Higher Risk Of Postoperative Complications Research Articles

Renal Disease Is Associated With Poor Outcomes Following Isolated Coronary Artery Bypass Grafting

BackgroundPeople with renal disease have a markedly higher risk of cardiovascular disease as well as morbidity and mortality after cardiac surgery. Little is known regarding the post-operative adverse outcomes following isolated coronary artery bypass graft (CABG) in the Australian population with renal disease. ObjectivesThe aim of this study was to examine the effect of different stages of renal disease on patients' risk of post-operative mortality and complications following isolated CABG in an Australian cohort. MethodsUsing the ANZSCTS (Australian and New Zealand Society of Cardiac and Thoracic Surgeons) registry, data from 44,968 patients who underwent isolated CABG between 2001 and 2014 were used. The effect of renal disease stages on short- and long-term outcomes were examined using multivariable logistic and Cox's regression methods respectively. ResultsThree of 4 Australian patients (74.6%) who underwent isolated CABG had some degree of renal disease: 50.2% mild; 20.9% moderate; 2.1% severe; and 1.6% dialysis-dependent. Adjusted risk of 30-day mortality increased with deteriorating renal disease from mild (1.6-fold) to dialysis-dependent (4.6-fold). Worsening renal disease was also associated with higher risk of post-operative complications. Hazard ratio for long-term survival shows steady increase of mortality risk with worsening renal disease categories from 1.1-fold for mild to 3.9-fold for patients on dialysis. ConclusionsPre-existing renal disease is significantly associated with 30-day and long-term mortality, length of intensive care unit and hospital stay as well as several other post-operative complications.

Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy.

Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40L for the forced expiratory volume in 1s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. POP occurred in 45 (21.7%) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.

Results of N1 and N2 surgery in non-small cell lung cancer

Lymph node involvement in non-small cell lung cancer shows considerable heterogeneity within the N1 and N2 descriptors with respect to localization, the number of lymph nodes affected and the extent of mass and volume. In an attempt to reflect the different prognostic behavior of lymph node metastases, the 8th classification of the TNM has been published with proposals for further subtyping of the N1 and N2 stages into N1a, N1b, as well as N2a1, N2a2, and N2b. The aim of this article is to discuss the value of surgery of non-small cell lung cancer in the N1 and N2 lymph node metastatic stages. While overall survival benefits were seen after concomitant chemotherapy for patients with N1 metastatic disease and surgery, radiotherapy concepts did not provide any survival benefit in this subgroup. For patients with N2 metastasis, surgical resection is part of amultimodal treatment concept with chemotherapy and radiotherapy. Careful restaging after neoadjuvant therapy is recommended in order to provide surgical treatment to patients deemed suitable for curative (R0) resection. In particular, it should be noted that after inductive chemoradiotherapy, patients should only be treated by pneumonectomy in specialized centers, as resection can be associated with a high risk of postoperative complications. With respect to the new subtyping of the N2 involvement situation in N2a1, N2a2, and N2b, further adapted multimodal treatment concepts are expected in the future. Initial results are reported for stage IIIA patients and the use of video-assisted thoracoscopic surgery (VATS), robotic assisted thoracic surgery (RAST) and thoracotomy for local resection. These indicate that the use of minimally invasive techniques can achieve comparable results to open thoracotomy procedures, at least in specialized treatment centers.

Effective prediction of postoperative complications for patients after open hepatectomy: a simplified scoring system based on perioperative parameters

BackgroundThe aim of the study was to develop a scoring system for the prediction of postoperative complications of open hepatectomy.MethodAll consecutive patients receiving open hepatectomy from 2015 to 2017 were included in the study. Univariate and multivariate analyses were used to confirm the risk factors for postoperative complications. Afterwards, a novel scoring system was developed to predict the postoperative complications.ResultsThe study included a total of 207 patients. For the test dataset, multivariate analysis indicated that diabetes, scale of surgery, serum potassium, and blood loss versus body weight were independent risk factors of the postoperative complications. The area under the curve (AUC) of the novel scoring system we proposed for prediction of postoperative complications of hepatectomy was 0.803, which is comparable with the AUCs of previous scoring systems. Furthermore, in the validation dataset, the corresponding AUC of the new scoring system was 0.717.ConclusionThis novel and simplified scoring system can effectively predict the postoperative complications of open hepatectomy and could help identify patients who are at high risk of postoperative complications.

