Independent Predictor Of Postoperative Complications Research Articles

The impact of gastrointestinal diseases on oral and maxillofacial surgery outcomes

We analyzed the complication rates and outcomes in patients with gastrointestinal disorders who had undergone maxillofacial surgery. We retrospectively analyzed 289 patients with inflammatory bowel disease (IBD), 142 with gastroesophageal reflux disease (GERD), and 42 with celiac disease (452 total) who had undergone oral and/or maxillofacial surgery. We examined their characteristics, medications they had taken, surgeries they had undergone, and complications they had experienced. Based on the results of univariate analysis, we selected variables for multivariable logistic regression to identify independent predictors of postoperative complications. We found a complication rate of 10% in patients with IBD, 6.9% in patients with GERD, and 9.5% in patients with celiac disease. Dentoalveolar treatment was significantly associated with an increased risk of postoperative complications in patients with IBD and GERD. Oral and/or maxillofacial surgery is safe in most patients with IBD, GERD, and celiac disease. Preventive measures for postoperative complications should be considered in patients with IBD and GERD undergoing dentoalveolar treatment.

O036 Postoperative complications are predicted by surgery duration in the unilateral deep inferior epigastric perforator (DIEP) flap reconstruction: a retrospective cohort study

Abstract Introduction Currently, one published study documented operative time (OT) as a predictor for postoperative outcomes in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstructions. No literature has investigated this in unilateral DIEP flaps. We aimed to determine the relationship between unilateral OT, postoperative complications and length-of-stay (LOS). Methods Electronic hospital data of adult women that underwent elective immediate or delayed unilateral DIEP reconstruction at a tertiary centre in London, between 2021 to 2022, was retrospectively analysed. Patients were divided into four groups depending on OT quartiles to define a critical cut-off period. Data on extensive potential confounders was recorded and used in univariable and multivariable regression models. Further statistical analyses were performed where appropriate. Results The final cohort contained 66 patients. Through quartiles, the risk-adjusted cut-off OT was defined as 515 minutes. After risk-adjustment, operations >515 minutes had a significantly higher overall complication rate than ≤515 minutes (HR: 2.16, p=0.032, 95% CI: 1.067, 4.38). No significant difference in mean ranks of LOS (p=0.16) was noted above the cut-off period. In patients that developed at least one complication type, no significant difference was observed in the unadjusted return-to-theatre rate between the two groups (HR: 0.86, p=0.82, 95% CI: 0.23, 3.24). Conclusion We confirmed OT was an independent predictor for postoperative complications in the DIEP flap and demonstrated this in unilateral reconstructions. Larger multicentre prospective studies are required to ascertain the significance of the OT effects, and to deduce the minimum OT threshold below which detriment to patient outcomes arises.

Assessment of the Predictive Value of Preoperative Serum Albumin and Postoperative Albumin Drop (ΔAlb) for Complications after Pancreas Surgery: A Single-Center Cross-Sectional Study.

Serum albumin has been shown to be predictive of complications after various gastrointestinal operations. The present study aimed to assess whether preoperative serum albumin and serum albumin drop on postoperative day 1 are associated with postoperative complications after pancreatic surgery. A single-center cross-sectional study was performed. All patients who underwent pancreatectomy between January 2010 and June 2019 and had preoperative serum albumin value and serum albumin value on postoperative day 1 were included. ΔAlb was defined as the difference between preoperative serum albumin and serum albumin on postoperative day 1. Binary logistic regressions were performed to determine independent predictors of postoperative complications. A total of 185 patients were included. Pancreatoduodenectomies were performed in 133 cases, left pancreatectomies in 36, and other pancreas operations in 16. The preoperative serum albumin value was found to be an independent predictor of complications (OR 0.9, 95%CI 0.9-1.0, p = 0.041), whereas ΔAlb was not significantly associated with postoperative complications (OR 1.0, 95%CI 0.9-1.1, p = 0.787). The threshold of 44.5 g/L for preoperative albumin level was found to have the highest combined sensitivity and specificity based on the maximum Youden index. Patients with preoperative albumin < 44.5 g/L had a higher incidence of postoperative complications and higher median comprehensive complication index than patients with preoperative albumin ≥ 44.5 g/L. This study highlighted that preoperative serum albumin is an independent predictor of postoperative complications after pancreas surgery.

