Independent Risk Factors For Complications Research Articles

How long can pulmonary resection surgery be performed after SARS-CoV-2 infection? A multicenter retrospective study.

No studies to date have focused on the timing of pulmonary resection in patients with previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the present study, the authors analyzed the surgical outcomes and evaluated the optimal time point of pulmonary resection surgery following SARS-CoV-2 infection. In this multicenter retrospective cohort study, patients were divided into different groups according to the time interval between SARS-CoV-2 diagnosis and pulmonary resection. The primary outcome measure was postoperative complications within 30 days after surgery, which was investigated to determine the optimal time point of pulmonary resection. Logistic regression models were used to calculate the risk factors for postoperative complications. In total, 400 patients were enrolled, and the postoperative pathologic examination of 322 (80.5%) patients showed lung cancer. As the interval between SARS-CoV-2 infection and pulmonary resection increased, the incidence of complications gradually decreased in each group. The incidence of grade ≥II complications was higher in the ≤2-week and 2-week to 4-week groups than in the 4-week to 6-week, 6-week to 8-week and >8-week groups [3 (21.4%), 17 (20.2%), 10 (10.6%), 13 (7.9%), and 3 (6.5%), respectively] ( P <0.05). Multiclassification regression analysis showed that the risk of grade ≥II complications in the ≤2-week and 2-week to 4-week groups was significantly higher than that in the >8-week group [odds ratio (95% CI), 3.937 (1.072-14.459), P =0.039 and 3.069 (1.232-6.863), P =0.015]. The logistic regression analysis suggested that underlying disease, persistent SARS-CoV-2 symptoms, and surgical timing (≤4 weeks) were independent risk factors for complications of pulmonary resection after SARS-CoV-2 infection. Pulmonary resection should be delayed for at least 4 weeks following SARS-CoV-2 infection to reduce the risk of postoperative complications.

Imaging risk factors for predicting postoperative complications of intramedullary nailing for tibial fracture.

The objective of this study was to analyze the ratio of fracture site diameter to tibial isthmus diameter (TFI ratio) as a predictor of postoperative complications, including malunion and delayed union, after tibial intramedullary nailing for middle and lower tibial fractures. Data were collected from all adult patients older than 20 years of age who underwent tibial intramedullary nailing for middle and lower tibial fractures between January 2015 and January 2023 and were followed up for at least 1 year. Diabetes history, smoking history, fracture type, injury mechanism, surgical method, surgical approach, diameter of the medullary cavity at the fracture site, and diameter of the tibial isthmus were recorded. Logistic regression analysis was used to determine the variables affecting the occurrence of complications. The TFI ratio was used to calculate the sensitivity and specificity of the parameters, and ROC curves were generated to establish TFI ratio thresholds for predicting complications. A total of 123 patients with middle and lower tibial fractures were treated with intramedullary nails. The mean age of the patients was 43.72 years (range, 21-81 years); 89 were males, and 34 were females. Univariate logistic regression analysis showed that fracture type, open reduction surgery, superior patellar approach, and TFI ratio were significantly correlated with postoperative complications after intramedullary nailing of a tibial fracture. Multivariate logistic regression analysis showed that the TFI ratio was an independent risk factor for complications (P = 0.001*). By using the TFI ratio as a predictor of complications, an ROC curve was generated to establish a threshold. The ROC curve showed that a TFI ratio ≥ 1.31 had a sensitivity of 0.89, a specificity of 0.71, and an area under the ROC curve of 0.82 for predicting complications. The results of this study suggest that a wider intramedullary diameter and a shorter fixed length at the fracture site are associated with a higher incidence of complications after tibial intramedullary nailing. The TFI ratio may be used as a reliable parameter for predicting complications after such surgery. In patients with a high TFI ratio (≥ 1.31), additional reduction and fixation techniques may be needed to obtain and maintain fracture reduction.

Outcomes After Induction of Labor Compared With Dilation and Evacuation for the Management of Rupture of Membranes in the Second Trimester.