Alpha rhythm collapse predicts iso-electric suppressions during anesthesia

Could an overly deep sedation be anticipated from ElectroEncephaloGram (EEG) patterns? We report here motifs hidden in the EEG signal that predict the appearance of Iso-Electric Suppressions (IES), observed during epileptic encephalopathies, drug intoxications, comatose, brain death or during anesthetic over-dosage that are considered to be detrimental. To show that IES occurrences can be predicted from EEG traces dynamics, we focus on transient suppression of the alpha rhythm (8–14 Hz) recorded for 80 patients, that had a Propofol target controlled infusion of 5 μg/ml during a general anesthesia. We found that the first time of appearance as well as changes in duration of these Alpha-Suppressions (αS) are two parameters that anticipate the appearance of IES. Using machine learning, we predicted IES appearance from the first 10 min of EEG (AUC of 0.93). To conclude, transient motifs in the alpha rhythm predict IES during anesthesia and can be used to identify patients, with higher risks of post-operative complications.

Pre-operative hypoalbuminemia is associated with complication rate and overall survival in patients with vulvar cancer undergoing surgery

ObjectiveHypoalbuminemia, a known marker for malnutrition, has been associated with an increased risk for perioperative morbidity and poor prognosis in patients with solid tumors. The aim of this study was to investigate the prognostic and predictive value of pre-treatment serum albumin levels for survival and postoperative complications in patients with vulvar cancer undergoing surgery.MethodsWithin in this retrospective study, we assessed data of 103 consecutive patients with vulvar cancer undergoing primary surgery into this study. Pre-treatment serum albumin levels were correlated with clinico-pathological parameters and complications. We performed univariate log-rank test and multivariable Cox regression models to evaluate the association between pre-treatment serum albumin and survival.ResultsWe found hypoalbuminemia (< 35 mg/dl) in 9 of 103 (8.7%) patients. No difference in tumor characteristics was observed between patients with hypoalbuminemia and normal serum albumin levels. Difference in postoperative complications (55.6% and 37.8% of patients with hypoalbuminemia and normal serum albumin levels, respectively) was not statistically significant (p = 0.345). Shorter overall survival (OS) was observed in patients with hypoalbuminemia (5-year OS rate 17.1%) when compared to patients with normal serum albumin levels (5-year OS rate 58.6%, p = 0.004). In multivariable analysis, age (p = 0.017), FIGO stage (p = 0.011) and serum albumin levels (p = 0.013) were independently associated with OS.ConclusionPre-treatment hypoalbuminemia is an independent prognostic biomarker for OS in patients with vulvar cancer. We did not find an association between pre-treatment hypoalbuminemia and a higher risk for postoperative complications.

Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary Bypass.

