High Risk Of Postoperative Morbidity Research Articles

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation.

Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5years (IQR 3.3-6.4), median weight 16kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.

Critical values for body mass index related to morbidity in high-volume low-complexity general surgery: a systematic review and meta-analysis.

The aim of this study was to investigate the effect of body mass index (BMI, kg/m2) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes. A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias. A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, p=0.040) but did not affect complications (OR: 0.69, p=0.400) or length of hospital stay (mean difference [MD]: -0.01 days, p=0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, p<0.00001), and higher risk of wound complications (OR: 3.01, p<0.00001) and hospital readmission (OR: 1.46, p=0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, p<0.0001) and hospital readmission (OR: 5.56, p<0.00001), and longer operative time (MD: 4.01 minutes, p=0.030). Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.

Postoperative complications among dialysis-requiring patients undergoing splenectomy.

Dialysis patients are at high risk for surgery, but their outcomes after splenectomy are unclear. We compared postoperative complications between dialysis and non-dialysis patients. Data were retrieved from the National Surgical Quality Improvement Program for this retrospective cohort. Adult patients undergoing elective splenectomy between 2005 and 2020 were included. Among 10,339 included patients, 143(1.4%) were on chronic dialysis. Postoperative mortality was higher in dialysis vs. non-dialysis patients (9.1% vs. 1.8%). Dialysis patients were more likely to have 30-day major morbidity, infectious and non-infectious complications, reoperation, and prolonged hospital stay. On multivariable regression, dialysis dependence significantly increased odds of mortality, major morbidity, blood transfusion, prolonged length of stay, reoperation, and failure-to-rescue (FTR). Dialysis patients were at higher risk of postoperative morbidity following splenectomy. Additionally, the risk of FTR in this patient population is also significantly more compared to non-dialysis patients.

Cannabis use disorder and perioperative outcomes following complex cancer surgery.

Cannabis usage is increasing in the United States, especially among patients with cancer. We sought to evaluate whether cannabis use disorder (CUD) was associated with higher morbidity and mortality among patients undergoing complex cancer surgery. Patients who underwent complex cancer surgery between January 2016 and December 2019 were identified in the National Inpatient Sample database. CUDwas defined according to ICD-10 codes. Propensity score matchingwas performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type. The primary composite outcome was in-hospital mortality and sevenmajor perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications). Among 15 014 patients who underwent a high-risk surgical procedure, a cohort of 7507 patients with CUD(median age;43 years [IQR:30-56 years]; n = 3078 [41.0%]female) were matched with 7507 patients who were not cannabis users (median age;44 years [IQR:30-58 years); n = 2997 [39.9%]female). CUDwas associated with slight increased risk relative to postoperative kidney injury (CUD, 7.8% vs. no CUD, 6.1%); however, in-hospital mortality was slightly lower (CUD, 0.9% vs. no CUD, 1.6%) (both p < 0.001). On multivariable analysis, after controlling for other risk factors, CUDwas not associated with higher morbidity and mortality (adjusted odds ratio: 1.06, 95% CI: 0.98-1.15; p = 0.158). CUD was not associated with a higher risk of postoperative morbidity and mortality following complex cancer surgery.

Investigating the weekend effect in decompressive thoracolumbar hemilaminectomy for acute intervertebral disc extrusion: An observational cohort study of 460 cases (2018-2023).

To investigate if weekend surgery is associated with poorer outcomes in dogs with acute thoracolumbar intervertebral disc extrusion (IVDE) undergoing decompressive thoracolumbar hemilaminectomy. Retrospective observational cohort study. A total of 460 consecutive cases were reviewed, with 401 dogs undergoing weekday surgery (Cohort WD), and 59 dogs undergoing weekend surgery (Cohort WE). Medical records of a surgical referral center in the UK were reviewed. Preoperative patient demographic and clinical data, and postoperative outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis was used to model the odds of a negative outcome. Cohort WE had a higher preoperative proportion of nonambulatory dogs (p = .0115) but there were no significant differences between the nonambulatory (p = .3762) and deep-pain negative subgroups (p = .6199). Cohort WE had a higher risk of not recovering ambulation compared to Cohort WD [79.2% vs. 91.6% recovery; adjusted OR 3.010 (95% CI: 1.259-7.190); p = .0132] and had a higher risk of postoperative morbidity [32.2% vs. 17.2%; adjusted OR 2.015 (95% CI: 1.089-3.729); p = .0257]. There were no significant differences in other outcome measures between cohorts. Weekend surgery in canine decompressive thoracolumbar hemilaminectomy may be associated with poorer patient outcomes, specifically higher postoperative morbidity and a poorer rate of recovery of ambulation. This study demonstrates a weekend effect in veterinary surgery, which may be important in surgical decision-making in acute thoracolumbar IVDE. Further scrutiny of the patient's journey through the veterinary healthcare system is warranted.