Preoperative controlling nutritional status score (CONUT) predicts postoperative complications of patients with bronchiectasis after lung resections.

The Controlled Nutritional Status (CONUT) score is a valid scoring system for assessing nutritional status and has been shown to correlate with clinical outcomes in many surgical procedures; however, no studies have reported a correlation between postoperative complications of bronchiectasis and the preoperative CONUT score. This study aimed to evaluate the value of the CONUT score in predicting postoperative complications in patients with bronchiectasis. We retrospectively analyzed patients with localized bronchiectasis who underwent lung resection at our hospital between April 2012 and November 2021. The optimal nutritional scoring system was determined by receiver operating characteristic (ROC) curves and incorporated into multivariate logistic regression. Finally, independent risk factors for postoperative complications were determined by univariate and multivariate logistic regression analyses. A total of 240 patients with bronchiectasis were included, including 101 males and 139 females, with an average age of 49.83 ± 13.23 years. Postoperative complications occurred in 59 patients (24.6%). The incidence of complications, postoperative hospital stay and drainage tube indwelling time were significantly higher in the high CONUT group than in the low CONUT group. After adjusting for sex, BMI, smoking history, lung function, extent of resection, intraoperative blood loss, surgical approach and operation time, multivariate analysis showed that the CONUT score remained an independent risk factor for postoperative complications after bronchiectasis. The preoperative CONUT score is an independent predictor of postoperative complications in patients with localized bronchiectasis.

Skeletal Muscle Loss During Neoadjuvant Chemotherapy Predicts the Incidence of Postoperative Infectious Complications in Esophageal Cancer Patients Undergoing Esophagectomy.

Malnutrition, immune deficiency, and skeletal muscle loss are associated with a risk of postoperative complications in patients with various types of cancer. This study evaluated whether malnutrition, immunological deficiencies, and skeletal muscle loss during neoadjuvant chemotherapy (NAC) predict postoperative complications in patients with esophageal cancer. We retrospectively reviewed 123 patients with esophageal squamous cell carcinoma treated with NAC and esophagectomy at our hospital between 2014 and 2019. Patients were divided into two groups based on the presence or absence of postoperative infectious complications, such as pneumonia, anastomotic leakage, surgical site infections, pyothorax, acalculous cholecystitis, and peripheral phlebitis. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Onodera prognostic nutritional index were used as indicators of systemic inflammation and nutritional status. Skeletal muscle mass was evaluated using the skeletal muscle index (SMI), calculated by evaluating the total cross-sectional area of muscle tissue at the third lumbar level in computed tomography imaging. Univariable and multivariable logistic regression analyses were used to identify predictors of postoperative infectious complications. Postoperative infectious complications occurred in 41 patients (33.3%). A reduction in SMI was observed in 105 patients (87.8%) during NAC. Univariable and multivariable analyses indicated that the reduction in SMI during NAC was an independent predictor of postoperative complications (odds ratio=0.89; 95% confidence interval=0.79-0.99; p=0.048). Skeletal muscle loss during NAC is a useful predictor of postoperative complications in patients with esophageal cancer undergoing esophagectomy.

Calf circumference is an independent predictor of postoperative complications in the surgical treatment of head and neck cance

Introduction: The prevalence of malnutrition is high among head and neck cancer (HNC) patients and negatively impacts their quality of life, treatment, and survival rates. Objective: To identify preoperative nutritional variables capable of predicting postoperative complications in surgically treated HNC patients. Methods: This was a prospective cohort study of HNC patients referred for surgery as initial treatment. Results: Sixty patients were included in the study; they had a median age of 65.5 years, were mostly men (85%), and most had low education levels (90%) and low household income (78.3%). The incidence rate of severe postoperative complications (grades II, III, IV, and V according to the Clavien-Dindo grading system) was found to be 50%. The nutritional variables under investigation, namely calf circumference (CC), triceps skinfold, body mass index, and adductor pollicis muscle thickness were shown to predict postoperative complications in HNC patients, especially CC, which was found to be an independent predictor of complications (OR=0.8; 95%CI: 0.65–0.96). Each 1-cm increase in calf circumference was associated with a 20% decrease in the risk of postoperative complications. Conclusion: Our findings show the nutritional variables studied are useful in the prognostic assessment of HNC surgery.