Cardiopulmonary bypass is associated with severe immune dysfunctions. Particularly, a cardiopulmonary bypass-related long-lasting immunosuppressive state predisposes patients to a higher risk of postoperative complications, such as persistent bacterial infections. This study was conducted to elucidate mechanisms of post-cardiopulmonary bypass immunosuppression. In vitro studies with human peripheral blood mononuclear cells. Cardiosurgical ICU, University Research Laboratory. Seventy-one patients undergoing cardiac surgery with cardiopulmonary bypass (enrolled May 2017 to August 2018). Peripheral blood mononuclear cells before and after cardiopulmonary bypass were analyzed for the expression of immunomodulatory cell markers by real-time quantitative reverse transcription polymerase chain reaction. T cell effector functions were determined by enzyme-linked immunosorbent assay, carboxyfluorescein succinimidyl ester staining, and cytotoxicity assays. Expression of cell surface markers was assessed by flow cytometry. CD15 cells were depleted by microbead separation. Serum arginine was measured by mass spectrometry. Patient peripheral blood mononuclear cells were incubated in different arginine concentrations, and T cell functions were tested. After cardiopulmonary bypass, peripheral blood mononuclear cells exhibited significantly reduced levels of costimulatory receptors (inducible T-cell costimulator, interleukin 7 receptor), whereas inhibitory receptors (programmed cell death protein 1 and programmed cell death 1 ligand 1) were induced. T cell effector functions (interferon γ secretion, proliferation, and CD8-specific cell lysis) were markedly repressed. In 66 of 71 patients, a not yet described cell population was found, which could be characterized as myeloid-derived suppressor cells. Myeloid-derived suppressor cells are known to impair immune cell functions by expression of the arginine-degrading enzyme arginase-1. Accordingly, we found dramatically increased arginase-1 levels in post-cardiopulmonary bypass peripheral blood mononuclear cells, whereas serum arginine levels were significantly reduced. Depletion of myeloid-derived suppressor cells from post-cardiopulmonary bypass peripheral blood mononuclear cells remarkably improved T cell effector function in vitro. Additionally, in vitro supplementation of arginine enhanced T cell immunocompetence. Cardiopulmonary bypass strongly impairs the adaptive immune system by triggering the accumulation of myeloid-derived suppressor cells. These myeloid-derived suppressor cells induce an immunosuppressive T cell phenotype by increasing serum arginine breakdown. Supplementation with L-arginine may be an effective measure to counteract the onset of immunoparalysis in the setting of cardiopulmonary bypass.

Geriatric Nutritional Risk Index, a predictive assessment tool, for postoperative complications after abdominal surgery: A prospective multicenter cohort study

Patients awaiting abdominal surgery are often malnourished, which puts them at a high risk of postoperative complications. The aim of the present study was to investigate the effects of preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) on postoperative complications and the course of recovery for patients undergoing abdominal surgery. In this prospective multicenter cohort study, we enrolled patients awaiting abdominal surgery from November 2015 to December 2017. The characteristics of patients and postoperative complications were compared between participants (median age 71 years; interquartile range 66-78 years) with low GNRI (<98) values and high GNRI (≥98) values. Multivariate logistic regression was carried out to identify postoperative complications-related factors. A total of 366 patients who underwent abdominal surgery were assessed. Patients in the low GNRI group had a significantly higher rate of postoperative complications (P = 0.01), and longer length of hospital stay compared with those in the high GNRI group (P < 0.01). Using multivariate analysis, low GNRI was found to be independently associated with postoperative complications (OR 2.50; P = 0.02) and activities of daily living on postoperative day 7 (OR 1.39; P = 0.03). Comorbidities, handgrip force for postoperative complications, age, preoperative chemotherapy and activities of daily living on postoperative day 7 were not independently associated. Malnutrition indicated by the GNRI might be predictive of postoperative complications after abdominal surgery and the delay of postoperative course. Geriatr Gerontol Int 2019; 19: 924-929.

Post-surgical outcomes of patients with chronic kidney disease and end stage renal disease undergoing radical prostatectomy: 10-year results from the US National Inpatient Sample

BackgroundChronic kidney disease (CKD) and end stage renal disease (ESRD) are not well characterized in prostate cancer patients. This study aimed to examine the clinical characteristics and postsurgical outcomes of patients with or without CKD and ESRD undergoing radical prostatectomy for prostate cancer.MethodsThis population-based, retrospective study used patient data from the Nationwide Inpatient Sample, the largest all-payer US inpatient care database. From 2005 to 2014, 136,790 male patients aged > 20 years diagnosed with prostate cancer and who received radical prostatectomy were included. Postoperative complications, postoperative acute kidney injury (AKI) and urinary complications, and length of hospital stay were compared between patients with or without underlying CKD and ESRD.ResultsAfter adjusting for relevant factors, the CKD group had a significantly higher risk of postoperative complications than the non-CKD group. In addition, the CKD group had a 5-times greater risk of postoperative AKI and urinary complications than the non-CKD group. Both CKD and ESRD groups had significantly longer hospital stays than the non-CKD group. Patients receiving RARP had a lower risk of postoperative complications than those who received open radical prostatectomy, regardless of having CKD or not. Both non-CKD and CKD patients receiving RARP had shorter hospital stays than those who received open surgery.ConclusionsProstate cancer patients with underlying CKD had significantly greater risk of postoperative complications, postoperative AKI and urinary complications, and longer hospital stays than those without CKD. The use of RARP significantly shortened hospital stays and reduced complications for these patients.

