Higher Risk Of Postoperative Complications Research Articles

Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: HIV and Hepatitis C Disparities.

This article is one of a series focusing on how the preoperative optimization process, if designed for underserved communities, can improve access to care and reduce disparities. In this article, we specifically focus on methods to improve optimization for patients with HIV and hepatitis C to facilitate their access to total joint arthroplasty. 1.2 million Americans are currently living with HIV (people living with HIV). African Americans and Hispanics account for the largest proportion of new HIV diagnoses and make up the highest proportion of people living with HIV. HIV-positive patients, many of them with complex comorbidities, are at a high risk for postoperative complications. Optimization of this vulnerable cohort involves a multidisciplinary strategy focusing on optimizing treatment modalities to reduce viral loads, leading to lower complication rates and a safer environment for the surgical team. The rates of hepatitis C have been increasing in the United States, and more than half of individuals living with hepatitis C are unaware that they are infected. Hepatitis C infections are highest in African Americans, and the rates of chronic hepatitis C are highest in those born outside the United States. Patients with hepatitis C have an increased risk for surgical complications after total joint arthroplasty, and studies have demonstrated that these risks normalize when patients are preoperatively screened and treated. Optimization in these vulnerable groups includes working closely with psychosocial resources, the primary care team, and infectious disease specialists to ensure treatment access and compliance.

The association between preoperative body composition and aerobic fitness in patients scheduled for colorectal surgery.

AimAlthough cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT‐scan‐derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery.MethodIn this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT‐scan‐derived body composition variables, CPET‐derived aerobic fitness and other preoperative patient‐related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤ 11.1 ml/kg/min as cut‐off for having a high risk for postoperative complications.ResultsData from 78 patients (45 men; mean [SD] age 74.5 [6.4 years]) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R 2 of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P = 0.033) and higher VAT mass (odds ratio 1.02; P = 0.036) were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.ConclusionBody composition variables from the preoperative CT scan were moderately associated with preoperative CPET‐derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.

Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database.

ABSTRACTObjective:To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types.Materials and Methods:We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD).Results:When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p<0.001) and without RC (34.0% vs 22.0%, p=0.032).Conclusions:RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.

A comparative Study between Tube Feeding versus Parenteral Nutrition in GIT Cancer Patients in ICU

Abstract Objectives Our study is designed to determine whether providing nutrition via parenteral route or enteral route is better in patients with GIT cancer after surgery in ICU. Background Patients with gastrointestinal malignancy have a higher risk of postoperative complications and alterations resulting from their pre and postadmission nutritional status. Malnutrition and subsequent weight loss have long been among the leading causes of morbidity and mortality, as well as increased costs with other organs dysfunction associated to cancer patients undergoing surgery. Methods A prospective randomized clinical trial conducted in critical care units in Ain Shams University Hospitals from August 2017 to February 2019.Eighty patients with GIT cancer were included. Half of them received enteral nutrition and the other half received parenteral nutrition. All patients were compared regarding demographic data, hemodynamic parameters, complications (Infection, GIT symptoms, and central venous line insertion), signs of malnutrition (weight loss and hypoalbuminaemia), time to pass flatus, ICU stay and mortality. An informed written consent was obtained from patients and/or their relatives. Results Postoperative complications occurred in 20 (50%) patients fed enterally versus 23 (57.5%) patients fed parenterally with p = 0.501.Infectious complications happened in 5 (12.5%) patients fed enterally versus 9 (22.5%) patients fed parenterally with p = 0.239.Surgical complications occurred in 3(7.5%) patients fed enterally versus 4(10%) patients fed parenterally with p = 0.905.GIT complications occurred in 9 (22.5%) patients fed enterally versus 6 (15%) patients fed parenterally with p = 0.872.Respiratory complications occurred in 4 (10%) patients fed enterally versus 2(5%) patients fed parenterally with p = 0.708. Time to flatus (days) was 2.90 ±1.0 in enteral group versus 3.78 ±0.8 in parentral group with p = 0.003. ICU stay (days) was 5.50 ±1.8 in enteral group versus 9.83 ±3.40 in parentral group with p = 0.003. Mortality n (%) was 1 (2.5%) in enteral group versus 2 (5.0%) in parentral group with p = 1.000. Albumin after 7 days and albumin after 14 days were increased statistically significantly in patients of enteral nutrition than parenteral nutrition group (p = 0.021) and (p = 0.003) respectively. There was a statistically significance improvement of albumin level within the same group (P = 0.003). There was a statistically significant improvement of weight in patients who had received enteral nutrition (p = 0.003) while There was a statistically significant decrease in weight in patients who had received parenteral nutrition (p = 0.003). Conclusion Enteral nutrition showed better results in comparison to parenteral nutrition regarding time to pass flatus, ICU stay, albumin after 7 days and albumin after 14 days. Both types of nutrition are equal statistically regarding complications and infection, mortality rate, post-operative weight after 7 days (kg) and weight after 14 days (kg).

