Higher Risk Of Postoperative Complications Research Articles

Effect of hemodialysis on short-term outcomes after colon cancer surgery.

Hemodialysis patients who undergo surgery have a high risk of postoperative complications. The aim of this study was to determine whether colon cancer surgery can be safely performed in hemodialysis patients. This multicenter retrospective study included 1372 patients who underwent elective curative resection surgery for colon cancer between April 2016 and March 2020. Of the total patients, 19 (1.4%) underwent hemodialysis, of whom 19 (100%) had poor performance status and 18 had comorbidities (94.7%). Minimally invasive surgery was performed in 78.9% of hemodialysis patients. The postoperative complication rate was significantly higher in hemodialysis than non-hemodialysis patients (36.8% vs. 15.5%, p = 0.009). All postoperative complications in the hemodialysis patients were infectious type. Multivariate analysis revealed a significant association of hemodialysis with complications (odds ratio, 2.9362; 95%CI, 1.1384-7.5730; p = 0.026). Despite recent advances in perioperative management and minimally invasive surgery, it is necessary to be aware that short-term complications can still occur, especially infectious complications in hemodialysis patients.

Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty

Category:Ankle Arthritis; Ankle; OtherIntroduction/Purpose:Ankle arthritis can significantly diminish the function and quality of life of affected individuals. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). Ongoing research seeks to identify patient factors associated with a higher risk of post-operative complications following TAA. A 5-item modified frailty index (mFI-5) has been found to predict adverse outcomes of multiple orthopaedic procedures. The aim of this study was to evaluate the suitability of the mFI-5 as a risk stratification tool for patients undergoing TAA.Methods:A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed on patients undergoing TAA between the years of 2011 and 2017. Data on patient demographics, post-operative complications, and length of stay were collected. Bivariate analysis and multivariate logistic regression were subsequently performed to investigate frailty as a possible predictor of post-operative complications.Results:1035 patients were identified (mean age = 63.9 years). Complication rates significantly increased with increasing mFI-5 score, from 5.24% in patients with no mFI-5 variables to 19.38% in patients with two or more mFI-5 variables present (P <0.0001). When comparing patients with an mFI-5 score of 0 to patients with an mFI-5 score of 2, 30-day readmission rate increased from 0.24% to 3.1% (P> 0.017), length of stay increased from 1.79 days to 2.18 days (P >0.007), adverse discharge rate increased from 3.81% to 15.5% (P <0.0001), and wound complications increased from 0.24% to 1.55% (> 0.02). After controlling for demographic factors, length of stay, and operative time, mFI-5 score remained significantly associated with patients' risk of developing any complication and 30-day readmission rate.Conclusion:Frailty as defined by the mFI-5 is associated with adverse outcomes following TAA. Implementing the mFI-5 as a risk stratification tool may assist in identifying patients who are at an elevated risk of sustaining a complication, and may allow for improved informed decision-making and perioperative care when considering TAA.

The correlation between common postoperative complications and quality of life, serum tumor markers, and prognosis in patients with esophageal cancer.

BackgroundEsophageal cancer (EC) is highly malignant, with poor prognosis. The main forms of treatment are surgery, radiotherapy, and chemotherapy. In recent years, the incidence and mortality rate of patients with EC has improved. However, the factors that affect the quality of life of EC patients are unclear. This study investigated the postoperative complications and quality of life of EC patients, and identified the related factors. The relationship between complications and quality of life was explored so as to provide guidance for the clinical treatment and rehabilitation these patients.MethodsA total of 120 patients with EC who underwent surgery at the First People’s Hospital of Lianyungang from January 2016 to August 2017 were retrospectively enrolled in this study. The patient’s subjective quality of life evaluation was documented and clinical data were collated. The correlation between the incidence of postoperative complications and the patient’s quality of life, serum tumor markers, and prognosis was analyzed.ResultsA total of 36 (30%) EC patients experienced postoperative complications. There were 12 cases of pulmonary complications (10%), 8 cases of arrhythmia (6.67%), 3 cases of anastomotic fistula (2.5%), 5 cases of pneumothorax and pleural effusion (4.17%), and 4 cases of gastroesophageal reflux (3.33%). Incision infection occurred in 2 patients (1.67%) and there was 1 case (0.83%) of chylothorax. Empyema was reported in 1 patient (0.83%). There were significant differences in the overall condition, physical function, fatigue, pain, and swallowing pain between patients with postoperative complications and those without complications (P<0.05). Preoperative and postoperative expression of the tumor marker CYFRA21-1 was found to be independent risk factors for postoperative complications after EC surgery.ConclusionsEC is a common malignant tumor with a high incidence of postoperative complications. Patients with high CYFRA21-1 expression should be aware of the higher risk of postoperative complications. Patients with complications have poorer quality of life and obvious symptoms of fatigue, pain, and swallowing pain. Health education and dietary guidance should be provided to such patients to improve their symptoms.

