgery in an obesity treatment center

IntroductionThe higher risk of perioperative complications associated with obesity has made anesthesiologists increasingly concerned with the management of obese patients. Measures that improve bariatric surgery patient safety have become essential. The implementation of ERAS protocols in several surgical specialties has made it possible to achieve appropriate outcomes as to surgery safety. The aim of this study was to evaluate patient compliance with the recommendations of an ERAS protocol for Bariatric Surgery (ERABS) at a hospital specialized in obesity treatment. MethodsCross-sectional study, using a medical record database, in a hospital certified as an International Center of Excellence in Bariatric and Metabolic Surgery. The definition of the variables to be assessed was based on the most recent ERABS proposed by Thorell et al. Results were analyzed using descriptive epidemiology. ResultsThe study evaluated all patients undergoing bariatric surgery in 2019. Mean compliance with the recommendations per participant was 42.8%, with a maximum of 55.5%, and was distributed as follows: 22.6% of compliance with preoperative recommendations, 60% to intraoperative recommendations, and 58.1% to postoperative recommendations. The anesthesiologist is the professional who provides most measures for the perioperative optimization of bariatric surgery patients. In our study we found that anesthesiologists complied with only 39.5% of ERABS recommendations. ConclusionsMean compliance with ERABS recommendations per participant was 42.8%. Considering that the study was carried out at a hospital certified as an international center of excellence, the need for introducing improvements in the care of patients to be submitted to bariatric surgery is evident.