Prognostic significance of preoperative prognostic immune and nutritional index in patients with stage I–III colorectal cancer

BackgroundTo explore the value of preoperative prognostic immune and nutritional index (PINI) in predicting postoperative complications and long-term outcomes in patients with stage I–III colorectal cancer (CRC).MethodsRestricted cubic splines were used to assess the relationship between PINI and survival in patients with CRC. The Kaplan–Meier method and log-rank test were used to plot the survival curves. The Cox proportional hazards model was used to evaluate independent prognostic predictors in patients with CRC. A logistic regression analysis was performed to identify independent predictors of postoperative complications. The least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used for feature screening.ResultsAn evident positive dose–response relationship between PINI and survival in patients with CRC was identified. Compared with patients with a high PINI, those with a low PINI had worse disease-free survival (DFS) (47.9% vs. 66.9%, p < 0.001) and overall survival (OS) (49.7% vs. 70.2%, p < 0.001). The Cox proportional hazards model revealed that PINI was independently associated with DFS (hazard ratio [HR], 0.823; 95% confidence interval [CI], 0.754–0.898; p < 0.001) and OS (HR, 0.833; 95% CI, 0.761–0.912; p < 0.001) in patients with CRC. In the logistic regression analysis, PINI was an independent factor affecting postoperative complications in patients with CRC (odds ratio, 0.710; 95%CI: 0.610–0.810, p < 0.001). The LASSO logistic regression algorithm was used to screen for effective prognostic variables. Finally, we constructed PINI-based nomograms to predict postoperative 1–5-year PFS, and OS in patients with CRC.ConclusionPINI is an effective biomarker for predicting postoperative complications, DFS, and OS in patients with stage I–III CRC.

Relationship between Preoperative Nutritional Status and Clinical Outcomes in Patients with Head and Neck Cancer

The nutritional status in cancer patients is related to cancer survival and surgical outcome. The objective of this study was to examine the relationship between preoperative prognostic nutritional index (PNI) and post-operative clinical outcomes in head and neck cancer (HNC) patients. A total of 1282 head and neck cancer patients receiving surgical resection in Changhua Christian Hospital between 1 January 2010 and 30 August 2021 were recruited in the final analysis after undergoing propensity score matching analysis. The logistic regression model was used to assess the association of the PNI group with overall and various complications. The patients in the high PNI group had a significant lower incidence of overall complications, medical complications, and pulmonary complications; but not significant surgical complications. The high PNI group had lower mortality risk. The results in this study revealed that PNI score was a significant independent predictor of postoperative complications in HNC patients undergoing surgical resection. We recommend preoperative testing and evaluation of HNC patients to identify low PNI and high-risk groups for postoperative surveillance.

Abdominal aortic calcification volume (AACV) is a predictive factor for postoperative complications associated with biliary tract cancer.

Curative surgical treatment of biliary tract cancer is highly invasive and involves postoperative complications. Abdominal aortic calcification is a parameter that is reportedly linked to systemic arteriosclerosis. We measured the abdominal aortic calcification volume (AACV), assessed the correlation between AACV and postoperative complications, and evaluated the clinical utility of AACV. We retrospectively evaluated 97 patients (ampullary carcinoma, n = 21; distal bile duct cancer, n = 43; hilar bile duct cancer, n = 33). We assessed the calcification volume of the abdominal aorta from the renal artery ramification to the common iliac artery bifurcation. The correlation between AACV, clinical factors, and postoperative complications was evaluated. The average AACV was 5.02cm3, and the median AACV was 3.74 (range 0-27.4)cm3. The AACV was significantly related to age (P = 0.009), Brinkman index (P = 0.007), and history of cardiovascular disease (P = 0.015). The AACV was strongly correlated with postoperative complications (P < 0.001) and Clavien-Dindo grade > III postoperative complications (P < 0.001). The AACV was also correlated with pancreatic fistula in pancreatectomy cases (P < 0.001). A multivariate analysis revealed that the AACV was an independent predictor of postoperative complications. The AACV was significantly associated with postoperative complications. The AACV could be used for the preoperative assessment of surgical risk.