Preoperative anemia: impact on short- and long-term outcomes following curative-intent resection of gastroenteropancreatic neuroendocrine tumors

ObjectiveThe impact of preoperative anemia on clinical outcomes of patients undergoing resection of gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) has not been previously investigated. The objective of the current study was to characterize how preoperative anemia affected short- and long-term outcomes of patients undergoing curative-intent resection of GEP-NETs. MethodsPatients who underwent curative-intent resection for GEP-NETs between January 1990 to December 2020 were identified from eight major institutions. The last preoperative hemoglobin level was recorded; anemia was defined as < 13.5g/dl in males or < 12.0g/dl in females based on instructions of American Society of Hematology. The impact of anemia on post-operative outcomes were assessed on uni- and multivariate analysis. ResultsAmong1,559 patients, median age was 58 years (IQR 48-66) and roughly one-half of the cohort was male (n=796, 51.1%). Most patients had a pancreatic tumor (n=1040, 66.7%), followed by small bowel (n=259, 16.6%), duodenum (n=103, 6.6%), stomach (n=66, 4.2%), appendix (n=53, 3.4%), and other locations (n=38, 2.6%). Median preoperative hemoglobin level was 13.4 (IQR 12.2-14.5) g/dl. Overall, 101 (6.7%) and 119 (8.5%) patients received an intra- or postoperative pRBC transfusion, respectively. A total of 972 (44.5%) patients experienced a postoperative complication. Although the overall incidence of complications was no different among patients who did (anemic 48.7%) versus did not (non-anemic 47.3%) have anemia (p=0.597), patients with preoperative anemia were more likely to develop a major (≥Clavien-Dindo grade IIIa: anemic 48.9% vs. non-anemic 38.0%, p=0.006) and multiple (≥3 types of complications: anemic 32.2% vs. anemic 19.7%, p<0.001) complications. 1-, 3-, and 5-year overall survival (OS) was 96.7%, 90.5%, and 86.6% respectively. On multivariable analysis, anemia (HR 2.0, 95% CI 1.2-3.2, p=0.006) remained associated with worse OS; postoperative pRBC transfusion was associated with a OS (5-year OS, 75.0% vs. 87.7%, p=0.017), as well as RFS (5-year RFS, 66.9% vs. 76.5%, p=0.047). Conclusionspreoperative anemia was commonly identified in roughly 1 in 3 patients who underwent curative-intent resection for GEP-NETs. Preoperative anemia was strongly associated with higher risk of postoperative morbidity and worse long-term outcomes.

Advantages of laparoscopy in gynecologic surgery in elderly patients.

Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar restuls were observed in cancer-only and benign-only cohorts. Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation.

Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.

454. GASTROINTESTINAL QUALITY OF LIFE, BODY COMPOSITION AND INFLUENCING FACTORS, IN ESOPHAGEAL CANCER SURVIVORS FOLLOWING CURATIVE ESOPHAGECTOMY