Previable and periviable rupture of membranes is associated with significant morbidity for the pregnant patient. For those who have a choice of options and undergo active management, it is not known how the risks of induction of labor compare with those for dilation and evacuation (D&E). We performed a retrospective cohort study of patients with rupture of membranes between 14 0/7 and 23 6/7 weeks of gestation who opted for active management. Adverse events (52.2% vs 16.9%, P <.01) and time to uterine evacuation greater than 24 hours (26.7% vs 9.6%, P =.01) were more common among patients undergoing induction of labor. In a multivariable regression, induction of labor was an independent risk factor for complications (odds ratio 5.70, 95% CI, 2.35-13.82) compared with D&E. Severe complications were rare across both groups (4.4% for patients undergoing induction vs 2.6% for D&E, P =.63). Given the differing risks by termination method, access to D&E is an important treatment option for this patient population.

Analysis of short-term outcome indicators and risk factors for postoperative complications in patients with sigmoid colon cancer by transumbilical single-port plus one port laparoscopy

This study aimed to compare the efficacy of Single-Port plus One Port Laparoscopy (SILS + 1) with Conventional Multi-Port Laparoscopic Surgery (CLS) and investigate risk factors associated with postoperative complications in patients with sigmoid colon cancer undergoing laparoscopy. Male patients with sigmoid colon cancer treated at our hospital were selected and evenly distributed into the CLS and SILS + 1 groups and further categorized into complication and non-complication groups based on their complications status within 30 days post-surgery. Compared to the CLS group, the SILS+ 1 group had significantly shorter incision length, greater distance to the lower edge of the tumor and shorter time to first postoperative ambulation (p &lt; 0.05). A total of 20 cases (16.67%) developed complications within 30 days post-surgery, and among them, 8 (13.33%) were in the SILS + 1 group and 12 (20.00%) in the CLS group (p = 0.327). Logistic multivariable regression analysis showed that age (p = 0.028; Odds Ratio (OR) = 1.028; 95% confidence interval (CI): 1.003–1.054), body mass index (BMI)(p = 0.002; OR = 1.950; 95% CI: 1.248–2.961) and operation time (p &lt; 0.001; OR = 1.067; 95% CI: 1.030–1.106) were independent risk factors for complication occurrence within 30 days post-surgery, and at 2-year follow-up, there was no significant difference in overall survival between both groups (p &gt; 0.05). In conclusion, age, BMI and duration of surgery were identified as independent risk factors for postoperative complications in male sigmoid colon cancer patients, among whom SILS + 1 was found to reduce postoperative discomfort and accelerate recovery compared to CLS while maintaining surgical efficacy.

Study on the Influence of Changes in Glucolipid Metabolism Parameters on the Incidence of Postoperative Complications in Patients Undergoing Renal Transplantation.

Changes in glucolipid metabolism parameters in patients undergoing renal transplantation (RT) and their influences on the incidence of postoperative complications were analysed. The objective was to provide a reference for clinical practice and reliable and safe implementation of RT. A total of 131 patients treated with RT at our institution from January 2019 to March 2024 were selected for retrospective analysis: 71 patients who developed postoperative complications (research group) and 60 patients who did not (control group). Differences in fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), total cholesterol (TC) and triglyceride (TG) levels before and three days after surgery were compared, and their predictive value for postoperative complications was analysed. In addition, relevant factors influencing complications after RT were identified. HbA1c level changed significantly in neither group after surgery (p > 0.05), but FPG, TG and TC levels increased in both groups (p < 0.05). Differences in FPG and TC levels before and after surgery were larger than those in the control group (p < 0.05). The receiver operating characteristic curve revealed the excellent diagnostic value of differences in FPG and TC levels for postoperative complications, and logistic regression analysis indicated that such differences were independent risk factors for complications after RT (p < 0.05). The early evaluation of postoperative complications can be achieved by monitoring differences in FPG and TC levels before and after RT, allowing for the timely formulation and implementation of interventions.