Perioperative outcomes and long-term quality of life after total pancreatectomy.

Total pancreatectomy is required to treat diseases involving the entire pancreas, and is characterized by high morbidity rates and impaired long-term quality of life (QoL). To date, risk factors associated with perioperative and long-term outcomes have not been determined fully. Data from patients undergoing total pancreatectomy between 2000 and 2014 at two high-volume centres were analysed retrospectively to assess risk factors for major surgical complications. Short Form (SF) 36, European Organisation for Research and Treatment of Cancer QLQ-PAN26 and Audit of Diabetes Dependent questionnaires, as well as an original survey were used to investigate factors influencing QoL. A total of 329 consecutive patients underwent total pancreatectomy in the two centres. Overall, total pancreatectomy was associated with a morbidity rate of 59·3 per cent and a 30-day mortality rate of 2·1 per cent. Age over 65 years and long duration of surgery (more than 420 min) were independently associated with major complications (at least Clavien-Dindo grade III). QoL analysis was available for 94 patients (28·6 per cent) with a median follow-up of 63 (i.q.r. 20-109) months; the most common indication for total pancreatectomy in these patients was intraductal papillary mucinous neoplasms (46 per cent). Both physical (PCS) and mental (MCS) component summary scores of SF-36® were lower after total pancreatectomy compared with scores for a normative population (P = 0·020 and P < 0·001 respectively). Linear regression analysis showed that young age, abdominal pain and worse perception of body image were negatively associated with the PCS, whereas diabetes, sexual satisfaction and perception of body image affected MCS. Total pancreatectomy can be performed with acceptable morbidity and mortality rates. Older patients had a higher risk of postoperative complications but reported better QoL than younger patients.

Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome

This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.

Management of Inguinal Hernia in Pediatric Age Group

Introduction: Incidence of indirect inguinal hernias in premature infants is reported to be as high as 30% with male predominance. Typically, inguinal hernia repairs are done under general anesthesia which has a high risk of post-operative complications, especially in the premature infant. The purpose of this study was to compare outcomes between early (neonatal) and delayed (older) inguinal hernia repair. Method: This is a prospective study in the department of pediatric surgery in alkhansaa Teaching Hospital Mosul / Iraq during a period from Jul 2018 to Dec 2019. All children with inguinal hernia were selected for the study and divided in two groups, those below one month and those above. Surgery is performed under general anesthesia with extracanalicular approach. Post-operative complications were observed and finally decided to discharge once patient is fit for discharge on the same day. Results: During the 18 months' period, we underwent 93 inguinal hernia repair those babies were divided into two groups, neonatal group (23 neonates) and older group (70 babies). The gender distribution ratio is 7.8 male :1 female. The side distribution among those babies in the neonatal group were 14,6 and 3 as right, left and bilateral respectively. In the neonatal group there were 9 babies presented with incarceration two (8.6%) of them shows testicular infarction and necrosis which necessitate excision at exploration while the other one atrophied in the period of follow up. We do not record any anesthetic complications or mortality in neonatal group in our period of study. Conclusion: Extracanalicular approach under general anesthesia is easy, safe, can be used for pediatric patients in neonatal age group with indirect inguinal hernia; with minimal complications, low recurrence rate.

Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer.