Glomerular hyperfiltration is a predictor of adverse outcomes following major urologic oncology surgery.

Glomerular hyperfiltration (GHF) has been associated with cardiovascular disease and all-cause mortality. We aimed to evaluate whether preoperative GHF is associated with 30-day complications following major urologic oncology procedures. We conducted a retrospective cohort study using subjects from the 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database who underwent prostatectomy, cystectomy, or nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Patients were classified as having either low, normal, or high eGFR based on the 5th and 95th percentiles of age- and sex-specific quintiles for eGFR. Using multivariable logistic regression, we evaluated GHF as an independent predictor of postoperative complications. A total of 120,013 patients were eligible for analysis, of which 1706 (1.4%) were identified as having GHF, with a median eGFR of 105.37ml/min per 1.73 m2 (IQR 94.84-116.77). Compared to patients with normal eGFR, patients with GHF were older (68years, [IQR 60-71], p < 0.001), had a lower BMI (27.52kg/m2 [IQR 23.71-31.95], p < 0.001), and greater 5-item modified frailty index scores (≥ 1, 70.6%, p < 0.001). Multivariable logistic regression demonstrated that GHF was associated with greater odds of any complication (OR 1.23, 95% CI 1.08-1.40, p = 0.002), non-home discharge (OR 1.86, 95% CI 1.50-2.30, p < 0.001), and prolonged LOS (OR 1.33, 95% CI 1.18-1.51, p < 0.001). GHF is associated with greater odds of 30-day complications following major urologic oncology surgery.

Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis

BackgroundThe literature on predictors for postoperative complications after Frey procedure (FP) is sparse. The aim of this study is to report our experience with 90-day complications of FP and predictors for complications. MethodsAll patients with chronic pancreatitis (CP), who underwent a FP between August 2007 and July 2021, were retrospectively reviewed. Univariate and multivariate analysis were used to identify predictors of 90-day morbidity and mortality. ResultsOf the total 270 patients, 84 (31%) patients developed at least one postoperative complication. Major complications occurred in 32 (12%) patients. Most common complication was wound infection and it was significantly more common in stented patients (p = 0.017). Pancreatic fistula and post pancreatectomy hemorrhage (PPH) developed in 7.4% of patients. Thirteen patients (4.8%) required early re-operation and the most common cause of re-exploration was PPH. 90-day mortality was 1% (n = 3) and all 3 patients required re-exploration for PPH. Median postoperative hospital stay was 9 (5–51) days. Perioperative blood transfusions was the only independent predictor of postoperative complications after FP. ConclusionsFrey procedure is an acceptable treatment modality with low rates of mortality and reasonable perioperative morbidities. Minimizing blood transfusions may further improve 90-day outcomes.

Perioperative outcomes of emergency and elective colorectal surgery: a bi-institutional study.

Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals. Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications. During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P= 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P= 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P< 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P= 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47). The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.

Muscle mass ratio in male gastric cancer patients as an independent predictor of postoperative complications after minimally invasive distal gastrectomy.

The current study aimed to investigate the relationship between muscle mass proportion and the incidence of total complications in male gastric cancer (GC) patients after minimally invasive distal gastrectomy (MIDG). Between March 2017 and March 2020, 152 male GC patients with clinical stage III or lower GC who underwent MIDG were enrolled in this study. The muscle mass ratio (MMR) was calculated by dividing the total muscle weight obtained from bioelectrical impedance analysis by the whole-body weight. Thereafter, the association between MMR and surgical outcomes was determined. Based on the optimal MMR cutoff value of 0.712 obtained using the receiver operating characteristic (ROC) curve, patients were divided into two groups (69 and 83 patients in the MMR-L and MMR-H groups). The MMR-L group had a significantly higher total complication rate compared to the MMR-H group (MMR-L, 24.6% vs. MMR-H, 7.2%; P = 0.005). Multivariate analysis also identified MMR-L as a significant independent risk factor for total complications and intra-abdominal infectious complications after MIDG. The MMR calculated using bioelectrical impedance analysis can be a useful predictor for postoperative complications after MIDG in male GC patients.

