Independent Risk Factors For Complications Research Articles

Comparison between AWGC-cachexia and GLIM-malnutrition in patients with gastric cancer

BackgroundThe newly released Asian Working Group for Cachexia (AWGC) criteria share similar diagnostic items with the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study aims to compare the AWGC cachexia and GLIM malnutrition in patients with gastric cancer and investigate whether one diagnosis continues to be a prognostic factor in individuals diagnosed with the other condition. MethodsData of patients who underwent radical gastrectomy for gastric adenocarcinoma were prospectively collected from 2013 to 2019. The AWGC and GLIM criteria were applied to diagnosis cachexia and malnutrition, respectively. Univariate and multivariate logistic and Cox regression were used to verify the effect of relevant factors on postoperative complications and overall survival. ResultsA total of 1420 patients were included, among whom 174 (12.3 %) were diagnosed with AWGC-cachexia alone, 85 (6.0 %) were diagnosed with GLIM-malnutrition alone, and 324 (22.8 %) had both AWGC-cachexia and GLIM-malnutrition. Both AWGC-cachexia and GLIM-malnutrition were independent risk factors for complications and overall survival. When they coexisted, the odds ratios (OR) and hazard ratios (HR) tended to be higher. In the AWGC-cachexia subset, GLIM-malnutrition remained an independent risk factor (HR = 1.544, 95 % CI = 1.098–2.171, P = 0.012) for overall survival after the adjustment of confounding factors. Similarly, in the GLIM-malnutrition subset, AWGC-cachexia remained an independent risk factor for overall survival (HR = 1.697, 95 % CI = 1.087–2.650, P = 0.020). Patients with both cachexia and malnutrition had the worst overall survival. ConclusionAWGC-cachexia and GLIM-malnutrition criteria were two non-redundancy tools in reflecting mortality risk in preoperative nutritional assessment.

Complications and Health-related Quality of Life following Lumbosacral Hemivertebra Resection and Short Segmental Fusion: A Retrospective Cohort Study

Previous literature has provided descriptions of postoperative complications. However, these studies have included heterogeneous cohorts of hemivertebra patients undergoing different surgical methods and addressing deformities at various locations. To assess independent risk factors for complications following lumbosacral hemivertebra (LSHV) resection and to further explored the potential association between complications and health-related quality of life (HRQOL). Retrospective cohort study. We retrospectively analyzed consecutive patients who underwent LSHV resection and short segment fusion at our institution between 2010 and 2022. In the current study, the outcome measure were complications and HRQOL. Between 2010 and 2022, a total of 64 consecutive patients with LSHV underwent hemivertebra resection. The diagnostic criteria for LSHV were delineated that the hemivertebra resides caudal to L5 and beyond. Electronic patient record and radiographic data were reviewed retrospectively in our electronic database. According to complications, the patients were divided into with and without complications, and further stratified as neurological, mechanical, and infectious complications. HRQOL outcomes were collected preoperatively, 3 months postoperatively, and at last follow-up using the Scoliosis Research Society-22 (SRS-22) questionnaire. Multivariate logistic regression models were used to determine independent risk factors affecting complications. A total of 64 patients were enrolled in this study for at least 2-year follow-up. The mean follow-up was 7.3±4.2 years. In the coronal plane, the mean main curve was corrected from 27.3° preoperatively to 8.0° postoperatively, and 9.3° at last follow-up. Global spine balance was significantly improved after surgery, and kept stable during the follow-up. In all, 18 complications were recorded in 15 (23.4%) patients. In the multivariate logistic regression model, 3 independent risk factors for complication were screened out, including age (OR=1.16, 95% CI 1.01-1.34, p=.042), anterior reconstruction (OR=3.40, 95% CI 1.03-11.2, p=.045), and preoperative CB (OR=1.06, 95% CI 1.00-1.12, p=.036). The mean SRS-22 total and domain scores for the entire cohort showed improvement at last follow-up. However, in the noncomplication group, the improvements in SRS-22 scores were more substantial. Postoperative neurological and mechanical complications are common medical events following LSHV resection. The age, anterior column reconstruction, and preoperative coronal balance were the independent risk factors. Compared to the noncomplication group, the improvements in HRQOL are blunted in the complication group.

Preoperative neutrophil-to-C-reactive protein ratio as a predictor of post-operative complications of pancreas cancer.

We would like to investigate the prognostic utility of the previously described factors and offer a new parameter called neutrophil-to-C-reactive protein ratio (NCR) as a predictor of post-operative complications of pancreas cancer. 92 patients underwent pancreaticoduodenectomy for the pancreatic head tumor were enrolled in this study. Receiver operating curve analysis was performed to detect the cutoff values, and logistic regression analyses were performed to identify the independent risk factors of complications. In univariate analysis, complications were observed in lymphocyte-to-C-reactive protein ratio levels below 0.06 (Odds Ratio [OR]: 3.92, 95% confidence interval [CI] = 1.08-14.21, p = 0.037). In multivariate analysis, albumin < 3.6 (OR: 3.25, 95% CI: 1.16-9.06, p = 0.024) and NCR < 0.28 (OR: 2.81, 95 % CI: 1.07-7.63, p = 0.042) were the independent and significant predictors of the overall survival. Quantification of preoperative NCR and albumin may help surgeons to settle an effective perioperative management, take extra caution, and be aware of post-operative complications of pancreatic cancer patients.

