Higher Rate Of Postoperative Complications Research Articles

Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer (GC). Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients, which may lead to a higher incidence and mortality rate of GC. Malnutrition decreases the physical function of elderly GC patients after surgery, severely affecting their postoperative life quality and hindering subsequent treatments. This retrospective study was conducted by Zhao et al , focusing on the clinical baseline data, postoperative complications, and hospitalization times of elderly GC patients who underwent curative gastrectomy. Additionally, the underlying causes of poor outcomes for patients were discussed. This study may provide a solid basis for the clinical treatment of elderly GC patients in the future. Therefore, malnutrition can serve as a negative prognostic factor for curative surgery in GC patients. Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

A large single-center propensity score-matched cohort study on outcomes and complications based on the number of corrective bars used in the Nuss procedure.

The Nuss procedure is the most common corrective surgery for pectus excavatum. We analyzed treatment outcomes and complication rates in 1238 patients treated with the Nuss procedure from 2002 to 2021, focusing on the number of corrective bars used. Using Propensity Score Matching based on age, sex, BMI, pre-operative FEV1, and the Haller index, we created two groups: 546 patients with a single bar and 546 with two bars. Both groups achieved similar correction effects (Haller index: single bar = 2.58 vs. two bars = 2.56; p = 0.65). In the univariate analysis, in the two-bar group, the postoperative complications were observed more often (28.6% vs. 15.4%, p < 0.001), including pneumothorax (11.2% vs. 6.2%, p < 0.001), hemothorax (3.7% vs. 0.7%, p < 0.001), additional drainage (13.7% vs. 5.3%, p < 0.001), the need for thoracentesis (8.6% vs. 2.9%, p < 0.001), bar displacement (3.8% vs. 0.7%, p < 0.001), pleural effusion (10.6% vs. 3.1%, p < 0.001), and fever (6.6% vs. 3.8%, p < 0.041). In the logistic regression, two bars significantly increased the risk of postoperative complications (p = 0.019), including hematoma (p = 0.036), pleural effusion (p = 0.002), and the need for thoracentesis (p = 0.013). Using two corrective bars during the Nuss procedure is associated with a higher rate of postoperative complications but similar corrective results.

Body composition as a prognostic factor in cholangiocarcinoma: a meta-analysis.

This investigation seeks to scrutinize the relationships between body composition metrics and the clinical outcomes observed in patients with cholangiocarcinoma (CCA). A comprehensive exploration was conducted across three prominent online databases: Embase, PubMed, and the Cochrane Library. This endeavor spanned the entirety of each database up to the cutoff date of September 29, 2023. To evaluate the quality of the included studies, the Newcastle-Ottawa scale was employed. This comprehensive analysis included a total of 26 articles with a combined patient cohort of 4398 individuals. The results demonstrated that CCA patients with low skeletal muscle index (SMI) had significantly inferior OS (HR: 1.93, p < 0.001) and RFS (HR: 2.02, p < 0.001), as well as a higher incidence of postoperative complications (OR: 1.69, 95% CI: 1.20-2.38, p < 0.001) compared to those with high SMI. The presence of sarcopenia in CCA patients was significantly related to poorer OS (HR: 1.96, p < 0.001) and RFS (HR: 2.05, p < 0.001), and a higher rate of postoperative complications (OR: 1.39, p = 0.049) in comparison to those without sarcopenia. Moreover, lower psoas muscle index (PMI) and myosteatosis were associated with shorter OS (PMI, HR: 1.56, p < 0.001; myosteatosis, HR: 1.49, p = 0.001) and RFS (PMI, HR: 2.16, p < 0.001; myosteatosis, HR: 1.35, p = 0.023). Our findings highlight incorporating body composition screening into clinical practice can help develop treatment strategies and optimize perioperative care, potentially improving patient outcomes.

Laparoscopic transabdominal vs. totally extraperitoneal inguinal hernia repair: outcomes, healthcare utilization, and cost differences.

Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair.

Factors associated with early mortality in pediatric tracheostomy placement: a retrospective cohort study.