Surgical treatment of glial tumors of the paralimbic system

Tumors of the paralimbic system were considered inoperable for a long time due to high risk of postoperative complications. However, there have been significant changes in surgical tactics for these neoplasms over the past decades. Despite the improvement of surgical principles for these tumors and development of new approaches, risks of surgical treatment are still high (up to 33.6%). To assess the results of surgical treatment of paralimbic glial tumors and identify predictors of adverse outcomes. We retrospectively analyzed postoperative outcomes in 52 patients with paralimbic glial tumors at the neurosurgical department of the Pirogov National Medical Surgical Center between 2016 and 2020. Tumor dimensions and topography with surrounding structures were evaluated using preoperative MRI. Resection quality was evaluated within the first postoperative day considering MRI data. We applied transcranial or transcortical electrostimulation, direct cortical and subcortical bi- and monopolar stimulation for intraoperative functional assessment of corticospinal tract. Neurological examination was performed prior to surgery, after 24 hours, 7 days, and 6 months. Total resection was performed in 39 patients, almost total - 5 patients, subtotal - 6 patients, partial resection - 2 patients. Mean volume of tumors before surgery was 95.1±55.1 cm3. After surgery, volume ranged from 0 to 24.7 cm3 (mean 2.2±5.01 cm3). After 24 hours, neurological symptoms de novo or aggravation of preoperative motor deficit was revealed in 17 (33%) patients. However, this impairment regressed in most patients, and only 4 (7%) patients retained these disorders after 6 months. Transcortical or combined surgical approach in conjunction with multimodal neurophysiological monitoring allows total or close to total resection of paralimbic glioma in 85% of cases. Risk of postoperative complications is 7%. Unfavorable prognostic factors of neurological impairment are decrease in muscle response amplitude ≥50% according to transcranial neurophysiological stimulation and tumor spread medial to perforator arteries.

Correlation between surgical site infection and TNM classification of malignant tumors after colorectal surgery: a single-center prospective study

Background: Surgery of colorectal cancer has been associated with a high risk of postoperative complications. Surgical site infections (SSIs) are one of the most common postoperative complications following colorectal procedures with many negative consequences for patients, such as extended hospital stay, morbidity, readmission, and death. The aim of this study is to assess the relationship between SSIs and TNM classification of malignant tumors and determine whether they are correlated or not.

Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery: a single-centre retrospective cohort study.

BackgroundAlthough small-bowel perforation is a life-threatening emergency even after immediate surgical intervention, studies have rarely investigated surgical outcomes due to its relatively low incidence. This study aimed to investigate the outcomes of emergency surgery for patients with small-bowel perforation transferred to the intensive care unit (ICU) and the risk factors for mortality.MethodsConsecutive patients with small-bowel perforation who were confirmed via emergency surgery and transferred to the ICU in Zhongshan Hospital, Fudan University (Shanghai, China) between February 2011 and May 2020 were retrospectively analysed. Medical records were reviewed to determine clinical features, laboratory indicators, surgical findings, and pathology.ResultsA total of 104 patients were included in this study, among whom 18 (17.3%), 59 (56.7%), and 27 (26.0%) underwent perforation repair, segmental resection with primary anastomosis, and small-bowel ostomy, respectively. Malignant tumours were the leading cause of perforation in these patients (40.4%, 42/104). The overall post-operative complication rate and mortality rates were 74.0% (77/104) and 19.2% (20/104), respectively. Malignant tumour-related perforation (odds ratio [OR], 4.659; 95% confidence interval [CI], 1.269–17.105; P = 0.020) and high post-operative arterial blood-lactate level (OR, 1.479; 95% CI, 1.027–2.131; P = 0.036) were identified as independent risk factors for post-operative mortality in patients with small-bowel perforation transferred to the ICU.ConclusionsPatients with small-bowel perforation who are transferred to the ICU after emergency surgery face a high risk of post-operative complications and mortality. Moreover, those patients with malignant tumour-related perforation and higher post-operative blood-lactate levels have poor prognosis.