Analysis of risk factors for complications in echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation

BackgroundThe feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM) has been previously reported. However, limited investigation has been conducted regarding the complications associated with this procedure.ObjectiveThis study aims to analyze the risk factors affecting the occurrence of complications during PIMSRA, such as pericardial effusion, ventricular premature beats, and interventricular septal perforation. In this study, the optimal cut-off values for these risk factors are also explored, and corresponding strategies for prevention are proposed.MethodsA total of 101 patients diagnosed with HOCM who underwent the PIMSRA procedure from 2021 to 2022 were included in this retrospective analysis. Patients were classified into subgroups with or without complications based on procedural records. Univariate and multivariate regression analyses were conducted to identify independent risk factors for complications during the PIMSRA procedure.ResultsThere were 48 patients with complications and 53 patients without complications. The heart rate at the start of the procedure and the maximum left ventricular outflow tract gradient (LVOTG) were independent risk factors related to PIMSRA complications. The optimal cut-off values for predicting complication occurrence were a heart rate > 49 bpm at the start of the procedure (OR: 3.79, 95% CI: 1.64–8.78, p = 0.002) and a maximum LVOTG > 92 mmHg (OR: 2.57, 95% CI: 1.15–5.75, p = 0.022), respectively.ConclusionsThe occurrence of PIMSRA complications is primarily associated with the heart rate at the start of the procedure and the maximum LVOTG. It is recommended to establish a comprehensive control plan to minimize the risk of complications during PIMSRA procedures.

Risk factors for complications following sacral neuromodulation for faecal incontinence: Long-term follow-up.

Sacral neuromodulation (SNM) has become a standard surgical treatment for faecal incontinence (FI). Prior studies have reported various adverse events of SNM, including suboptimal therapeutic response, infection, pain, haematoma, and potential need for redo SNM. The aim of this study was to identify the risk factors associated with long-term complications of SNM. This retrospective cohort reviewed patients who underwent two-stage SNM for FI at our institution between 2011-2021. Preoperative baseline characteristics and follow-up were obtained from the medical record and/or by telephone interview. Management and outcome of each postoperative event were evaluated by univariate and multivariate regression analyses. A total of 291 patients (85.2% female) were included in this study. Postoperative complications were recorded in 219 (75.2%) patients and 154 (52.9%) patients required surgical intervention to treat complications. The most common postoperative event was loss of efficacy (46.4%). Other common adverse events were problems at the implant site (pain, infection, etc.) in 16.5% and pain during stimulation in 11.7%. Previous vaginal delivery (OR 2.74, p = 0.003) and anal surgery (OR = 2.46, p = 0.039) were independent predictors for complications. Previous colorectal (OR = 2.04, p = 0.026) and anal (OR = 1.98, p = 0.022) surgery and history of irritable bowel syndrome (IBS) (OR = 3.49, p = 0.003) were independent predictors for loss of efficacy. Postoperative adverse events are frequently recorded after SNM. Loss of efficacy is the most common. Previous colorectal or anal surgery, vaginal delivery, and IBS are independent risk factors for complications.

Risk factor analysis and nomogram prediction model construction of postoperative complications of thoracoscopic non-small cell lung cancer.

A series of complications will inevitably occur after thoracoscopic pulmonary resection. How to avoid or reduce postoperative complications is an important research area in the perioperative treatment of thoracic surgery. This study analyzed the risk factors for thoracoscopic postoperative complications of non-small cell lung cancer (NSCLC) and established a nomogram prediction model in order to provide help for clinical decision-making. Patients with NSCLC who underwent thoracoscopic surgery from January 2017 to December 2021 were selected as study subjects. The relationship between patient characteristics, surgical factors, and postoperative complications was collected and analyzed. Based on the results of the statistical regression analysis, a nomogram model was constructed, and the predictive performance of the nomogram model was evaluated. A total of 872 patients who met the study criteria were included in the study. A total of 171 patients had complications after thoracoscopic surgery, accounting for 19.6% of the study population. Logistic regression analysis showed that thoracic adhesion, history of respiratory disease, and lymphocyte-monocyte ratio (LMR) were independent risk factors for complications after thoracoscopic surgery (P<0.05). Variables with P<0.1 in logistic regression analysis were included in the nomogram model. The verification results showed that the area under curve (AUC) of the model was 0.734 [95% confidence interval (CI): 0.693-0.775], and the calibration curve showed that the model had good differentiation. The decision curve analysis (DCA) curve showed that this model has good clinical application value. In subgroup analysis of complications, gender, history of respiratory disease, body mass index (BMI), type of surgical procedure, thoracic adhesion, and Time of operation were identified as significant risk factors for prolonged air leak (PAL) after surgery. Tumor location and forced expiratory volume in the first second (FEV1) were identified as important risk factors for postoperative pulmonary infection. N stage and thoracic adhesion were identified as significant risk factors for postoperative pleural effusion. The AUC for PAL was 0.823 (95% CI: 0.768-0.879). The AUC of postoperative pulmonary infection was 0.714 (95% CI: 0.627-0.801). The AUC of postoperative pleural effusion was 0.757 (95% CI: 0.650-0.864). The calibration curve and DCA curve indicated that the model had good predictive performance and clinical application value. This study analyzed the risk factors affecting the postoperative complications of NSCLC through thoracoscopic surgery, and the nomogram model built based on the influencing factors has certain significance for the identification and reduction of postoperative complications.