THE SURGICAL BILIO-DIGESTIVE BYPASS BEFORE CEPHALIC PANCREATICODUODENECTOMY, REPORT OF EIGHT CASES

The cephalic pancreaticoduodenectomy (CPD) has a universally high morbidity and surgery in patients with obstructive jaundice is associated with a high risk of postoperative complications especially in patients with high bilirubin levels. For this reason, endoscopic preoperative biliary drainage (PBD) has been proposed to improve the postoperative courses.. Nevertheless, this solution is not always feasible and the use of a surgical bilio-digestive bypass may be necessary, which may complicate a later surgical procedure.In this work we report a case series of patients who underwent CPD preceded by a double surgical bypass and we analyze its impact on morbi-mortality.

Сoronary Artery Bypass Grafting in a Patient with Congenital Chest Abnormality with Poland Syndrome

Introduction: A rare clinical case of coronary artery bypass grafting in congenital chest abnormality with Poland syndrome is described. This syndrome is a congenital anomaly, which is characterized by a combination of unilateral aplasia or hypoplasia of the sternocostal head of the pectoralis major muscle with ipsilateral brachysyndactyly in the classic version. The cause of Poland syndrome is unknown, but it is believed that it can form with a short-term decrease in blood flow in the subclavian and vertebral arteries. Case Presentation: The presented case shows the possibility of successful completion of coronary artery bypass grafting in Poland syndrome. Revascularization by transluminal balloon angioplasty with stenting reduces the risk of postoperative complications. However, given the degree of damage to the coronary bed and myocardium, in some cases, the patient needs to undergo only coronary artery bypass grafting. The presented case shows the possibility of successful completion of coronary artery bypass grafting in Poland syndrome. Conclusions: We believe that, despite the high risks of postoperative complications, patients with Poland syndrome can be recommended to perform a planned operation of coronary artery bypass grafting, including access through a median sternotomy.

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu.

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.

Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia.

The purpose of this study is to assess the role of the lateral wall in post-operative clinical outcomes in patients with intertrochanteric fractures treated with the proximal femoral nail anti-rotation-Asia (PFNA-II). A cohort of 466 patients (OTA type 31A1 or A2) was divided into two groups: one was intact lateral wall group, and the other was fractured lateral wall group. Radiographic outcomes were measured by using the loss of neck-shaft angle (NSA), femoral neck shortening (FNS), and offset shortening (OS). Functional outcomes were assessed by using the Harris score and SF-36 Physical Component Summary (SF-36 PCS). Post-operative complications were recorded. The fractured lateral wall group had a greater loss of NSA (mean [SD], fractured group (8.7°) [2.7°] vs intact group (4.8°) [2.8°]; mean difference, 3.3° [95% CI 2.9 to 3.8]; P < 0.001) compared with the intact lateral wall group. Similar results were found for FNS and OS. The fractured lateral wall group had a worse Harris scores at the threemonth follow-up (mean [SD] score, fractured group (66.6) [5.2] points vs intact group (71.3) [5.8] points; mean difference, - 3.3 points [95% CI - 3.9 to - 2.7]; P < 0.001) compared with the intact lateral wall group. Similar results were observed for Harris scores at the threeand 12-month follow-ups and SF-36 PCS at the three, six and 12-month follow-ups. The fractured lateral wall group had a higher risk of post-operative complications compared with the intact lateral wall group. Among older patients with intertrochanteric fractures, the fractured lateral wall was associated with worse clinical outcomes compared with the intact lateral wall. Clinicians should pay attention to the lateral wall integrity in patients with intertrochanteric fractures treated with the PFNA-II.