The purpose of this study was to evaluate the correlation between serum albumin level change (ΔALB) and post-operative complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. A total of 193 patients undergoing curative (R0) gastrectomy from September 2015 to May 2017 were enrolled in this study. The risk factors for predicting post-operative complications were identified by univariate and multivariate analysis. The cut-off value and diagnostic accuracy of ΔALB were measured by receiver operating characteristic curves. ΔALB was defined as: (albumin level before surgery - albumin on post-operative day (POD) 1)/albumin level before surgery × 100%. A total of 60 patients (31.0%) had post-operative complications. Our results showed that the cut-off value of ΔALB was 19.0%. Using a cut-off value of 19.0%, multivariate analysis identified that ΔALB was able to predict post-operative complications as an independent factor (odds ratio 13.98, 95% confidence interval 6.048-32.32, P < 0.001). In addition, the area under the curve of ΔALB is higher than C-reactive protein on POD 3 (0.773 versus 0633). Compared with patients with ΔALB <19.0%, patients with ΔALB ≥19.0% have higher risk of post-operative complications suffered (62.3 versus 13.7%, P < 0.001) and longer post-operative stay (22.1 ± 13.5 versus 17.5 ± 4.2, P < 0.001). ΔALB acted as an independent predictor in short-term complications for patients with normal preoperative serum albumin and its diagnostic accuracy was higher than C-reactive protein on POD 3. It is promising to be a precise and straight predictor for incidence of post-operative complications to patients with normal preoperative serum albumin.

Influencing Factors on the Outcome in Female Groin Hernia Repair: A Registry-based Multivariable Analysis of 15,601 Patients.

Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair. In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair. In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified. In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates. Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.

New Role for the Anesthesia Preoperative Clinic: Helping to Ensure That Surgery Is the Right Choice for Patients With Serious Illness.

New Role for the Anesthesia Preoperative Clinic: Helping to Ensure That Surgery Is the Right Choice for Patients With Serious Illness.

Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study.

Surgical complications after total laryngopharyngectomy (TLP) are common, reconstruction is challenging, and patients often lose their ability to swallow and speak. To evaluate these aspects, we analysed outcome after TLP. We reviewed all patients who underwent TLP and subsequent circumferential pharyngeal reconstruction through 2004-2017 at the Helsinki University Hospital. For the 26 eligible patients, TLP was the primary treatment for 11 and salvage surgery for 15, followed by reconstruction with free flaps in 22 patients and pedicled flaps in 4. An early (≤ 30days) pharyngocutaneous fistula developed in seven patients (27%; median time 13days; range 6-26), and a late (> 30days) fistula in five patients (19%; median time 370days; range 46-785). In addition, ten patients (39%) developed an oesophageal stricture. Four patients (15%) resumed full oral feeding. A speech prosthesis was inserted for 15 patients (58%) and most of them could produce intelligible speech. We found acceptable survival figures for patients undergoing TLP both as a primary treatment and as salvage procedure: the overall survival at 1year was 82% and 67%, and at 5years 33% and 27%, respectively. Disease-specific survival at 1year was 90% and 70%, and that at 5years was 45% and 43%, respectively. Despite fair survival, TLP carries a high risk for postoperative complications with limited functional outcome, thus necessitating cautious patient selection and surgical experience.

Unilateral Occipital Transtentorial Approach with Multimodal Assistance for Resection of Large Supracerebellar Hemangioblastomas: Preliminary Experience of 2 Cases

The surgical resection of large supracerebellar hemangioblastomas (SHBs) is exceptionally challenging due to their vascularity and deep anatomic location and is associated with a high risk of postoperative complications and mortality. Access to the posterior incisural space can be achieved by either an infratentorial supracerebellar approach or occipital transtentorial approach (OTA). However, the optimal surgical strategy has not yet been established. Here, we report 2 cases of large SHBs that were successfully and safely resected via a unilateral OTA with multimodal assistance. Two patients presented to our hospital with ataxia due to large, solid SHBs. After preoperative embolization, gross total resection of the SHBs was achieved via an OTA. Furthermore, endoscopic assistance was used to resect the remnant portion of the tumor in the second patient. Both patients experienced transient ataxia but were discharged from the hospital without serious complications. The combination of an OTA with preoperative embolization and endoscopic assistance may reduce the intraoperative risk and contribute to improved outcome in patients with such clinically challenging tumors.

Not all hip arthroplasties are created equal: increased complications and re-admissions after total hip arthroplasty for femoral neck fractures compared with osteoarthritis.

Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student's t-test, and the chi-squared test was used to compare categorical variables. Multivariate and propensity-matched logistic regression analyses were performed to control for risk factors of interest. Analyses included 139 635 patients undergoing THA. OA was the indication in 135 013 cases and FNF in 4622 cases. After propensity matching, mortality within 30 days (1.8% vs 0.3%; p < 0.001) and major morbidity (24.2% vs 19%; p < 0.001) were significantly higher among FNF patients. Re-operation (3.7% vs 2.7%; p = 0.014) and re-admission (7.3% vs 5.5%; p = 0.002) were significantly higher among FNF patients. Hip fracture patients had significantly longer operative time and length of stay (LOS), and were significantly less likely to be discharged to their home. Multivariate analyses gave similar results. This large database study showed a higher risk of postoperative complications including mortality, major morbidity, re-operation, re-admission, prolonged operative time, increased LOS, and decreased likelihood of discharge home in patients undergoing THA for FNF compared with OA. While THA is a good option for FNF patients, there are increased costs and financial risks to centres with a joint arthroplasty bundle programme participating in fracture care. Cite this article: Bone Joint J 2019;101-B(6 Supple B):84-90.

Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration.

Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects. The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures. A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla. The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.

PB2306 SURGICAL PROCEDURES AND OUTCOMES AMONG CHILDREN WITH SICKLE CELL DISEASE

Background:Although children with sickle cell disease (SCD) often undergo surgery, there are limited current epidemiological data for this pediatric population. Sickle cell patients present a high risk of postoperative complications and have a higher morbidity and mortality than the general population after surgery. During the perioperative period there are certain situations that can trigger an increase in falciformation and vaso‐occlusive crises that lead to complications mainly of respiratory type. Our protocol of perioperative general care includes: transfusion of packed red blood cells to obtain a hemoglobin value of 10 g/dL, hyperhydration, avoiding hypoxia and cold, strict control of pain, early ambulation and incentivized spirometry.Aims:To study the prevalence and severity of postoperative complications in pediatric patients with SCD (HbSS/Sβ0 o SC) followed in our center in a period of 22 yearsMethods:We reviewed the medical records of patients with SCD who underwent surgery between January 1997 and January 2019. We described characteristics of patients, the type of surgery that was performed and the postoperative complications they presented.Results:From 1997 to 2019 out of 91 pediatric patients followed in our center with SCD, 38 patients underwent surgery (41.8%). A total of sixty‐one interventions were performed in these patients (1.6 surgeries per patient). The median age at the moment of surgery was 7.5 years. The most frequent procedure was otorhinolaryngological surgery (21.3%), followed by trauma surgery (18%), splenectomy (14.7%), herniorrhaphy (11.4%), cholecystectomy (8.2%), circumcision (6.6%) and others (19.6%). Postoperative complications were observed in 7 out of the 61 surgical interventions: 4 acute thoracic syndromes, 2 bronchospasm crises and 1 vaso‐occlusive crisis. In 4 of the 7 cases, complications occurred after abdominal surgeries. Most complications occurred within 24‐48 hours after the surgery (1 day median with a range of 0 to 6 days). In 4/7 of the perioperative complications patients were previously receiving hydroxyurea, 3/7 were not receiving hydroxyurea at the moment of the surgery; two because of medical indications and one patient arrived from country of origin where the medication was not administered. Three patients required admission to the intensive care unit (ICU). Two patients required exchange transfusion and respiratory support. There were no strokes and no deaths.Summary/Conclusion:We observed a high rate of surgical procedures in our patients. The burden of surgical disease in SCD children differs from the general pediatric population. In our series the most frequent indication for surgery was tonsillectomy and adenoidectomy. Despite the perioperative care described, we observed a prevalence of postsurgical complications of 11.5%. The majority of the complications were of respiratory type coinciding with the existing literature, practically half of them required admission to the ICU and a 28.5% underwent exchange transfusion and required respiratory support after the event. The incidence of death and stroke is nule in our series. There are few adequate trials to determine optimal perioperative management in these patients. Future research should determine how to predict and decrease perioperative complications.image