Preoperative COVID-19 infection status negatively impacts postoperative outcomes of geriatric hip fracture surgery

ObjectivesCompare outcomes for patients with recently diagnosed COVID-19 infection to those without COVID-19 infection undergoing operative treatment of hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. DesignRetrospective propensity score matched cohort. MethodsPatients who received surgery for an acute hip fracture (intramedullary nail (IMN), open reduction internal fixation (ORIF) or hemiarthroplasty) in 2021 were identified from the NSQIP database. Propensity score matching was implemented using patient demographics and preoperative medical conditions to compare outcomes for COVID-19-positive and COVID-19-negative cohorts. ResultsAfter matching, COVID-19-positive patients exhibited a higher risk of 30-day mortality (Odds ratio (OR) 1.48, 95 % confidence interval (CI) 1.01 – 2.04), pneumonia (OR 2.90, 95 % CI: 1.91 – 4.33), unplanned intubation (OR 2.53, 95 % CI: 1.39 – 4.39), and septic shock (OR 2.51, 95 % CI: 1.10 – 4.67). COVID-19-positive patients were also more likely to have a longer length of hospital stay (Hazard Ratio 1.3, 95 % CI: 1.20 – 1.41) and were more likely to be discharged to an acute care hospital (OR 1.90, 95 % CI: 1.03 – 3.06). ConclusionsActive COVID-19 infection is an independent risk factor for complications as well as increased resource utilization in patients undergoing surgical treatment of acute hip fracture. Using the results of this multicenter study, quantification of these risks can help inform practice and treatment protocols for this population. Level of EvidenceIII.

Risk factors for complications and incomplete resection after endoscopic resection for duodenal submucosal tumors.

Endoscopic resection (ER) has been used to remove submucosal tumors (SMTs) in recent years; however, duodenal ER is associated with high rates of immediate or delayed bleeding and perforation. Whether ER can be recommended for the treatment of duodenal SMTs remains controversial. Therefore, we aimed to investigate the clinical outcomes associated with the ER of duodenal SMTs and to assess possible predictive factors for complications and incomplete resection. This retrospective study included 141 patients with duodenal SMTs. The therapeutic outcomes from ER and procedure-related complications were analyzed. Of the 141 patients, 78.7% achieved complete resection and nine (6.4%) developed complications. The multivariate analysis suggested that location near the duodenal papilla (P = 0.010) and diameter exceeding 15mm (P = 0.091) of duodenal SMTs were independent risk factors for complications in ER. Besides, submucosal fibrosis (P = 0.042), location near the duodenal papilla (P = 0.049), and irregular morphology (P = 0.067) were independent risk factors for incomplete resection. ER can be recommended as an effective and minimally invasive treatment for duodenal SMTs.

Application Value of Novel Coagulation Markers in Predicting Postoperarative Complications in the Early Stage After Liver Transplantation

To investigate the relationship between thrombin-antithrombin complex (TAT), plasmin-α 2-plasmininhibitor complex (PIC), soluble thrombomodulin (sTM), and tissue plasminogen activator-inhibitor complex (tPAIC) and postoperative complications in the early stage after liver transplantation (LT). We analyzed the perioperative clinical data, including plasma TAT, PIC, sTM, and tPAIC, of 130 post-LT patients admitted to the intensive care unit (ICU), West China Hospital, Sichuan University between December 2021 and November 2022. Patients were divided into two groups, a complication group and a non-complication group, according to whether they experienced complications of Clavien-Dindo (CD) grade Ⅲb and above within 30 days after the surgery. Univariate analysis and binary multivariate logistic regression models were used to determine the risk factors for complications within 30 days post-LT. The incidence of complications of CD grade Ⅲb and above within 30 days post-LT was 33.1% (43/130). Patients in the complication group had significantly higher scores for the Model for End-Stage Liver Disease (MELD), operative time, intraoperative red blood cell transfusion volume, intraoperative plasma transfusion volume, and plasma TAT, PIC, sTM and tPAIC measured at the time of admission to ICU after the operation than those in the non-complication group did (all P<0.05). Logistic regression showed that for every single U of red blood cells transfused during the transplant surgery, the probabilities of complications within 30 days post-LT increased by 15.1% (95% confidence interval [ C I]: 1.070-1.239, P<0.001) and for the increase of every single TU/mL of plasma sTM measured upon post-LT admission to ICU, the probabilities of complications increased by 13.7% (95% CI: 1.060-1.220, P<0.001). Plasma sTM measured upon admission to ICU after LT is an independent risk factor for complications within 30 days post-LT, and additional assessment of sTM may help predict complications in the early stage post-LT.