The association between serum CD4 T lymphocyte counts and surgical outcomes in HIV/AIDS patients in Guangxi, China: a retrospective cohort study.

BackgroundHIV/AIDS is a chronic disease leading to complications in infected individuals that often require surgical intervention. These patients’ serum CD4 T lymphocyte (CD4) counts represent one of the most important indicators of their ability to tolerate surgical treatment. Previous studies have demonstrated that CD4 cell count (CD4-CC) < 200 cells/μl may increase the risk of surgical complications in these patients, limiting their ability to undergo surgery, which may negatively affect their quality of life. Further investigation into the surgical outcomes of patients with CD4-CC < 200 cells/μl should provide guidance in making appropriate clinical decisions for the optimal healthcare of this patient demographic.MethodsAll enrolled patients were selected from 14 prefecture-level general hospitals in Guangxi, China, and were referred to AIDS outpost hospitals for inpatient surgical therapy. A total cohort of 168 adult patients was retrospectively analyzed. Multifactorial and stratified analyses were performed to evaluate the in surgical outcome differences for patients with CD4-CC < 200 cells/μl (N = 43), using those with CD4-CC ≥ 200 cells/μl (N = 125) as controls.ResultsPoor incisional healing was used as the primary outcome indicator, and postoperative complications were used as the secondary outcome indicator. In the patient group with CD4-CC < 200 cells/μl, the risk of surgical complications was significantly increased (OR 2.379; 95% CI [1.049–5.394]) after adjustment. Adjusted stratified analysis of the CD4-CC < 200 cells/μl group revealed that individuals over 60 years (OR 27.504; 95% CI [2.297–329.317]) with erythrocyte counts below 4.00/ml for males or 3.50/ml for females (OR 3.353; 95% CI [1.079–10.419]) had a significantly higher risk of postoperative complications; this finding was statistically different from the control (CD4 ≥ 200 cells/μl) group. However, there was no significant difference between the two groups regarding the risk of poorly healed incision outcomes.ConclusionsPreliminary findings suggest that a serum CD4-CC < 200 cells/μl is not a definitive contraindication for surgical therapy and that baseline and surgical characteristics may help predict surgical outcomes in these patients. Further studies are needed to confirm these findings.

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

Pharmacotherapy for the Treatment of Gastric Antral Vascular Ectasia: A Narrative Review.

Gastric antral vascular ectasia (GAVE) is an uncommon clinical entity leading to recurrent gastrointestinal bleeding. There is no consensus regarding treatment of GAVE. Endoscopic therapy is the preferred treatment option, but has a fairly high recurrence rate. Surgical resection can completely resolve GAVE, but is invasive with a relatively high risk of postoperative complications. Recently, the role of pharmacotherapy for GAVE has been recognized. However, the evidence is limited to scattered case reports or small case series. This review comprehensively summarizes the efficacy and side effects of drugs commonly used for the treatment of GAVE, including octreotide, cyproheptadine, cyclophosphamide, prednisolone, estrogen-progesterone, thalidomide, bevacizumab, and tranexamic acid.

The Glasgow Prognostic Score Before Curative Resection May Predict Postoperative Complications in Patients with Gastric Cancer