Numerous factors are associated with an increased likelihood of early mortality following tracheostomy placement. These findings are particularly relevant for planning the timing for tracheostomy among critically ill children and engaging in discussions with caregivers about the heightened risks for mortality and complications of the procedure. • The prevalence of tracheostomies in children has risen significantly due to major advancements in neonatal and pediatric intensive care treatments. • Nonetheless, the mortality rate among children undergoing tracheostomy remains elevated, with approximately one-third of them experiencing mortality during the same hospital admission in which their tracheostomy is carried out. • We hypothesize that certain risk factors may discourage tracheostomy placement, potentially advocating for a more conservative management in carefully selected cases of critically ill children. • In children who underwent tracheostomy placement, the 30-day mortality rate was 10.9%, and the complication rate was 26%. • Prematurity, age < 12 months, American Society of Anesthesiologists class 4, congenital heart disease, heart failure, and ventilatory dependency were associated with a higher likelihood of mortality. These children also exhibited higher rates of postoperative complications. • These findings are particularly relevant for planning the timing for tracheostomy among critically ill children and engaging in discussions with caregivers about the heightened risks for mortality and complications of the procedure.

Possibly more favorable short‐term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high‐volume center study

AbstractBackgroundMinimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short‐term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated.MethodsWe retrospectively compared short‐term outcomes between MTG and OTG for locally advanced gastric and esophago‐gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders.ResultsIn total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien–Dindo classification (C‐D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra‐abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C‐D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C‐D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C‐D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen.ConclusionsMTG for locally advanced gastric cancer may provide improved short‐term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.

Risk Factors of Reoperation in Patients with Intestinal Behçet’s Disease Treated by Initial Bowel Resection

Background/Objectives: Intestinal Behçet’s disease (iBD) often requires surgical intervention, with a significant proportion of patients needing reoperation. This study aimed to investigate the risk factors associated with reoperation in patients with iBD who underwent initial bowel resection and to evaluate the perioperative and long-term outcomes in these patients. Methods: This was a retrospective case-control study analyzing patients who underwent their initial bowel resection due to iBD between 2005–2021 at a tertiary referral hospital. Reoperation was considered a surgery due to postoperative complications (within 30 days of the initial surgery) or disease progression. Results: A total of 81 patients were included. The median follow-up duration was 107.1 months, during which 26 patients (32%) underwent reoperation. Multivariable analysis showed that the presence of hematological disorders (hazards ratio [HR], 9.13; 95% confidence interval [CI], 3.79–22.02, p &lt; 0.001), higher c-reactive protein (CRP) levels before the initial surgery (HR, 1.01; 95% CI, 1.01–1.02, p &lt; 0.001), and a shorter specimen resection length (HR, 0.96; 95% CI, 0.93–0.99, p = 0.011) were risk factors for reoperation. Patients who underwent reoperation had higher rates of postoperative complications (69.2% vs. 43.6%, p = 0.031), required longer antibiotic use (12 vs. 7 days, p = 0.012), and had extended hospital stays (18 vs. 9 days, p = 0.011). They also had worse 5-year survival rates than those who did not undergo reoperation (83.5% vs. 98.4%, p = 0.012). Conclusions: Concurrent hematological disorders, high preoperative CRP levels, and short specimen resection were associated with an increased risk of reoperation in patients with iBD who underwent their initial bowel resections. They also had worse perioperative and long-term outcomes.

Is conversion to duodenal switch after Roux-en-Y gastric bypass safe? Short-term outcomes review.

Weight regain after Roux-en-Y gastric bypass (RYGB) can be seen in approximately 20% of patients. Surgical management options include revision of RYGB and conversion to duodenal switch (DS). Using recently included revisional surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of RYGB revision versus conversion to DS. An analysis of the 2020 MBSAQIP Participant Use Data File (PUF) revealed 1421 patients who underwent revision of RYGB (n = 1255) or conversion from RYGB to DS (n = 166) for inadequate weight loss or weight regain. Patient characteristics, preoperative body mass index (BMI), operating room (OR) time, and 30-day complications were compared between groups. When compared with the revision RYGB group, the DS group had higher mean BMI (47.5 vs 42.7, p < 0.001) and longer operative time (209.1 vs 133.4min, p < 0.001). DS had higher rates of any complication compared to revision RYGB (22.3 vs 5.58%, p < 0.001). DS had higher 30-day readmission rates (16.3 vs 5.50%, p < 0.001), reoperation within 30days (9.04 vs 2.87%, p < 0.001), venous thromboembolism (VTE) (3.01 vs 0.08%, p < 0.001), intensive care unit (ICU) admission (8.43 vs 0.72%, p < 0.001), anastomotic leak (7.83 vs 0.40%, p < 0.001), surgical site occurrence (SSO) (11.5 vs 2.71%, p < 0.001), and death (0.60 vs 0%, p < 0.001). This short-term data suggests that conversion of RYGB to DS is associated with higher rates of postoperative complications when compared with revision of RYGB. Given the complexity of the procedure, it is best performed by experienced surgeons with careful consideration given to appropriate patient selection and only after extensive patient counseling on associated risks and complications.