Abstract Background Recent improvements in treatment modalities for locally advanced esophageal cancer have resulted in markedly improved survival outcomes. This has resulted in an increasing population of esophageal cancer survivors. Surgery is the mainstay of treatment, which has a high risk of post-operative morbidity. This study focused on characterising health-related quality of life with a specific interest in the gastrointestinal quality of life of esophageal cancer survivors following curative esophagectomy. Methods This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery between 2010 and 2015. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Body composition was assessed using surveillance computed tomography scans. Linear and logistic regression analyses were utilised to determine the impact of treatment and pathologic variables on survivorship issues. Results Gastrointestinal symptoms were common, with persistent eating symptoms independently predictive of overall poor HR-QL on multivariable analysis (P = 0.026, odds ratio [OR] 1.05 [95% confidence interval [95% CI] 1.01–1.10]). Persistent eating symptoms were independently associated with impaired physical and role function (both P &amp;lt; 0.001). Cervical anastomosis was associated with increased risk of dumping syndrome (P = 0.013, OR 0.34 [95% CI 0.14–0.80]), while squamous histology was independently associated with increased Gastrointestinal Symptom Rating Scale (P = 0.027) and Sigstad dumping syndrome scores (P = 0.034). Conclusion Persistent gastrointestinal and nutritional issues are common after esophagectomy. These eating symptoms are associated with impaired health-related quality of life. Further research is warranted to investigate how patient pathways can be enhanced to minimise the long-term impact of curative treatment for patients with esophageal cancer.

456. PHYSICAL ACTIVITY AND FRAILTY AS PART OF HEALTH RELATED QUALITY OF LIFE ASSESSMENT IN ESOPHAGEAL CANCER SURVIVORS AFTER CURATIVE ESOPHAGECTOMY

Abstract Background Survival rates for patients with esophageal cancer are improving, resulting in an increasing population of esophageal cancer survivors. Surgery is the mainstay of treatment but has a high risk of post-operative morbidity. This study aimed to characterise health related quality of life with a specific focus on physical activity and frailty assessment within an esophageal cancer survivor population. Methods This was a cross-sectional cohort study of patients who underwent esophageal cancer surgery between 2010 and 2015. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Linear and logistic regression analyses were utilised to determine the impact of treatment and pathologic variables on physical activity and frailty. Results On multivariable analysis, age was a significant predictor of level of physical activity (P = 0.001). Male sex, critical care length of stay and eating symptoms were independent predictors of frailty in both the PRISMA7 and SARCF tools (all P &amp;lt; 0.001). Inpatient length of stay (P &amp;lt; 0.001) and persistent eating symptoms following treatment (P &amp;lt; 0.001) were both predictive of physical function following completion of treatment. Conclusion Curative esophagectomy can have significant effects on patients physical function, levels of physical activity and risk of frailty. Current methods of assessing health related quality of life in esophageal cancer survivorship may under-investigate the effects of curative esophagectomy on physical activity and frailty. Further research is warranted to investigate how patient pathways can be enhanced to minimise the long-term health-related quality of life impact of curative treatment.

426 Utility of the Fried Phenotype as a Frailty Assessment Tool in Predicting Post-Operative Outcomes in Lumbar Degenerative Spine Surgery Patients

INTRODUCTION: Frailty is a syndrome of physiological decline that can predispose surgical patients to increased peri-operative morbidity. The Fried phenotype is a clinical measure of frailty and categorizes patients’ frailty based on grip strength, walking speed, unintentional weight loss, low physical activity, and exhaustion. It has been validated in non-spine surgical populations and has been shown to be correlated with poor postoperative outcomes and longer hospital lengths of stay (LOS); it has not yet been validated in patients undergoing spine surgery. Other assessment tools, including the Modified Frailty Index-11 (mFI-11) and Charlson Comorbidity Index (CCI), are calculated based on comorbidities. The mFI-11 has previously been studied in spine patients - a higher mFI-11 score has been associated with a higher risk of post-operative morbidity and mortality. METHODS: Patients &gt;65 years of age who underwent elective lumbar spine surgery for degenerative disease since 2015 were included. Data for the Fried phenotype, mFI-11, CCI, and outcomes were gathered for each patient. ROC curves were generated, and multivariate analyses were performed. RESULTS: 248 patients (128 females; 120 males) with an average age of 71.8 years were included. The median Fried score was 1, median CCI was 1, and median mFI-11 was 0.18. The median LOS was 4 days, with 11 30-day re-admissions. Fried phenotype was found to be the best predictor of an extended LOS and of a non-home discharge. CONCLUSIONS: The Fried phenotype is now shown to be a validated measure of frailty in the spine population. Because it relies on categories that are impacted by the patient's functional condition (instead of the comorbidity burden), it has profound implications for optimizing patients through pre-habilitation prior to elective surgery.