PurposeDespite improvements in surgical techniques and devices and perioperative care of gastric cancer (GC), the rate of postoperative complications still has not decreased. If patients at high risk for postoperative complications could be identified early using biomarkers, these complications might be reduced. In this study, we investigated usefulness of the preoperative Glasgow Prognostic Score (GPS) as a predictive factor for complications after surgery in patients with stage II/III GC.MethodsThis study retrospectively analyzed the outcomes of 424 patients who underwent curative surgery for pathological stage II/III GC from February 2007 to July 2019 at a single center. The GPS was assessed within 4 days before surgery. To identify independent risk factors for postoperative complications, univariate and multivariate analyses were performed using a Cox proportional hazards model.ResultsThe numbers of patients with a GPS of 0, 1, and 2 were 357, 55, and 12, respectively. The rate of complications after surgery was significantly higher among patients with a GPS of 1 or 2 than among patients with a GPS of 0 (p = 0.008). Multivariate analysis identified a GPS of 1 or 2 as an independent predictive factor for postoperative complications (p = 0.037).ConclusionThe preoperative GPS may be a useful predictive factor for postoperative complications in patients with stage II/III GC. Being aware of the risk of complications after surgery as indicated by the GPS before surgery may promote safe and minimally invasive surgery that we expect will improve outcomes in patients with a GPS of 1 or 2.

Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14-Year Experience with More than 700 Patients

Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs). We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs. We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m2, and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72-5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27-4.25; p= 0.006), but not HR (OR 1.06; 95% CI 0.57-1.98; p= 0.859). SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination.

Moving Pediatric Complex Care Forward: Big Data and National Research Collaborations.

The growing population of children with medical complexity (CMC), especially those with neurologic impairment (NI), is increasingly the focus of researchers, clinician leaders, and policy makers.1 In this issue of Pediatrics, Mpody et al2 add to this emerging literature base by clearly demonstrating that NI, a common health condition among CMC, is strongly associated with postoperative pneumonia. Using data from the National Surgical Quality Improvement Program (NSQIP), the authors confirm what most pediatricians learn during training: compared with children without underlying neurologic comorbidities, children with NI are at significantly higher risk for developing pneumonia and experiencing prolonged hospitalizations after a surgical procedure.3This study raises important questions, some of which are noted by the authors. For example, which specific clinical characteristics put children with cerebral palsy or neuromuscular disorders at increased risk for postoperative pneumonia, and which ones are protective? Among children with NI, which surgical procedures are associated with the highest risk of postoperative complications? How do other postoperative outcome metrics (eg, 30-day rehospitalization rate) differ by NI status? Answering these questions will improve clinical decision-making and clinicians’ ability to engage in shared decision-making with families of CMC and NI.Importantly, this study demonstrates how big data can improve care and highlights the need to increase efforts in organizing national data collection collaborations. In addition to the NSQIP, other large datasets, such as PEDSnet or PediQUEST, that draw from electronic health records and patient- and family-generated data sources across multiple locations enable targeted examinations of pediatric subpopulations often limited by small sample sizes at any one institution.4,5 However, despite significant advancements in informational technology over the last 2 decades, data collection infrastructure is not fully integrated into health systems serving CMC and NI.6 Additionally, challenges in appropriately classifying children by diagnoses in large datasets remain. As the authors note, many children in the NSQIP database have conditions in multiple NI categories (eg, a child may have both cerebral palsy and seizure disorder because of a remote hypoxic-ischemic event), making it difficult to ascertain which is truly driving increased risk of postoperative pneumonia. Even with expert chart extractors, this is a limitation of such datasets and points to the need for significant investment to optimize their utility.7Mpody et al2 discuss identifying effective postoperative pneumonia prevention strategies, which illuminates potential future research directions yet also has broader implications. The authors review the topic of perioperative oral care, a low-cost and low-burden intervention that clearly deserves further evaluation. Alternatively, examining pre- and perioperative respiratory physiotherapy may be considered given successes with this resource in adult populations across a wide range of surgical procedures.8 One could also justify studying adaptation of Enhanced Recovery After Surgery protocols (multimodal evidence-based approaches for the care of adult surgical patients), not to mention comparing different anesthesia regimens (eg, intravenous versus inhalation) given the risk of interactions between anesthetic agents and the multitude of central nervous system–acting medications children with NI are often prescribed.9,10There is a paucity of clinically relevant interventional research focused on the CMC and NI population.11 Unlike the body of literature supporting the patient- and family-centered medical home and pediatric complex care centers, the evidence guiding day-to-day clinical management of CMC with NI is woefully insufficient. In part, this is due to challenges inherent to all pediatric research, but it also reflects barriers unique to children with complex chronic health conditions. Not only are population sizes small, but for any particular condition, there exists high levels of heterogeneity regarding disease severity, stability, duration of an illness experience, development, and functioning. Multicenter complex care research collaborations to address these barriers are rare and need to be fostered to improve clinical management.As we recognize these challenges, the pipeline for developing pediatric complex care investigators must be expanded. Early research opportunities should be available to students and trainees in all relevant disciplines. Academic institutions and national funding agencies should increase early career development support (eg, postdoctoral research mechanisms, career development awards) of investigators whose scholarship is focused on topics directly relevant and impactful to the health and well-being of CMC and NI. Secondly, pediatric health care systems (ie, children’s hospitals) should ensure clinicians have the time and tools to collaborate in and contribute to research and quality initiatives.12 Lastly, current investigators should familiarize themselves and employ advanced methodologies in clinical informatics (eg, incorporation of machine learning into clinical decision-making) and interventional research (eg, Bayesian decision theory, adaptive trial designs, propensity score analyses).13–16Although significant progress in pediatric complex care has been made over the past decade, the field still faces enormous questions and challenges in its quest to improve the health and well-being of all CMC and NI. We hope studies such as this one by Mpody et al2 inspire more investigators and clinicians to focus their talent and expertise on pediatric complex care medicine.