Complications after cardiac implantable electronic devices in patients with severe mental illness: a Danish nationwide study

Abstract Background Patients with mental illness experience higher rates of postoperative complications and mortality across several types of surgery, but knowledge is lacking in relation to cardiac implantable electronic device (CIED) implantations. Purpose Our study aimed to investigate the 7-day, 30-day, and 90-day postoperative complication rate and mortality in patients with severe mental illness compared to the general population. Methods All adult patients in Denmark with a first-time pacemaker or ICD implantation during the study period from July 1995 to December 2022 were identified using the Danish nationwide registers. Severe mental illness was defined as having a preexisting diagnosis of schizophrenia and other non-affective psychotic disorders, bipolar affective disorders or major depressive disorder. Postoperative complications were obtained as diagnosis codes possibly relating to device implantation and categorized into seven types of complications: arterial thrombosis, venous thrombosis, pneumothorax, bleeding, infection, device function problem, and death. Stratified logistic regression analyses adjusted for sex and age were used to calculate the odds of postoperative complications within 7, 30, and 90 days of device implantation. Results Among 108,790 patients who had a de novo pacemaker or ICD implantation the mean age was 73.5 (± 12.8), 37.5% were women and 3,393 (3.1%) of the patients had preexisting severe mental illness. In total, 10,690 (9.8%) patients had one or more complications within 90 days. The number of patients with severe mental illness who experienced a complication were 407 (12.0%) while it was 10,283 (9.8%) of those without severe mental illness. Odds of death (OR 1.57, 95% CI: 1.03-2.29) were higher in patients with severe mental illness 7 days postoperatively, and 30 days postoperatively odds of venous thromboembolism (OR: 1.69, 95% CI: 1.05-2.56) and death (OR: 1.62, 95% CI: 1.29-2.01) were higher in patients with severe mental illness. 90 days postoperatively odds of venous thrombosis (OR: 1.95, 95% CI: 1.37-2.70), infection (OR: 1.45, 95% CI: 1.16-1.79), and death (OR: 1.40, 95% CI: 1.19-1.65) were higher in patients with severe mental illness compared to patients without severe mental illness, while the odds of pneumothorax were lower at all three time points for patients with severe mental illness (OR 7-days: 0.49, 95% CI: 0.21-0.95). The odds of arterial thrombosis, bleeding and device function problems were similar between the two groups at all three time points. Conclusion Severe mental illness was associated with increased risk of several types of complications and death following CIED implantation. This indicates that further care and attention is needed to ensure adequate treatment of patients with severe mental illness suffering from cardiac arrhythmias.Forest plot, SMI: severe mental illness