Functional outcome after pediatric cerebral cavernous malformation surgery

The purpose of this study was to investigate the functional outcome following surgical resection of cerebral cavernous malformations (CCM) in pediatric patients. We screened our institutional database of CCM patients treated between 2003 and 2021. Inclusion regarded individuals younger or equal than 18 years of age with complete clinical baseline characteristics, magnetic resonance imaging dataset, and postoperative follow-up time of at least three months. Functional outcome was quantified using the modified Rankin Scale (mRS) score and assessed at admission, discharge, and last follow-up examination. The primary endpoint was the postoperative functional outcome. As a secondary endpoint, predictors of postoperative functional deterioration were assessed. A total of 49 pediatric patients with a mean age of 11.3 ± 5.7 years were included for subsequent analyses. Twenty individuals (40.8%) were female. Complete resection of the lesion was achieved in 44 patients (89.8%), and two patients with incomplete resection were referred for successive remnant removal. The mean follow-up time after surgery was 44 months (IQR: 13 – 131). The mean mRS score was 1.6 on admission, 1.7 at discharge, and 0.9 at the latest follow-up. Logistic regression analysis adjusted to age and sex identified brainstem localization (aOR = 53.45 [95%CI = 2.26 − 1261.81], p = .014) as a predictor of postoperative deterioration. This study indicates that CCM removal in children can be regarded as safe and favorable for the majority of patients, depending on lesion localization. Brainstem localization implies a high risk of postoperative morbidity and indication for surgery should be balanced carefully. Minor evidence indicates that second-look surgery for CCM remnants might be safe and favorable.

Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era.

Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay. A retrospective analysis on 895 patients undergoing pulmonary lobectomy from January 2014 to December 2019 was performed. PAAL was defined as air leak lasting more than 5 days after lung surgery. Univariate analyses and logistic regressions were performed to identify the predictors of PAAL. A backward selection algorithm was used to identify the optimal set of predictors. The incidence of PAAL was 8.2% (74/895). Male gender (p=0.017), BMI (p<0.001), transient ischemic attack (p=0.031), FEV1 (p=0.018), lobectomy combined with adjacent subsegmentectomy (p=0.018), partial and extended pleural adhesions (p=0.033 and p=0.038, respectively) were identified as independent risk factors for PAAL through logistic regression. A weak positive correlation was found between video-assisted thoracic surgery (VATS) and PAAL following pulmonary lobectomy (p=0.100). PAAL was found to be associated with higher risk of postoperative morbidity (p=0.002) and with longer hospital stay (p<0.001). Both preoperative and intraoperative risk factors may be responsible for PAAL after pulmonary lobectomy. VATS does not appear to prevent this postoperative complication. An alveolar air leak lasting beyond 5 days after pulmonary lobectomy is associated with worse postoperative outcomes.

USEFULNESS OF THE AGE-ADJUSTED CHARLSON COMORBIDITY INDEX AS A PREDICTOR OF MORBIDITY AND MORTALITY IN PATIENTS OVER 80 YEARS OF AGE WITH COLORECTAL CANCER

Abstract Introduction The age adjusted Charlson Comorbidity Index (aCCI) is the most widely used prognostic tool in patients with comorbidity. Our aim is to evaluate its relationship with postoperative morbidity and mortality. Methods Retrospective observational analysis of 145 patients &amp;gt;80 years with CRC operated upon between 2018–2020 in a tertiary center with 2-year follow-up. Pre- and postoperative variables such as aCCI, tumor stage and location, Clavien-Dindo and 2-year survival were selected. Survival analysis was performed according to Kaplan-Meier and ROC curves to predict postoperative mortality/complications. To determine association, a Cox univariate regression model was used. Results The mean age was 86 years, the right colon was the most frequent tumor location and laparoscopy was the predominant approach. Only 12.4% presented major complications (Clavien-Dindo &amp;gt;=3). There was no statistically significant association between aCCI and surgical complications HR 1.118 (p 0.095), and there was a relationship with the development of medical complications OR 1.28 (p 0.020) with a sensitivity of 71% and a cut-off point of aCCI 7.5 AUC 0. 637. Overall survival at 2 years was 79% (26 deaths). We did not find a statistically significant association between aCCI and mortality (p 0.286), a weak predictor AUC 0.582. Conclusions Elevated aCCI is not related to a higher risk of postoperative morbidity and mortality and has little predictive capacity for surgical complications; however, aCCI &amp;gt;7 is associated with a higher probability of medical complications. Prospective studies are needed to include multivariable analyses associated with aCCI.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Prognostic Value of Preoperative Serological Biomarkers in Patients Undergoing Curative-Intent Cytoreductive Surgery for Colorectal Cancer Peritoneal Metastases