Development of a scoring scale for predicting the risk of postoperative complications after spinal tuberculosis debridement: a retrospective cohort study of 233 patients.

This investigation established a scoring scale for predicting the incidence of postoperative complications in patients after spinal tuberculosis debridement. A total of 232 spinal tuberculosis patients who underwent debridement surgery between January 2012 to May 2020 were included in this retrospective study. The study cohort was divided into 2 groups according to the presence or absence of postoperative complications. The complications were defined as abnormal or impaired body function caused by surgical factors (such as nerve injury and internal fixation looseness) or other factors (such as chemotherapy and bed stay). Clinical characteristics include age, body mass index (BMI), diabetes mellitus, pulmonary tuberculosis, smoking history, preoperative serum albumin, preoperative C-reactive protein (CRP), Cobb angle correction, surgical approach, operation time, etc. operative blood loss was recorded and analyzed. The clinical characteristics of spinal tuberculosis patients who suffered postoperative complications were evaluated, and a scoring scale was established using logistic regression analysis. The performance of this scoring scale was prospectively validated. Out of 232 patients, a total of 188 (81.03%) suffered postoperative complications after surgery. Multivariate binary logistic regression analysis showed that diabetes mellitus [adjusted odds ratio (OR) =1.110, P=0.046], pulmonary tuberculosis (adjusted OR =1.181, P=0.002), low preoperative serum albumin (adjusted OR =0.789, P=0.005), anterior surgical approach (adjusted OR =5.934, P=0.035), and long operation time (adjusted OR =1.019, P<0.01) were independent risk factors of postoperative complications after spinal tuberculosis debridement surgery. The above independent risk factors were assigned to establish a scoring scale for predicting postoperative complications, and receiver operating characteristic (ROC) analysis showed that the optimal cut-off value for the scoring scale was 4 points. The sensitivity and specificity of the scoring scale were 60.8% and 81.8%, respectively, based on the validation set. Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.