Radiomics in Addition to Computed Tomography-Based Body Composition Nomogram May Improve the Prediction of Postoperative Complications in Gastric Cancer Patients

Objectives: The study aimed to determine the impact of computed tomography (CT)-based body composition and radiomics nomogram on the prediction of postoperative complications in gastric cancer. Methods: The clinical data of 457 individuals with surgically confirmed gastric cancer, 320 patients in the training cohort (TC) and 137 patients in the validation cohort (VC), were retrospectively analyzed. Body composition data were measured using CT. Postoperative complications were graded using the Clavien-Dindo system. Dedicated radiomics prototype software was used to segment lesions and extract characteristics from preoperative portal venous-phase CT images. Clinical, radiomics, and combined models were developed using logistic regression analysis. Model performance was evaluated using the area under the curve (AUC) of receiver operating characteristic curve, and the prediction ability of the optimal model was evaluated using calibration curves and decision curve analysis (DCA). Results: Nutritional Risk Screening 2002 (NRS2002) score, sarcopenia, and blood loss were independent predictors of postoperative complications in gastric cancer. A radiomics signature was created using 19 conserved radiomics features. The nomogram based on both the clinical model and radiomics signature showed the greatest predictive performance, with AUCs of 0.763 (95% confidence interval [CI], 0.708–0.817) and 0.748 (95% CI: 0.667–0.818) in the TC and VC, respectively. The calibration curve and DCA revealed that the nomogram was beneficial in clinical practice for the preoperative prediction of postoperative complications. Conclusions: The combined model consisting of NRS2002 score, sarcopenia, blood loss, and a radiomics signature holds potential application value for the individualized prediction of postoperative complications in gastric cancer patients.

The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis

Malnutrition is an independent predictor for postoperative complications in low- and middle-income countries (LMICs). We systematically reviewed evidence on the impact of preoperative oral nutrition supplementation (ONS) on patients undergoing gastrointestinal cancer surgery in LMICs. We searched EMBASE, Cochrane Library, Web of Science, Scopus, WHO Global Index Medicus, SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) databases from inception to March 21, 2022 for randomised controlled trials evaluating preoperative ONS in gastrointestinal cancer within LMICs. We evaluated the impact of ONS on all postoperative outcomes using random-effects meta-analysis. Seven studies reported on 891 patients (446 ONS group, 445 control group) undergoing surgery for gastrointestinal cancer. Preoperative ONS reduced all cause postoperative surgical complications (risk ratio (RR) 0.53, 95% CI 0.46–0.60, P < 0.001, I2 = 0%, n = 891), infection (0.52, 0.40–0.67, P = 0.008, I2 = 0%, n = 570) and all-cause mortality (0.35, 0.26–0.47, P = 0.014, I2 = 0%, n = 588). Despite heterogeneous populations and baseline rates, absolute risk ratio (ARR) was reduced for all cause (pooled effect −0.14, −0.22 to −0.06, P = 0.006; number needed to treat (NNT) 7) and infectious complications (−0.13, −0.22 to −0.06, P < 0.001; NNT 8). Preoperative nutrition in patients undergoing gastrointestinal cancer surgery in LMICs demonstrated consistently strong and robust treatment effects across measured outcomes. However additional higher quality research, with particular focus within African populations, are urgently required.

Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study

BackgroundDecrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications.MethodsThis was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien–Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range).ResultsThe incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12–25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05–31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90–0.99).ConclusionsThe HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications.

Predicting the Risk of Postoperative Complications of Schwannoma Surgery: Development and Assessment of a New Predictive Nomogram.

The aim of this study was to develop and internally validate a risk nomogram for postoperative complications of schwannoma surgery. From 2016 to 2020, we reviewed 83 patients who underwent schwannoma resection with a total number of 85 schwannomas. A predictive model was developed based on the dataset of this group. During model construction, univariate and multivariate logistic regression analysis were used to determine the independent predictors of postoperative complications. Assessment of the discriminative function, calibrating proficiency, and clinical usefulness of the predicting model was performed using C-index, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis. Internal validation was assessed using bootstrapping validation. Predictors contained in the prediction nomogram included age, tumor location, symptoms, and surgical approach. The model displayed satisfying abilities of discrimination and calibration, with a C-index of 0.901 (95% confidence [CI]: 0.837-0.965). A high C-index value of 0.853 was achieved in the interval verification. Decision curve analysis showed that the nomogram was clinically useful when intervention was decided at the complication possibility threshold of 2%. This new risk nomogram for postoperative complications of schwannoma surgery has taken age, tumor location, symptoms, and surgical approach into account. It has reasonable predictive accuracy and can be conveniently used. It shall help patients understand the risk of postoperative complications before surgery, and offer guidance to surgeons in deciding on the surgical approach.