Outpatient vs. inpatient total shoulder arthroplasty: complication rates, clinical outcomes, and eligibility parameters

Improvements in total shoulder arthroplasty (TSA), fast-track surgery, multimodal anesthesia, and rehabilitation protocols have opened up the possibility of outpatient care that is now routinely practiced at our European institution. The first objective of this study was to define the TSA outpatient population and to verify that outpatient management of TSA does not increase the risk of complications. The second objective was to determine patient eligibility parameters and the third was to compare functional outcomes and identify influencing factors. The study included 165 patients who had primary TSA (106 outpatient and 59 inpatient procedures). The operative technique was the same for both groups. Demographics, complications, readmissions, and revisions were collected. American Society of Anesthesiologists, Constant, American Shoulder and Elbow Surgeons, University of California Los Angeles shoulder, and Shoulder Pain and Disability Index scores were obtained preoperatively and at 1.5, 6, and 12 months postoperatively. Satisfaction and visual analog scale pain scores also were documented. Statistical analysis was completed using multivariate linear regression. Outpatients were significantly younger and had lower American Society of Anesthesiologists scores than inpatients. The rates of complications, readmissions, and reoperations were not significantly different between groups. Outpatient surgery was not an independent risk factor for complications. At 1.5 months, better outcomes were noted in the outpatient group for all scores, and these reached statistical significance. Distance to home, dominant side, operative time, and blood loss were not associated with functional results. Multivariate analysis demonstrated that outpatient care was significantly associated with improved scores at 1.5 months and did not affect functional outcomes at 6 and 12 months. This study reports the results of routine outpatient TSA within a European healthcare system. TSA performed in an outpatient setting was not an independent risk factor for complications and seemed to be an independent factor in improving early functional results.

Inpatient vs outpatient arthroplasty: A in-state database analysis of 90-day complications

IntroductionAn increase in the number of policy initiatives, such as alternative payment models, have prompted healthcare providers to examine health-care expenditures while seeking to improve quality of care. Performing total joint arthroplasty (TJA) in the outpatient setting is an attractive option in driving costs down and providing psychological benefits to patients. Concerns regarding the safety and effectiveness of same-day discharge protocols warrants further investigation, especially on the state level. Due to the lack of consensus, we aimed to compare: (1) risk factors for outpatient arthroplasty and (2) incidences of postoperative complications between inpatient vs outpatient arthroplasty using an in-state database. MethodsPatients who underwent total knee or hip arthroplasty between January 1, 2022 and December 31, 2022 were identified. Data was drawn from the Maryland State Inpatient Database (SID) and Maryland State Ambulatory Surgery and Services Database (SASD). A total of 7817 patients had TJA within this time. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). Demographic variables, medical comorbidities, and 90-day complication rates were compared between inpatient and outpatient procedures. Additional independent variables included: marital status, primary language, race, and median household income. A multivariate logistic regression analysis was performed to identify independent risk factors for complications following TJA after controlling for risk factors and patient comorbidities. ResultsArthroplasty in the outpatient setting were more likely to be married (61.3% vs. 51.2%, p < 0.001), white (75.5% vs. 60.9%, <0.001), speak English as primary language (98.7% vs. 88.6%, p < 0.001), and have lower rates of diabetes (4.8% vs. 9.7%, p < 0.001), chronic obstructive pulmonary disease (16.3% vs. 21.8%, p < 0.001), and obesity (30.0% vs. 45.2%, p < 0.001) compared to arthroplasty in the inpatient setting, respectively. There were lower incidences of acute kidney injury (0.2 vs. 0.8%, p < 0.001) and infection (0.3% vs. 1.1%, p < 0.001) in the outpatient cohort compared to the inpatient cohort, respectively. Inpatient arthroplasty (Odds Ratio (OR) 1.98, 95% CI 1.30–3.02, p = 0.002) and hypertension (OR 2.12, 95% CI 1.23–3.64, p = 0.007) were independent risk factors for total complications following TJA. ConclusionArthroplasty in the outpatient setting showed fewer complications than compared to patients in the inpatient setting. Although multiple factors should guide the decision for arthroplasty, outpatient arthroplasty may be a safe option for select, healthier patients without the increased burden of increased complications.

Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty

Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty

Preoperative frailty as a predictive factor for postoperative complications in patients with pancreatic cancer.