BackgroundCytoreductive surgery (CRS) for peritoneal metastases of colorectal cancer (PMCRC) is associated with a high risk of postoperative morbidity, thus making patient selection of upmost importance. Further to data showing an association between preoperative serological biomarkers and patient outcome in various solid tumors, in this study we aim to evaluate their prognostic value in patients with PMCRC treated with curative intent.Patients and MethodsThis is a retrospective study including patients with PMCRC treated by complete CRS ± HIPEC at our institution between 2011 and 2020. Preoperative serological biomarkers, along with other standard clinicopathological variables, were studied to determine their prognostic value.ResultsA total of 94 out of 108 patients met the inclusion criteria. Forty-three patients (46%) presented with synchronous PM. The median peritoneal cancer index (PCI) was 6. On univariate analysis, a higher neutrophil-to-lymphocyte ratio (NLR) was associated with poor prognosis in terms of overall survival (OS) [cutoff 3.567, hazard ratio (HR) 2.8 (1.4–5.3), p = 0.002], whereas a higher platelet-to-lymphocyte ratio (PLR) predicted favorable prognosis in terms of disease-free survival (DFS) [cutoff 185.4, HR 1.9 (1.07–3.53), p = 0.030]. On multivariate analysis, NLR > 3.567, positive lymph nodes (LNs), and PCI > 7 were independent predictive factors for worse OS, whereas NLR > 3.567 and positive LNs were significantly associated with worse DFS. PLR > 185.4 was associated with better DFS.ConclusionHigh preoperative NLR (> 3.567) and PLR (> 185.4) can predict outcome of patients with PMCRC treated by complete CRS ± HIPEC.

Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas – a retrospective population based study

BackgroundAlthough high grade gliomas largely affect older patients, current evidence on neurosurgical complications is mostly based on studies including younger study populations. We aimed to investigate the risk for postoperative complications after neurosurgery in a population-based cohort of older patients with high grade gliomas, and explore changes over time.MethodsIn this retrospective study we have used data from the Swedish Brain Tumour Registry and included patients in Sweden age 65 years or older, with surgery 1999–2017 for high grade gliomas. We analysed number of surgical procedures per year and which factors contribute to postoperative morbidity and mortality.ResultsThe study included 1998 surgical interventions from an area representing 60% of the Swedish population. Over time, there was an increase in surgical interventions in relation to the age specific population (p < 0.001).Postoperative morbidity for 2006–2017 was 24%. Resection and not having a multifocal tumour were associated with higher risk for postoperative morbidity. Postoperative mortality for the same period was 5%. Increased age, biopsy, and poor performance status was associated with higher risk for postoperative mortality.ConclusionsThis study shows an increase in surgical interventions over time, probably representing a more active treatment approach.The relatively low postoperative morbidity- and mortality-rates suggests that surgery in older patients with suspected high grade gliomas can be a feasible option. However, caution is advised in patients with poor performance status where the possible surgical intervention would be a biopsy only.Further, this study underlines the need for more standardised methods of reporting neurosurgical complications.

Impact of neoadjuvant chemotherapy on fitness for surgery in high-risk patients with advanced ovarian cancer (566)