Fat Grafting before Delayed Prophylactic Mastectomy and Immediate Implant Reconstruction for Patients at High Risk of Complications.

The majority of patients undergoing bilateral prophylactic mastectomy request immediate implant-based breast reconstruction. Some patients, especially those with prior radiotherapy, are at increased risk of early cutaneous complications and implant loss. The authors developed the technique of primary fat grafting before delayed prophylactic mastectomy to minimize early complications for selective high-risk patients. They have completed 21 cases in 14 patients, 10 of whom had previous lumpectomy and radiation treatment for breast cancer. A single session of fat grafting, with a median injection volume of 250 ml (interquartile range, 200 to 300 ml), was performed a median period of 19 weeks (interquartile range, 16 to 28 weeks) before prophylactic mastectomy. All cases were direct-to-implant reconstruction using textured silicone implants. The median implant volume was 410 ml (interquartile range, 318 to 450 ml). A minor early complication developed in 14 percent of cases (three of 21), with no early implant loss. At a median follow-up of 9 months (interquartile range, 5 to 27 months), the authors found no cases of implant loss and an excellent or good aesthetic outcome (score of 5 or 4) in 16 of 21 cases (76 percent). Fat grafting before prophylactic mastectomy is a novel strategy to minimize early complications and avoid implant loss in patients at high risk of postoperative complications. . Therapeutic, IV.

Peculiarities of knee replacement in patients with rheumatoid arthritis

Introduction. Rheumatoid arthritis (RA), as a steadily progressive disease leading to joint destruction and functional instability of the knee joints, often requires orthopedic correction.The aim. Of the review was to analyze the surgery strategy and technical features of knee arthroplasty and replacement in patients with RA.Basic provisions. RA is characterized by a number of abnormalities not only due to erosive arthritis and active persistent synovitis, but also caused by a decrease in bone mineral density, damage to the periarticular structures and patella, the formation of bone defects, as well as a high risk of postoperative complications. All these factors should be taken into account while choosing relevant surgical treatment and knee replacement technique. The article presents the optimal approaches for performing knee replacement in RA patients, taking into account the peculiarities of the existing structural and functional disorders.Conclusion. TEC in patients with RA requires a personalized approach based on evaluation of disease-associated risk factors affecting the results of orthopedic correction and the likelihood of complications.

Endoscopic Vacuum-assisted Closure in a Patient with an Overtube-induced Esophageal Perforation

An esophageal perforation is one of the most fatal clinical events, with a mortality rate of up to 21%. This may arise postoperatively or post-endoscopically. In the past, surgical treatment, such as an esophagectomy, was performed these cases. However, the procedure was challenging and had a high risk of postoperative complications. Recently, advancements in endoscopic techniques have been made, and endoscopic procedures became a common treatment modality for patients with esophageal perforation, even in those with underlying diseases. Among the endoscopic procedures, endoscopic vacuum-assisted closure (E-VAC) has been known to be safe and effective. We present the case of a 64-year-old female with advanced liver cirrhosis and an overtube-induced esophageal perforation during esophageal variceal ligation. She was successfully treated with E-VAC.

Current Use of EEN in Pre-Operative Optimisation in Crohn's Disease.

Despite the increasing array of medications available for the treatment of Crohn’s disease and a focus on mucosal healing, approximately 35% of patients with Crohn’s disease undergo bowel surgery at some stage. The importance of nutritional optimisation before Crohn’s surgery is well-highlighted by surgical, nutritional, and gastroenterological societies with the aim of reducing complications and enhancing recovery. Surgical procedures are frequently undertaken when other treatment options have been unsuccessful, and, thus, patients may have lost weight and/or required steroids, and are therefore at higher risk of post-operative complications. EEN is used extensively in the paediatric population to induce remission, but is not routinely used in the induction of remission of adult Crohn’s disease or in pre-operative optimisation. Large prospective studies regarding the role of pre-operative EEN are lacking. In this review, we evaluate the current literature on the use of EEN in pre-operative settings and its impact on patient outcomes.

Effect of music on clinical outcome after hip fracture operations (MCHOPIN): study protocol of a multicentre randomised controlled trial

BackgroundPatients undergoing proximal femur fracture surgery are at high risk of postoperative complications, with postoperative delirium occurring in 25%–40% of patients. Delirium has profound effects on patient outcome and recovery,...