Frailty is considered one of the most important indicators of a patient's general condition. However, only a few studies have investigated the association between preoperative frailty and postoperative complications in pancreatic cancer. Therefore, this study aimed to examine this association in patients with pancreatic cancer. We retrospectively reviewed 52 consecutive patients who underwent pancreatectomy for pancreatic cancer between July 2019 and March 2021. Patients were classified into two groups according to the presence of postoperative complications. Their characteristics and clinical parameters, including physical function, were analyzed. Patients with postoperative complications had a higher prevalence of frailty (58.8% vs 14.3%, p = 0.003) and a shorter 6-min walk distance (380 m vs 436 m, p = 0.020) than those without postoperative complications. Logistic regression analysis identified preoperative frailty as the only independent risk factor for complications after pancreatectomy (p = 0.002). Preoperative frailty is associated with postoperative complications of pancreatectomy. Since preoperative frailty can be easily evaluated, it is a useful predictor of postoperative complications after pancreatectomy.

Analysis of risk factors for complications after laparoscopic cholecystectomy

ObjectiveTo analyze the risk factors of complications after laparoscopic cholecystectomy in 478 patients in our hospital. Methods: The clinical data of 478 patients who underwent laparoscopic cholecystectomy in our hospital from March 2018 to September 2022 were collected, and the occurrence of postoperative complications and related risk factors were analyzed. Results: A total of 36 patients (7.53%) had complications, including 9 cases (1.88%) of abdominal hemorrhage, 8 cases (1.67%) of bile duct injury, and 19 cases (3.97%) of biliary fistula. Univariate analysis showed that adhesions of Calot triangle, anatomical variation and gallbladder wall thickness greater than 5 mm were associated with postoperative complications (all P < 0.05). Multivariate analysis showed that: Calot triangle adhesion (OR = 3.041, 95%CI = 1.422–6.507), anatomical variation (OR = 4.368, 95%CI = 1.764–10.813) and gallbladder wall thickening (OR = 2.827, 95%CI = 1.422–6.507). 95%CI = 1.274–6.275) were independent risk factors for complications after laparoscopic cholecystectomy (all P < 0.05). Conclusion: In order to reduce the occurrence of postoperative complications, the risk factors of LC should be well understood and the preoperative preparation should be made.

Weight Is a Predictor of Delayed Operation Time in Primary Isolated Anterior Cruciate Ligament Reconstruction.

Few studies have evaluated the impact of obesity on operation time in patients with ACL reconstruction. The purpose of this study was to understand the effect of obesity on operation time in patients with arthroscopic anterior cruciate ligament (ACL) reconstruction. A total of 103 patients were included. The mean pure operation time was 45.9 ± 13.4 min. Considering that 15 min incremental increases in operation time are an independent risk factor for complications, all patients were classified into two groups according to operation time: more or less than 61 min. Demographic data were compared between both groups. Pure operation time was defined as operative time without suture time (pure operation time = suture start time - operation start time). Correlation analysis between demographic data and pure operation time was performed, and multiple linear regression analysis was used to identify the predictors of pure operation time. The pure operation time ≥61 min group (n = 34) had a 14.7 kg higher weight and 4.5 kg/m2 higher body mass index (BMI) than those with pure operation time < 61 min (n = 69). Weight (r = 0.635, p < 0.001) and BMI (r = 0.584, p < 0.001) were positively correlated with operation time. Multiple linear regression analysis showed that weight (β = 0.635, p < 0.001) was the only predictor of operation time. A weight of 74.25 kg was a cut-off value for a pure operation time of >61 min. The weight and BMI of the group with pure operation time of ≥61 min were 14.7 kg and 4.5 kg/m2 higher, respectively. The weight of patients with ACL tears was a factor affecting delay in the operation time. Patients weighing over 74.25 kg were more likely to delay ACL reconstruction.

Identifying Risk Factors of Complications following Total Gastrectomy for Gastric Cancer: Comparison between Splenectomy and Spleen-Preserving Surgery – A Supplementary Analysis of JCOG0110

Introduction: Splenectomy for proximal gastric cancer was found to offer no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). Although many studies have explored risk factors for morbidities following total gastrectomy, none have assessed the risk factors for postoperative complications in spleen-preserving total gastrectomy. Methods: Using data from 505 patients enrolled in a previous randomized trial, risk factors for postoperative complications were identified by multivariable logistic regression analysis. Then, the risk factors were assessed separately between splenectomy and spleen-preserving total gastrectomy. Results: Postoperative complications were identified in 119 patients (23.6%) and were more common following splenectomy than following spleen-preserving surgery (30.7% and 16.1%, respectively, p < 0.01). Multivariable analysis revealed that age ≥65 years (p = 0.032), body mass index ≥25 (p = 0.003), and blood loss ≥350 (p = 0.019) were independent risk factors for postoperative complications in the entire cohort. Among them, only body mass index was a significant independent risk factor for complications in both spleen preservation (p = 0.047) and splenectomy groups (p = 0.017). Conclusion: Risk factors for postoperative complications were essentially the same between splenectomy and spleen preservation. Being overweight increased the risk of postoperative complications.