<b>Objectives:</b> Using a validated surgical triage algorithm, we identified women who are at high risk of postoperative morbidity & mortality (M/M) after surgery for advanced ovarian cancer (OC). We sought to determine the impact of neoadjuvant chemotherapy (NACT) on variables used to determine fitness for surgery and the resultant perioperative outcomes. <b>Methods:</b> Women who underwent primary (PDS) or interval (IDS) debulking surgery for stage IIIC/IV OC (institution 1: From January 2012 to July 2016; institution 2: From October 2011 to November 2019) were classified as high-risk or triage-appropriate retrospectively using a validated triage algorithm. A woman was considered high-risk if at least one of the following high-risk criteria were present: <i>(i)</i> Albumin <3.5g/dL, <i>(ii)</i> age ≥80 years, or <i>(iii)</i> age 75-79 and at least one of the following: ECOG (Eastern Cooperative Oncology Group) performance status >1, stage IV disease, or complex surgery required (more than hysterectomy, salpingo-oophorectomy, and omentectomy). For the NACT/IDS group, we compared serum albumin (normal: >3.5g/dL, low: <3.5g/dL) and triage risk classification before and after NACT, including only women who had data available at both time points. Outcomes were compared between groups using the Wilcoxon rank-sum test, Chi-square test, or Fisher's exact test. <b>Results:</b> Among 959 included women, 65.3% (626/959) underwent PDS, and 34.7% (333/959) underwent NACT/IDS. Among 97 women in the NACT/IDS group who had low albumin before NACT, 90.7% (88/97) improved to normal, and a minority (9.3%, 9/97) remained low after NACT. A small proportion (2%, 3/148) of women who had normal albumin before NACT worsened to low albumin after NACT. Similarly, 66.1% (76/115) of women who were high-risk before NACT improved to triage-appropriate after NACT, and 33.9% (39/115) remained highrisk. A minority (2.2%, 3/136) of women who were triage-appropriate before NACT worsened to high-risk after NACT. When compared to the high-risk group who underwent PDS, the group who underwent NACT and improved to triage-appropriate before IDS had a significantly shorter median operative time, a lower proportion with high surgical complexity, a higher proportion with complete cytoreduction (no gross residual disease), and shorter median hospital stay (Table). The 90-day mortality for high-risk women who improved to triage-appropriate after NACT was five times lower than that of the high-risk group who underwent PDS (1.3% vs 6.5%; p=0.11), although this difference was not statistically significant due to low numbers. <b>Conclusions:</b> For women with advanced OC who are poor surgical candidates, NACT is an effective prehabilitation strategy for improving serum albumin levels, changing triage risk classification, and improving perioperative outcomes.

Using the Revised Cardiac Risk Index to Predict Major Postoperative Events for People With Kidney Failure: An External Validation and Update

BackgroundPeople with kidney failure have high risk of postoperative morbidity and mortality. Although the revised cardiac risk index (RCRI) is used to estimate the risk of major postoperative events, it has not been validated in this population. We aimed to externally validate the RCRI and determine whether updating the model improved predictions for people with kidney failure. MethodsWe derived a retrospective, population-based cohort of adults with kidney failure (maintenance dialysis or sustained estimated glomerular filtration rate < 15 mL/min per 1.73 m2) who had surgery in Alberta, Canada between 2005 and 2019. We categorized participants based on RCRI variables and assigned risk estimates of death or major cardiac events, and then estimated predictive performance. We re-estimated the coefficients for each RCRI variable and internally validated the updated model. Net benefit was estimated with decision curve analysis. ResultsAfter 38,541 surgeries, 1204 events (3.1%) occurred. The estimated C-statistic for the original RCRI was 0.64 (95% confidence interval: 0.62, 0.65). Examination of calibration revealed significant risk overestimation. In the re-estimated RCRI model, discrimination was marginally different (C-statistic 0.67 [95% confidence interval: 0.66, 0.69]), though calibration was improved. No net benefit was observed when the data were examined with decision curve analysis, whereas the original RCRI was associated with harm. ConclusionsThe RCRI performed poorly in a Canadian kidney failure cohort and significantly overestimated risk, suggesting that RCRI use in similar kidney failure populations should be limited. A re-estimated kidney failure-specific RCRI may be promising but needs external validation. Novel perioperative models for this population are urgently needed.

Postoperative functional results of older patients after pancreas and liver surgery

In clinical observational studies, overall survival and cancer-specific survival are usually considered the gold standard endpoints. Equally or even more important for older patients are patient-reported outcomes, defined as a set of patient­-centered measures that evaluate physical, mental, and social health. This is particularly important due to the complexity of surgical treatment and the higher risk of postoperative morbidity and mortality. The studies showed that after these operations, the quality of life (QoL) decreases and that is improving with time. After 6 months there was no difference in QoL between younger and older patients. Nevertheless, the results refer mostly to the group of patients who survived the follow-up period and had no recurrence. Therefore, age itself should not be a contraindication for pancreatic or liver surgery. QoL of patients not qualified for surgery decreased constantly.