Influence of Diabetes Mellitus on Postoperative Complications After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background and Objectives: Total knee arthroplasty (TKA) is an effective treatment option for severe knee osteoarthritis. Understanding the impact of diabetes mellitus (DM) on postoperative outcomes is crucial for improving patient satisfaction after TKA. This study aimed to investigate the influence of DM on postoperative complications and mortality after TKA. Materials and Methods: We conducted a systematic review and meta-analysis by searching relevant studies published before December 2023 in the PubMed, EMBASE, Cochrane Library, Medline, and Web of Science databases. The assessment included demographic data, comorbidities, and postoperative complications after primary TKA for both DM and non-DM patients. The odds ratio (OR) was used to represent the estimate of risk of a specific outcome. Results: Thirty-nine studies were finally included in this meta-analysis. Patients with DM had higher rates of periprosthetic joint infection (OR: 1.71, 95% confidence interval [CI]: 1.46–2.00, p &lt; 0.01) and prosthesis revision (OR: 1.37, 95% CI: 1.23–1.52, p &lt; 0.01). Moreover, patients with DM showed an elevated incidence of pneumonia (OR: 1.54, 95% CI: 1.15–2.07, p &lt; 0.01), urinary tract infection (OR: 1.86, 95% CI: 1.07–3.26, p = 0.02), and sepsis (OR: 1.61, 95% CI: 1.46–1.78, p &lt; 0.01). Additionally, the postoperative risk of cardiovascular (OR: 2.49, 95% CI: 1.50–4.17, p &lt; 0.01) and cerebrovascular (OR: 2.38, 95% CI: 1.48–3.81, p &lt; 0.01) events was notably higher in patients with DM. The presence of DM increased the risk of deep vein thrombosis (OR: 1.58, 95% CI: 1.22–2.04, p &lt; 0.01), but did not lead to an increased risk of pulmonary embolism. Most importantly, DM was associated with a higher mortality rate within 30 days after TKA (OR: 1.27, 95% CI: 1.02–1.60, p = 0.03). Conclusions: Patients with DM exhibited a higher rate of postoperative complications after TKA, and DM was associated with a higher mortality rate within 30 days after TKA. It is crucial to educate patients about the perioperative risk and develop evidence-based guidelines to prevent complications after TKA.

'Low-Plane' Fractures of the Distal Humerus in Elderly Patients with Osteoporosis Show High Postoperative Complication Rates.

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of -2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes.

Prediction of complications after laparoscopic partial nephrectomy: feasibility of E‑PASS score.

With significant advancements in laparoscopic procedures and tools over the last decade, the partial nephrectomy (PN) surgical approach has gradually transformed from open to laparoscopic partial nephrectomy (LPN). Although numerous studies evaluating the postoperative complications of laparoscopic partial nephrectomy can be found in the literature, a scoring system that addresses both preoperative physical condition and intraoperative risk factors has not yet been established. The Estimation of Physiological Ability and Surgical Stress (E-PASS) score is a scoring system that considers both the patient's preoperative condition and intraoperative variables to predict the risk of postoperative complications in surgically treated patients. This study aimed to assess the applicability of the E-PASS scoring system for predicting postoperative complications following LPN. We analyzed data of 196 patients who underwent LPN between 2017 and 2024 by a single surgeon in this single-center retrospective study. Demographic data of the patients, parameters reflecting patients' preoperative physical condition, and intraoperative risk factors were recorded. Postoperative complications were classified using the Clavien-Dindo system. The E-PASS score and its sub-scores were calculated for each patient. Various degrees of complications developed in 46 patients (23.5%). Patients who developed complications had significantly higher mean age, performance scores, tumor sizes, length of hospital stay, and E-PASS values. The cutoff value of the E-PASS Comprehensive Risk Score (CRS) for predicting the development of postoperative complications was determined to be -0.1692 (AUC = 0.676; 95% CI 0.581-0.771; p < 0.001). According to the results of the multivariate analysis, the presence of E-PASS CRS > -0.1692 (OR 4.872; 95% CI 2.384-9.957; p < 0.001) and tumor size (OR 1.021; 95% CI 1-1.041; p = 0.047) was identified as independent risk factors predicting postoperative complications. Patients with a CRS higher than the cutoff value had a 4.87 times higher rate of postoperative complications after LPN. The E-PASS scoring model successfully predicts postoperative complications in patients undergoing LPN by utilizing preoperative data on the patient's physical condition and surgical risk factors. The E-PASS score and its sub-scores can serve as objective criteria to determine the risk of postoperative complications both preoperatively and immediately postoperatively.

Association of intra-operative red blood cell transfusion on the systemic immune index and recovery in patients undergoing cesarean section: a large propensity score-matched study.