Smoking is associated with surgical site infection, unplanned reoperation, and unplanned 30-day readmission with distal upper extremity fractures

Background: The purpose of this study is to 1) determine the effect of smoking status on the rate of acute postoperative complications and 2) evaluate smoking as an independent risk factor for complications following open reduction and internal fixation (ORIF) of distal upper extremity fractures. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify adult patients (&gt;18 yr old) who underwent open reduction and internal fixation (ORIF) of distal upper extremity fractures between 2005 and 2018. Closed fractures of the distal radius, distal ulna, carpals, metacarpals, and phalanx were included. Open fractures, closed reduction and percutaneous pinning (CRPP) procedures, and operations with concomitant procedure codes were excluded. Patients were classified as either current smokers or non-smokers. Univariate analysis and multivariate logistic regression were used to assess the risk of perioperative complications based on current smoking status. Results: A total of 22,002 patients met inclusion criteria. Smoking was independently associated with an increased risk of post-operative complications (OR 1.43, 1.15-1.78, P&lt;0.001), specifically, superficial surgical site infections (OR 2.11, CI 1.23–3.60, P=0.007). Current smokers were additionally associated with an increased risk of unplanned reoperation (OR 1.65, CI 1.10–2.48, P=0.022), and unplanned readmission (OR 1.39, CI 1.02-1.90, P=0.037). Conclusions: Smoking independently increases the risk for overall complications including superficial infections, unplanned reoperation, and unplanned readmission following ORIF of distal upper extremity fractures. Level of Evidence: III.

Analysis of Factors of Complications in Patients with Moyamoya Disease After Revascularization

Objective: In this study, the driving factors of complications in patients with moyamoya disease after revascularization are analyzed and discussed. Methods: A total of 1500 cases with moyamoya disease after revascularization in Yunan Shuifu People’s Hosptial and Beijing University of Chinese Medicine Third Affiliated Hospital from November 2017 to November 2022 were selected retrospectively, and they were divided into an observation group (with postoperative complications) and a control group (with no complications), resulting in 313 cases and 1187 cases in each group, respectively. Univariate and multivariate analysis were performed to screen out independent risk factors for complications in patients with moyamoya disease after revascularization. Results: Univariate analysis showed that the proportion of patients with cerebral ischemia, history of hypertension, and modified Rankin scale (mRs) score of 3-5 in the observation group were significantly higher than those in the control group. Complications were used as the dependent variable, and the indicators with statistically significant differences based on the univariate analysis were included as independent variables in the logistic regression analysis. The results showed that the first symptoms before operation were cerebral ischemia, history of hypertension, and mRs score of 3 to 5 were risk factors for complications in patients with moyamoya disease after revascularization, and there were significant differences in the data (OR = 1.781, 1.811, 1.859, all P &lt; 0.05). Conclusion: Cerebral ischemia is the first symptom before operation, and history of hypertension and mRs score of 3 to 5 are all risk factors for complications in patients with moyamoya disease after revascularization. Therefore, clinical prevention should be strengthened, and corresponding treatment measures should be given in time to reduce the risk of postoperative complications in patients with moyamoya disease.

Platelet-to-Albumin Ratio: The Prognostic Utility in the Prediction of 2-Month Postoperative Heart Transplant Complications.