MP01-10 DIFFERENCES IN SURGICAL AND FUNCTIONAL OUTCOMES IN BENIGN PROSTATE HYPERPLASIA PATIENTS WITH ONLY LOWER URINARY TRACT SYMPTOMS VERSUS THOSE IN RETENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-10 DIFFERENCES IN SURGICAL AND FUNCTIONAL OUTCOMES IN BENIGN PROSTATE HYPERPLASIA PATIENTS WITH ONLY LOWER URINARY TRACT SYMPTOMS VERSUS THOSE IN RETENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS Yu Xi Terence Law, Daniele Castellani, Lucio Dell’atti, Tevita Aho, Jeremy Yuen-Chun TEOH, and Vineet Gauhar Yu Xi Terence LawYu Xi Terence Law More articles by this author , Daniele CastellaniDaniele Castellani More articles by this author , Lucio Dell’attiLucio Dell’atti More articles by this author , Tevita AhoTevita Aho More articles by this author , Jeremy Yuen-Chun TEOHJeremy Yuen-Chun TEOH More articles by this author , and Vineet GauharVineet Gauhar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evaluating outcomes after benign prostate hyperplasia (BPH) surgery among men with lower urinary tract symptoms (LUTS) only versus those with urinary retention (UR) METHODS: Eligible studies identified from four electronic databases. Search, data extraction and quality assessment were performed independently by two reviewers. Studies with perioperative, functional, early and late complication outcomes included. RESULTS: Twenty-five studies, 14,593 patients including 1 randomized controlled trial, 11 prospective and 13 retrospective studies included for meta-analysis. This showed higher risk of immediate transient re-catherization (Risk Ratio (RR): 5.29, p <0.00001), longer days to trial-off-catheter (mean difference (MD):0.25, p <0.00001), longer hospitalization stay in the urinary retention group (MD: 0.35, p <0.00001),and higher risk of intraoperative blood transfusions (RR: 1.90, p=0.002), post-operative urinary tract infections (RR: 1.49, p <0.00001) and sepsis (RR: 8.15, p=0.009) too. Failure of surgery like permanent re-catheterization (RR: 5.27, p <0.00001) was more in pre-operative UR group. Negligible differences seen in long term functional outcomes between the two groups (International Prostate Symptom Score at 12 months, MD: -0.06, p=0.68; Quality of Life at 12 months, MD: 0.20, p <0.00001; maximum urinary flow rate (Qmax) at 12 months, MD: -0.33, p=0.10; and post void residual volume at 12 months, MD: 4.32, p <0.00001) CONCLUSIONS: Preoperative UR patients undergoing surgery for BPH have higher risk of post-operative complications versus LUTS only group including the need for permanent catheterisation. Both groups had similar long-term functional outcomes. We could infer that patients with UR on whom surgery is successful, with time may recover bladder function akin to patients with LUTS alone. Source of Funding: N.A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e4-e4 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu Xi Terence Law More articles by this author Daniele Castellani More articles by this author Lucio Dell’atti More articles by this author Tevita Aho More articles by this author Jeremy Yuen-Chun TEOH More articles by this author Vineet Gauhar More articles by this author Expand All Advertisement Loading ...

Survival and complications of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients: a systematic review and meta-analysis.

Peritoneal cancer is an uncommon form of terminal malignancy with substantial morbidity and mortality. While both young and elderly population groups with peritoneal cancer are treated by joint cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, studies suggest that they might have a differential prognostic outcome in terms of postoperative morbidity and mortality. To date, only one review has attempted to evaluate the comparative impact of postoperative complications and overall mortality in these age groups. However, a recent publication of several high-quality cohort trials needs an update of the existing consensus. To compare the impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on postoperative complications and overall mortality in younger and elderly population groups. A systematic search of the academic literature was performed according to the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the comparative outcomes between the impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on postoperative complications and overall mortality in younger and elderly population groups. From 963 studies, 16 eligible studies that evaluated the comparative outcomes of morbidity and mortality between 3067 young and 878 elderly patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were included. A meta-analysis revealed higher risks of postoperative complications (Odds ratio: 1.18, 95% C.I: 0.90 to 1.55) and overall mortality (3.28, 1.93 to 5.5) for elderly patients as compared to the younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. There were no differences in risks of the onset of anastomotic leakage (1.0, 0.47 to 2.14) and duration of hospital stay (Hedge's g: 0.02, -0.08 to 0.14) between elderly and younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The study provides updated evidence regarding poor postoperative morbidity and mortality outcomes in elderly patients as compared to younger patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and may help clinicians to better stratify the risks associated with the conventional management of peritoneal carcinomatosis in elderly population groups.

Surgical Risk Calculators to Assess Mortality for Lower Extremity Amputation

Surgical calculators can be used to stratify patients at higher risk for postoperative complications. Patients with peripheral arterial disease that undergo major lower extremity amputation (LEA) are higher risk patients because of their medical comorbidities. The objective of this study was to compare various surgical risk calculators to assess 30-day mortality of patients undergoing major LEA.