Total Risk Points Predict Short- and Long-term Outcomes Following Colorectal Cancer Resection in Older Patients.

Estimation of physiological ability and surgical stress (E-PASS) is reported to be useful as a predictor of postoperative complications and poor long-term survival after colorectal cancer. The total risk points (TRP) system is a simplified scoring system of E-PASS, and this study evaluated the utility of TRP in colorectal cancer resection in older patients. The clinicopathological data of 237 patients who underwent curative resection for colorectal cancer from 2015 to 2020 were analyzed retrospectively. The data were compared between a high TRP group (≥1,000, n=38) and a low TRP group (<1,000, n=199). We also conducted an analysis to determine risk factors of postoperative complications and poor long-term survival. TRP showed statistically significant correlations with the comprehensive risk score (CRS) of E-PASS (R=0.999, p<0.001). The high TRP group experienced postoperative complications (Clavien-Dindo grade ≥2) more frequently (42.1% vs. 11.1%, p<0.001). Multivariate analysis showed that high TRP [odds ratio (OR)=5.214; 95% confidence interval (95%CI)=2.338-11.629; p<0.001] and age ≥80 (OR=2.760; 95%CI=1.308-5.826; p=0.008) were independent predictors of postoperative complications. Overall survival (OS) was poor in the high TRP group (5-year OS, 61.2% vs. 82.6%, p<0.001) compared with the low TRP group, and in the low prognostic nutritional index (<45) group (5-year OS, 70.9% vs. 86.3%, p=0.013) compared with the high prognostic nutritional index (≥45) group. Multivariate analysis showed that high TRP [hazard ratio (HR)=3.202; 95%CI=1.324-7,745; p=0.010] was an independent prognostic factor for poor OS. Patients aged ≥80 years should be closely monitored regarding postoperative complications. Reducing TRP to less than 1,000 is important to reduce postoperative complications and improve OS.

MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION

MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION

Racial disparities in minimally invasive esophagectomy and gastrectomy for upper GI malignancies.

Esophageal cancer and gastric cancer are two important causes of upper GI malignancies. Literature has shown that minimally invasive esophagectomies (MIE) and gastrectomies (MIG), have shorter length of stay and fewer complications. However, limited literature exists about the association between race and access to MIE and MIG. This study aims to identify the racial disparities in the different approaches to esophagectomy and gastrectomy. We further evaluate the relationship between the race and postoperative complications. This IRB-approved retrospective study utilized data from the American College of Surgeons National Quality Improvement Program. All recorded cases of MIE, MIG, open gastrectomy, and esophagectomy between 2012 and 2019 were isolated. Propensity score matching and univariate analysis was performed to assess the independent effect of black self-identified race on access and outcomes. p < 0.05 was required to achieve statistical significance. 7891 cases of esophagectomy and 5,132 cases of gastrectomy cases were identified. Using Propensity and logistic regression, we identified that black self-reported race is an independent predictor of open approach to gastrectomy (OR 1.6871943, 95% CI 1.431464-1.989829, p < 0.001). Black self-reported race was not predictive of operative approach among esophagectomy patients (OR 0.7942576, 95% CI 0.5698645-1.124228, p = 0.183). In contrast, black self-reported is an independent predictor of postoperative complications among esophagectomy patients only. Esophagectomy patients of black self-reported race were more likely to experience any complication (OR 1.4373437, 95% CI 1.1129239-1.8557096, p = 0.00537), severe complications (OR 1.3818966, 95% CI 1.0653087-1.7888454, p = 0.0144), and death (OR 2.00779762, 95% CI 1.08034921-3.56117535, p = 0.0211) within 30days of their surgeries. Our analysis revealed a significant racial disparity in access to MIG and a higher incidence of post-operative complications amongst esophagectomy patients. Minimally invasive techniques are underutilized in racial minorities. The findings herein warrant further investigation to eliminate barriers and disparities.