The platelet-to-albumin ratio (PAR), leucocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), and monocyte-to-albumin ratio (MAR) represent easily reproducible markers, which may predict the outcomes in various diseases. Early postoperative complications might appear after heart transplantation, such as infections, diabetes mellitus type 2 (DM2), acute graft rejection, and atrial fibrillation (AFib). The aim of our study was to investigate the PAR, LAR, NPAR, and MAR values before and after heart transplantation, and the associations of the preoperative levels of these markers with the presence of postoperative complications in first two months after surgery. Our retrospective research was directed from May 2014 to January 2021, with a total number of 38 patients being included. We used cut-off values for the ratios from previously published studies, as well as our own determination of these levels by using a receiver operating characteristic (ROC) curve. By ROC analysis, the optimal preoperative PAR cut-off value was 38.84 (AUC: 0.771, p = 0.0039), with 83.3% sensitivity, and 75.0% specificity. Applying a Chi square (χ2) test, PAR > 38.84 represented an independent risk factor for complications, regardless of cause, and postoperative infections. Preoperative PAR > 38.84 was a risk factor of developing complications of any cause, and postoperative infections in the first two months after heart transplantation.

Risk Factors for Maxillofacial Space Infection Complications: A Retrospective Analysis of 457 Patients.

This study was performed to determine the risk factors associated with systemic complications of maxillofacial space infection (MSI), and to propose an objective evaluation index - severity score of MSI. 457 MSI patients from Jan 2010 to Dec 2020 were reviewed retrospectively. The predictor variables included demographic, origin of infection, underlying systemic disease, pre-hospital medication history, laboratory examinations and severity scores of space infection. The severity score of space infection was proposed to evaluate the airway compromise of anatomic spaces. The primary outcome variable was the complication. The impact factors of complications were analyzed using univariate analysis and multivariate logistic regression. 457 patients were included (average age 46.3y, male to female ratio 1.43:1). Among them, 39 patients developed postoperative complications. In the complication group, there were 18 patients (46.2%) with pulmonary infection, and two patients died. We found that the history of diabetes mellitus (OR=4.74, 95% confidence interval (CI)=2.22, 10.12), high temperature (≥39°C) (OR=4.16, 95% CI=1.43, 12.06), advanced age (≥65y) (OR=2.88, 95% CI=1.37, 6.01), and severity score of space infection (OR=1.14, 95% CI=1.04, 1.25) were independent risk factors for complications of MSI. All the risk factors needed to be closely monitored. Severity score of MSI was an objective evaluation index to predict complications.

Sarcobesity, but not visceral fat, is an independent risk factor for complications after radical resection of colorectal cancer.

The influence of body composition on the outcome of colorectal cancer surgery is controversial. The aim of this study was to evaluate the effects of visceral obesity and sarcobesity on the incidence of total and surgical complications after radical resection of colorectal cancer. We collected a total of 426 patients who underwent elective radical resection of colorectal cancer at Beijing Friendship Hospital, Capital Medical University from January 2017 to May 2018. According to the inclusion and exclusion criteria, 387 patients were finally included. A CT scan at the level of the L3-L4 intervertebral disk was selected to measure the values of visceral fat area and skeletal muscle area. Multivariate analysis was used to explore the independent risk/protective factors affecting postoperative complications. 128 (33.1%) patients developed complications, and 44 (11.4%) patients developed major complications. Among them, 111 patients developed surgical complications and 21 developed medical complications. Visceral fat area (Z = -3.271, p = 0.001), total fat area (Z = -2.613, p = 0.009), visceral fat area to subcutaneous fat area ratio (V/S, Z = -2.633, p = 0.008), and sarcobesity index (Z = -2.282, p = 0.023) were significantly associated with total complications. Visceral fat area (Z = -2.119, p = 0.034) and V/S (Z = -2.010, p = 0.044) were significantly associated with total surgical complications. Sarcobesity index, smoking, stoma, blood loss, surgery time, and American Society of Anesthesiology (ASA) score were selected as risk factors for total postoperative complications according to LASSO regression. Multivariate logistic regression analysis suggested that sarcobesity index was an independent risk factor for postoperative total complications and surgical complications. Subgroup analysis suggested that albumin level was an independent protective factor for postoperative total complications in male patients. Smoking, operative time, and sarcobesity index were independent risk factors, and cholesterol was an independent protective factor for total postoperative complications in female patients. Increased sarcobesity index is an independent risk factor for postoperative complications in patients with colorectal cancer, while visceral fat area is not. For female patients, smoking, operation time, and obesity index are independent risk factors for postoperative complications, while cholesterol is an independent protective factor. For male patients, serum albumin is an independent protective factor for postoperative complications.