199. HbA1c and BMI are modifiable risk factors for reducing wound complications but do not influence risk of pseudarthrosis

<h3>BACKGROUND CONTEXT</h3> Patients with diabetes mellitus (DM) undergoing posterior spinal fusion (PSF) with elevated HbA1cs are at higher risk of postoperative complications than those with lower HbA1cs. DM patients with an HbA1c >7.05% are prone to postoperative complications such as wound complications (WC). Pseudarthrosis (PA) is another complication for PSF and requires further insight in determining risk factors for DM. <h3>PURPOSE</h3> To determine if DM patients with higher preoperative HbA1c levels will have higher rates of WC and PA. <h3>STUDY DESIGN/SETTING</h3> Single-center retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 229 DM patients. <h3>OUTCOME MEASURES</h3> Patient demographics, osteopenia, preoperative HbA1c, WC, PA, and levels-fused (LF). <h3>METHODS</h3> Included: DM patients undergoing thoracolumbar PSF from 2014-2019 with preoperative HbA1C levels, and a minimum 1-year postoperative follow-up. PA was defined by the treating surgeon via clinical presentation, radiographs and postoperative CT scan with minimum 1-year postoperative interval. WC included dehiscence, seroma requiring aspiration or infection of the surgical site. Excluded: Patients undergoing LLIFs and ALIFs or diagnosed with prior pars fracture, spinal tumor, ankylosing spondylitis, fracture and infection. Relationships between complications and HbA1c were determined using t-test, chi-squared analyses and multivariate regressions (α=0.05). In risk factors, the cutoff HbA1C value as a predictor for multiple postoperative complications was identified via receiver operating characteristic (ROC) analyses using Youden's index. <h3>RESULTS</h3> A total of 229 patients met these criteria. Age (Normal: 65.4±11.0, PA: 63.0±8.2, p=0.249; Normal: 65.2±10.6, WC: 64.5±9.7, p=0.753), CCI (Normal: 4.6±2.0, PA: 4.0±1.2, p=0.06; Normal: 4.6±1.9., WC: 4.6±1.7, p=0.761), gender, percent female, (Normal: 57%, PA: 47%, p=0.286; Normal: 55%, WC: 58%, p=0.829), osteopenia (Normal: 3%, PA:3%, p=0.968; Normal: 3%, WC: 0.0%, p=0.377), and smoker status (Normal: 11%, PA: 16%, p=0.44; Normal: 11%, WC: 12%, p=0.915) did not have a significant impact in the tested postoperative complications. Mean HbA1c (7.6±1.5%, p=0.001), LF (3.9±3.2, p=0.024) and BMI (35.8±7.4, p=0.004) in patients with WC were significantly higher than those without WC (HbA1C: 6.8±1.0%; LF: 2.5±2.9 BMI: 31.7±6.7). HbA1c (OR: 1.7 [1.2-2.5], p=0.005), BMI (OR: 1.1 [1.0-1.2], p=0.007) and LF (OR: 1.1[1.1-1.3], p=0.031) was an independent risk factor WC. In those with PA, mean HbA1c (7.0±1.3, p=0.289) was not significantly higher than those without PA (HbA1C:7.0±1.1). HbA1c (OR: 1.039 [0.73-1.478], p=0.831) was not an independent risk factor for PA.ROC analyses demonstrated HbA1c>7.05% (AUC: 0.693[0.587-0.800], p=0.001], BMI>32.92 (AUC: 0.664[0.555-0.772], p=0.007) and >1.5 LF (AUC: 0.626[0.502-0.750], p=0.036) as fair predictive models for WC. <h3>CONCLUSIONS</h3> Preoperative HbA1C>7.05%, BMI>32.92 and LF>1.5 are independent risk factors of WC; however, neither of these are predictors for PA in diabetics who had PSF. Regardless, DM patients undergoing PSF should strive to lower their HbA1c<7.05% and BMI<32.92 before surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

This Month in Anesthesiology

This Month in Anesthesiology