Early postoperative complications were common in non‐ambulant paediatric patients with neuromuscular scoliosis

A high risk of postoperative complications has been reported after scoliosis surgery in ambulant and non-ambulant paediatric patients with neuromuscular scoliosis (NMS), including wound and respiratory infections. Low skeletal muscle mass is common in children with NMS, especially in non-ambulant patients, due to decreased mobility, malnutrition and underweight. They often rely on respiratory support and are at risk of developing hypoglycaemia during prolonged fasting. These patients are fragile and need special attention. A 33% rate of major complications has been reported in non-ambulatory children with cerebral palsy after spinal fusion.

Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA: A Prospective Multicenter Study.

Objective:To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA.Background:Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.Methods:As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.Results:A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65–3.69]), male sex (2.26 [1.53–3.35]), ASA grades 3–5 (3.08 [1.60–5.95]), emergent surgery (2.44 [1.31–4.54]), malignancy (2.97 [1.58–5.57]), respiratory comorbidities (2.08 [1.30–3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02–1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03–0.61]).Conclusions:Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.

Hypoalbuminemia Predicts Adverse Events following Unicompartmental Knee Arthroplasty.

Hypoalbuminemia is a potentially modifiable risk factor associated with adverse events following total knee arthroplasty. The present study aimed to evaluate whether hypoalbuminemia similarly predisposes to adverse events following unicompartmental knee arthroplasty (UKA). Patients who underwent UKA during 2006-2018 were identified through the American College of Surgeons National Surgical Quality Improvement Program. Only patients with preoperative serum albumin concentration were included. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL). All associations were adjusted for demographic, comorbidity, and laboratory differences between populations. A total of 11,342 patients were identified, of whom 6,049 (53.3%) had preoperative serum albumin laboratory values available for analysis. After adjustment for potential confounders, patients with hypoalbuminemia had a greater than 2-fold increased probability for occurrence of any complication (7.02% vs. 2.23%, p = 0.009) and a 4-fold increased probability of receiving a blood transfusion (1.81% vs. 0.25%, p = 0.045). Among procedures performed as inpatients, mean postoperative length of stay (LOS) was longer in patients with hypoalbuminemia (2.2 vs. 1.8 days; p = 0.031). Hypoalbuminemia is independently associated with complications and increased LOS following UKA and a marker for patients at higher risk of postoperative complications. Patients should be screened for hypoalbuminemia and nutritional deficiencies addressed prior to UKA.

Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit.

Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs. The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit. Retrospective cohort study. A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors. The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n=1505). The multivariate logistic regression analysis showed that age >65 (OR=1.561, 95% CI 1.371-1.778, p<.001), non-supine position [lateral decubitus position (OR=1.341, 95% CI 1.133-1.586, p=.001), lithotomy position (OR=1.639, 95% CI 1.295-2.075, p<.001)], non-superficial surgery (OR=2.195, 95% CI 1.566-3.077, p<.001), non-open surgery [laparoscopic surgery (OR=1.205, 95% CI 1.020-1.423, p=.029), endoscopic surgery (OR=1.430, 95%CI 1.084-1.887, p=.011)], the volume of intravenous infusion fluid >1000ml (OR=1.814, 95% CI 1.500-2.194, p<.001), blood transfusion (OR=1.552, 95% CI 1.159-2.078, p=.003), operation performed in the summer or fall (OR=1.874, 95%CI 1.656-2.122, p<.001) and use of dexmedetomidine (OR=1.147, 95%CI 1.015-1.296, p=.028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25kg/m2 (OR=0.556, 95%CI 0.491-0.630, p<.001), higher baseline body temperature (OR=0.641, 95%CI 0.541-0.761, p<.001) and duration of fasting ≥18h (OR=0.487, 95%CI 0.345-0.689, p<.001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4days, p<.001). For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia. The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.

A Sarcopenia-Based Prediction Model for Postoperative Complications of ex vivo Liver Resection and Autotransplantation to Treat End-Stage Hepatic Alveolar Echinococcosis.