Post-partum hemorrhage (PPH) is a leading cause of maternal death worldwide. However, the effect of blood transfusion in patients undergoing cesarean section remains unclear. The analysis was based on the retrospective evaluation of the pre- and post-operative data for 1231 patients who underwent a cesarean section at our hospital between January 2016 and June 2020. Patients were classified into the blood transfusion group (BT) and the no blood transfusion group (NBT) based on their intra-operative blood transfusion status. After propensity score matching, 322 patients were included in both groups and between-group differences in length of hospital stay (LOS), perioperative systemic inflammation indicators, and post-operative complications were evaluated. The LOS was longer in the BT (median, 6.6days) than the NBT (median, 4.2days) group (P = 0.026). The post-operative complication rate was higher for the BT than NBT group, as follows: vomiting, 3.2% vs. 4.9%, P = 0.032; fever, 5.41% vs. 2.24%, P = 0.032; wound complications, 15.44% vs. 10.45%, P = 0.028; and intestinal obstructions, 5.88% vs. 2.75%, P = 0.034. Systemic inflammation indicators increased significantly, from the pre-operative baseline, for both groups at post-operative day (POD) 1 and POD3. On multivariate analysis, intra-operative blood transfusion was associated with a longer LOS (hazard ratio, 1.52; 95% confidence interval, 1.07-2.25). Intraoperative blood transfusion for cesarean section was associated with increased levels of systemic inflammation indicators, higher post-operative complication rates, and prolonged hospital stay.

Robotic kidney transplant has superior outcomes compared to open kidney transplant: results of a propensity match analysis.

Several studies have demonstrated the feasibility of robotic kidney transplant (RKT) as a safe alternative to open kidney transplant (OKT). However, significant selection bias in RKT patient selection limits meaningful comparison between the two techniques. This is a single-center retrospective review of a prospectively maintained kidney transplant database (2021-2024). Outcomes after the first 50 "non-selected" RKTs are compared with a contemporary cohort of 100 OKTs after propensity score matching for age, gender, BMI and type of donation (living vs deceased). Data pertinent to recipient demographics, intraoperative parameters, and short-term post-operative outcomes were collected and compared. Both groups were well-matched for recipient age, gender, BMI, and donation type. RKT group had significantly longer total operative time (RKT 258min vs. OKT 183min; p < 0.0001) and warm ischemia time (RKT 37min vs. OKT 31min; p < 0.0001) but significantly less blood loss (OKT 155ml vs. RKT 93ml). Average length of hospital stay for both groups was 5days, with OKT group demonstrating significantly higher rates of post-operative complications (OKT 31% vs. RKT 14%; p = 0.028), return to OR (OKT 15% vs. RKT 2%; p = 0.021), hematoma (OKT 13% vs. RKT 2%; p = 0.0355), and lymphocele (OKT 25% vs. RKT 6%; p = 0.0039). OKT group also had higher 30-day readmission rate (OKT 31% vs. RKT 14%) and post-operative opioid requirement (OKT 93 MME vs. RKT 65; p = 0.0254). There were no differences in rates of wound infection, urine leaks, delayed graft function, acute rejection, graft loss, and patient death between the two groups. RKT is a safe and viable alternative to OKT as a first-choice procedure for all patients with ESRD. RKT offers many advantages over OKT which can lead to its wider adoption in the coming years as the new standard of care for ESRD patients.

An Automated Electronic Health Record Score to Estimate Length of Stay and Readmission in Patients Undergoing Radical Cystectomy for Bladder Cancer.

Patients treated with radical cystectomy experience a high rate of postoperative complications and frequent hospital readmissions. We sought to explore the utility of the Care Assessment Need (CAN) score, derived from electronic health data, to estimate the risk of these adverse clinical outcomes, thereby aiding patient counseling and informed treatment decision-making. We retrospectively examined data from 982 patients with bladder cancer who underwent radical cystectomy between 2013 and 2018 within the national Veterans Health Administration system. We tested for associations between the preoperative CAN score and length of stay, discharge location, and readmission rates. We observed a correlation between higher CAN scores and longer hospital stays (adjusted relative risk = 1.03 [95% CI: 1.02-1.05]). An increased CAN score was also linked to greater odds of discharge to a skilled nursing facility or death (adjusted odds ratio = 1.16 [95% CI: 1.06-1.26]). Furthermore, the score was associated with hospital readmission at both 30 and 90 days postdischarge (adjusted HR = 1.03 [95% CI: 1.00-1.07] and 1.04 [95% CI: 1.00-1.07], respectively). The CAN score is associated with length of hospital stay, discharge to a skilled nursing facility, and readmission within 30 and 90 days after radical cystectomy. These findings highlight the potential of health care systems leveraging electronic health records for automatically calculating multidimensional tools, such as the CAN score, to identify patients at risk of adverse clinical outcomes after radical cystectomy.

Recurrence and postoperative quality of life after surgical resection of unilateral cT1-T3N1bM0 papillary thyroid carcinoma.

Determining the optimal extent of surgery and improving postoperative quality of life for patients with papillary thyroid cancer has been an important challenge. Here, we evaluated postoperative quality of life after cT1-T3N1bM0 papillary thyroid carcinoma (PTC) to explore the optimal scope of surgical resection. In this study, we investigated surgical outcomes in patients diagnosed with unilateral cT1-T3N1bM0 PTC, who were treated at Harbin Medical University Cancer Hospital from January 2008 to December 2018. To achieve this, we divided the patients into two distinct groups based on the extent of surgery they received: the non-total thyroidectomy group (group A) and the total thyroidectomy group (group B). To comprehensively evaluate the patients' well-being, we assessed their psychological status, disease recurrence rate, postoperative complications, and quality of life. A total of 362 patients diagnosed with thyroid cancer were included in this study, with group A (n=88) and group B (n=274) classified based on the extent of surgery received. Significant differences were observed between the two groups in terms of clinical and pathological characteristics, including age (χ2=10.962, P=0.001), sex (χ2=5.906, P=0.02), multifocal (χ2=5.515, P=0.02), contralateral glandular nodule (χ2=34.616, P<0.001), clinical Tumor, Node, Metastasis (TNM) stage (χ2=11.340, P=0.001), and complication rate (χ2=4.265, P=0.04). Notably, group B exhibited higher rates of postoperative complications, including temporary recurrent laryngeal nerve injury (χ2=4.630, P=0.03), and temporary hypocalcemia (χ2=3.954, P=0.047) compared to group A. However, after adjustment for propensity score matching (PSM), the recurrence rate was independent of the surgical extent in both groups. In contrast, tumour size (>1 cm) (χ2=4.497, P=0.03), extrathyroidal invasion (χ2=5.133, P=0.02) and pathological T stage (χ2=7.663, P=0.02) increased the risk of recurrence. Moreover, there was no significant difference in the Hospital Anxiety and Depression Scale (HADS) scores between two groups (χ2=1.266, P=0.53). Nevertheless, the postoperative quality of life, as well as the incidence of hoarseness (t=11.77, P<0.001), symptoms of calcium deficiency (t=8.13, P<0.001), and willingness to reduce medication (t=3.60, P<0.001) were significantly lower in group A than in group B. In patients with PTC diagnosed as unilateral cT1-T3N1bM0 and a contralateral glandular nodule ≤2 cm, the preservation of the contralateral gland does not appear to have a significant impact on the rate of tumour recurrence in patients with tumour size (<1 cm), no extrathyroidal invasion, and pathological T stage (< T3). Instead, preserving gland potentially improves the prognosis, quality of life, and complication rates in these patients.

Changes in health-related quality of life in young-old and old-old patients undergoing elective orthopedic surgery: A systematic review.

There is a significant gap in research exploring changes in postoperative health-related quality of life (HRQoL) among patients aged 65 years and older undergoing hip or knee arthroplasty. To investigate the variations in HRQoL improvement, as evaluated by patient-reported outcome measures following total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between the young-old and old-old adults. We searched six online databases (including MEDLINE, Embase) from their inception dates to May 15, 2023. We included studies using a validated HRQoL assessment tool to evaluate changes in HRQoL in patients aged ≥65 years undergoing hip or knee arthroplasty. These include the EuroQol five-dimension (EQ-5D), Short Form 36 (SF-36) and Short Form 12 (SF-12). The primary outcomes were postoperative HRQoL changes between young-old (65-74 years) and old-old groups (≥75 years). The secondary outcomes included complications, length of stay, and mortality. The search yielded 12,229 articles; twelve studies (n = 103,613) were included. Studies using EQ-5D found no significant differences between young-old and old-old patients after hip and knee arthroplasty. Analyses of SF-36 and SF-12 scales showed no significant age-related differences in postoperative improvements in physical and mental health. Our review of four studies that included multivariable analyses revealed inconsistent associations between age and EQ-5D. Comparisons between the young-old and old-old age groups in postoperative complications, hospital length of stay, and mortality revealed no associated age-related changes in HRQoL. The young-old and old-old patients exhibited comparable improvement in HRQoL following hip or knee arthroplasty. The older patients did not have higher postoperative complications rates, longer hospital length of stay, and increased mortality. While chronological age should be considered when planning hip and knee arthroplasty, greater emphasis should be placed on assessing the comorbidities and functional status of patients.