BackgroundSarcopenia and visceral adiposity have been shown to be associated with postoperative complications in numerous diseases. However, their effects on the postoperative complications of end-stage hepatic alveolar echinococcosis (HAE) patients undergoing ex vivo liver resection and autotransplantation (ELRA) remain unclear.MethodsThis retrospective study included 101 end-stage HAE patients who underwent ELRA from January 2014 to August 2020. We measured the skeletal muscle and adipose tissue of all patients at the level of the third lumbar vertebra on plain abdominal computed tomography (CT) images and subsequently derived an equation via least absolute shrinkage and selection operator (LASSO) regression analysis to calculate the sarcopenia score. Univariate and multivariate regression were performed to reveal the relationship between major postoperative complications and perioperative clinical data, and the obtained nomogram was validated with the bootstrapping method.ResultsThe sarcopenia score was constructed as a personalized indicator to evaluate sarcopenia and visceral adiposity in each patient. Logistic regression analysis finally selected duration from primary diagnosis to obvious symptoms (OR=1.024, 95% CI, 1.007–1.042), surgical time (OR=1.003, 95% CI, 0.999–1.007) and sarcopenia score (OR=4.283, 95% CI, 1.739–10.551) as independent risk factors for predicting major postoperative complications following ELRA for end-stage HAE patients. The area under the receiver operating characteristic curve (AUROC) of 0.807 (95% CI, 0.720–0.895) and the calibration curve for this prediction model were satisfactory.ConclusionThe sarcopenia score, which systematically evaluates the skeletal muscle and adipose tissue of end-stage HAE patients, was a significant predictive factor for major postoperative complications of ELRA. Relevant interventions should be conducted for those who have a high risk of postoperative complications according to the nomogram.

Perioperative Risk Assessment in Pancreatic Surgery Using Machine Learning.

Pancreatic surgery is associated with a high risk for postoperative complications and death of patients. Complications occur in a variable interval after the procedure. Often, a patient has already left the ICU and is not properly monitored anymore when the complication occurs. Risk stratification models can assist in identifying patients at risk in order to keep these patients in ICU for longer. This, in turn, helps to identify complications earlier and increase survival rates. We trained multiple machine learning models on pre-, intra- and short term postoperative data from patients who underwent pancreatic resection at the Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin. The presented models achieve an area under the precision-recall curve (AUPRC) of up to 0.51 for predicting patient death and 0.53 for predicting a specific major complication. Overall, we found that a classical logistic regression model performs best for the investigated classification tasks. As more patient data becomes available throughout the perioperative stay, the performance of the risk stratification model improves and should therefore repeatedly be computed.

Elevated preoperative suPAR is a strong and independent risk marker for postoperative complications in patients undergoing major noncardiac surgery (SPARSE)

BackgroundPatients undergoing major surgery are often at risk of developing postoperative complications. We investigated whether a preoperative marker of chronic inflammation, soluble urokinase plasminogen activator receptor, can aid in identifying patients at high risk for postoperative complications, morbidity, and mortality. MethodsIn this prospective observational study (ClinicalTrials.gov identifier: NCT03851965), EDTA blood was collected from consecutive adult White patients scheduled for major noncardiac surgery with expected duration ≥2 hours under general anesthesia. Inclusion criteria were age ≥18 years and American Society of Anesthesiologists physical status I to IV. Plasma soluble urokinase plasminogen activator receptor levels were determined using the suPARnostic quick triage lateral flow assay. The primary endpoint was postoperative complications defined as presence of any complication and/or admission to intensive care unit and/or mortality within the first 90 postoperative days. ResultsPreoperative soluble urokinase plasminogen activator receptor had an odds ratio of 1.50 (95% confidence interval: 1.24–1.82) for every ng/mL increase. When including age, sex, American Society of Anesthesiologists score, C-reactive protein, and grouped soluble urokinase plasminogen activator receptor in multivariate analysis, patients with soluble urokinase plasminogen activator receptor between 5.5 and 10 ng/mL had an odds ratio of 11.2 (confidence interval: 3.1–40.8) and patients with soluble urokinase plasminogen activator receptor >10 ng/mL had an odds ratio of 19.9 (95% confidence interval: 4.3–92.9) compared to patients with soluble urokinase plasminogen activator receptor ≤5.5 ng/mL, respectively. Receiver operating characteristic analysis of soluble urokinase plasminogen activator receptor showed an area under the curve of 0.82 (confidence interval: 0.72–0.91). Receiver operating characteristic analysis combining age, sex, C-reactive protein levels, and American Society of Anesthesiologists score and had an area under the curve of 0.71 (95% confidence interval: 0.61–0.82). Adding soluble urokinase plasminogen activator receptor to this model increased the area under the curve to 0.83 (95% confidence interval: 0.74–0.92) (P = .033). ConclusionPreoperative soluble urokinase plasminogen activator receptor provided strong and independent predictive value on postoperative complications in White patients undergoing major noncardiac surgery.

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.