Lung cancer and obesity: A contentious relationship (Review).

The global obesity epidemic, attributed to sedentary lifestyles, unhealthy diets, genetics and environmental factors, has led to over 1.9 billion adults being classified as overweight and 650 million living with obesity. Despite advancements in early detection and treatment, lung cancer prognosis remains poor due to late diagnoses and limited therapies. The obesity paradox challenges conventional thinking by suggesting that individuals with obesity and certain diseases, including cancer, may have an improved prognosis compared with their counterparts of a normal weight. This observation has prompted investigations to understand protective mechanisms, including potentially favorable adipokine secretion and metabolic reserves that contribute to tolerating cancer treatments. However, understanding the association between obesity and lung cancer is complex. While smoking is the primary risk factor of lung cancer, obesity may independently impact lung cancer risk, particularly in non‑smokers. Adipose tissue dysfunction, including low‑grade chronic inflammation, and hormonal changes contribute to lung cancer development and progression. Obesity‑related factors may also influence treatment responses and survival outcomes in patients with lung cancer. The impact of obesity on treatment modalities such as chemotherapy, radiotherapy and surgery is still under investigation. Challenges in managing patients with obesity and cancer include increased surgical complexity, higher rates of postoperative complications and limited treatment options due to comorbidities. Targeted interventions aimed at reducing obesity prevalence and promoting healthy lifestyles are crucial for lung cancer prevention. The impact of obesity on lung cancer is multifaceted and requires further research to elucidate the underlying mechanisms and develop personalized interventions for prevention and treatment.

Perioperative Management Of Diabetes Mellitus In Older Hip Fracture Patients

Abstract Background Hip fracture is one of the most serious injuries sustained by older adults worldwide, associated with increased morbidity and almost 25% mortality at one year. Pre-existing comorbidity worsens prognosis, e.g. hip fracture patients with Diabetes Mellitus (DM) have increased mortality rates, worse functional outcomes, and higher post-operative complications rates. Perioperative blood glucose optimisation may improve outcomes, however this can be challenging due to periods of fasting and reduced intake, as well as complications such as infection. Local guidelines for the peri-operative management of DM have been developed and are sign-posted in our hip fracture integrated admission document. This audit aimed to compare current practice with those recommended in local guidance. Methods Since 1st January 2024, 31 hip fracture patients aged ≥65 years with DM have been admitted. Charts were available on twenty patients, and hence reviewed. Results Of 20 patients, four were on insulin; 13 on metformin; four on sulphonylureas; five on SGLT2 inhibitors; and six on DPP4 inhibitors. No intraoperative hypoglycemic events nor episodes of Diabetic Ketoacidosis were documented; however, ketones were not checked in the majority of patients during admission. Eleven (55%) had HbA1C either done in the previous six months or during admission. Blood Sugar Levels were checked on admission in 9/20 (45%). The protocol was followed in only one patient on insulin; and 5/13 metformin patients. The protocol was followed in all Sulphonylurea prescriptions, and in 4/5 SGLT2 inhibitor prescriptions, however these medications were not held by the Orthopaedic team, rather by nursing staff while the patient was fasting pre-operatively. Conclusion This audit demonstrates poor adherence to local guidance on peri-operative management of diabetes, particularly perioperative insulin adjustments. We aim to develop an educational intervention (including group teaching, plus distribution of flashcards and posters) for Orthopaedic SHOs and interns and re-audit in the coming months.

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems. Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant. Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p&lt;0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p&lt;0.05). Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.