The Geriatric Nutritional Risk Index Is an Independent Predictor for Adverse Outcomes After Anterior Cervical Discectomy and Fusion

Malnutrition has frequently been associated with increased complications and worse outcomes after surgery. The purpose of this study was to determine if malnutrition status determined using the Geriatric Nutritional Risk Index (GNRI) serves as an independent risk factor for complications in patients undergoing anterior cervical discectomy and fusion (ACDF). The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2016 for patients aged ≥65 years who underwent ACDF. Patients were categorized into 3 groups based on the GNRI: >98 were normal nutritional status, 92-98 were moderately malnourished, and <92 were severely malnourished. Multivariate logistic regression models adjusted for covariates of demographics, comorbidities, and operative metrics were used to evaluate GNRI as an independent risk factor for postoperative outcomes. 3,148 patients who underwent ACDF were analyzed, of which 78.9% had normal nutrition, 16.1% were moderately malnourished, and 5.0% patients were severely malnourished. On multivariate analysis, moderate and severe malnutrition were found to be independent risk factors for any complication, pulmonary complications, pneumonia, unplanned intubation, and hospital length of stay >6 days (all, p<0.05). In addition, moderate malnutrition was a risk factor for failure to wean from ventilator >48 hours and 30-day readmission. Severe malnutrition was an independent risk factor for septic-shock and non-home discharge. In elderly patients after ACDF, malnutrition determined using GNRI is an independent risk factor for 30-day complications, readmissions, prolonged hospital length of stays, and non-home discharge.

Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery.

The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated. Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery. Retrospective cohort study. HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication. In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs (r=0.351, P=0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle (P>0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2-7.6]; P=0.009). Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning. Level-III.

Elevated Serum Alkaline Phosphatase is an Independent Predictor of Complications After Lumbar Spinal Fusion

BackgroundAlkaline phosphatase (ALP) is an enzyme which has been proven useful as a biomarker for bone turnover and inflammation. We hypothesized that high serum ALP levels are associated with increased complication rates following lumbar spinal fusion. MethodsLumbar spinal fusion procedures from 2005-2019 were queried from the national Surgical Quality Improvement Program (NSQIP) database. Serum alkaline phosphatase levels were stratified into low <44 IU/L, normal 44-147 IU/L, and high >147 IU/L. A risk-adjusted multivariate logistic regression was used to analyze ALP as an independent risk factor for complications. ResultsA total of 16,441 patients who underwent lumbar fusion procedures were included. Adjusted multivariate logistic regression analysis demonstrated that patients with a high serum ALP level had a significantly increased risk for developing septic shock (OR 4.68, 95% CI 1.83-11.97), pneumonia (OR 2.89, 95% CI 1.59-5.25), requiring a transfusion (OR 2.09, 95% CI 1.68-2.59), reoperation within 30 days (OR 1.68, 95% CI 1.12-2.52), readmission within 30 days (OR 1.60, 95% CI 1.16-2.21), increased length of stay (OR 1.87, 95% CI 1.49-2.36), and nonhome discharge (OR 2.18, 95% CI 1.80-2.66). Clinical RelevanceSerum alkaline phosphatase is a valuable and readily available tool for preoperative risk stratification of patients undergoing lumbar spinal fusion. ConclusionsElevated serum ALP in patients undergoing lumbar fusion procedures is associated with increased risk for multiple in-hospital complications as well as higher rates of readmission and reoperation.

Metabolic dysfunction-associated fatty liver disease increases the risk of complications after radical resection in patients with hepatocellular carcinoma

Background and aimsThe prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in hepatocellular carcinoma (HCC) patients is increasing, yet its association with postoperative complications of HCC remains unclear. The aim of this study was to investigate the impact of MAFLD on complications after radical resection in HCC patients.MethodsPatients with HCC who underwent radical resection were included. Patients were stratified into MAFLD group and non-MAFLD group. Clinical features and post-hepatectomy complications were compared between the two groups, and logistic regression analysis was used to determine independent risk factors associated with post-hepatectomy complications.ResultsAmong the 936 eligible patients with HCC who underwent radical resection, concurrent MAFLD was diagnosed in 201 (21.5%) patients. Compared to the non-MAFLD group, the MAFLD group exhibited a higher incidence of complications, including infectious and major complications after radical resection in HCC patients. The logistic regression analysis found that MAFLD was an independent risk factor for complications, including infectious and major complications in HCC patients following radical resection (OR 1.565, 95%CI 1.109–2.343, P = 0.012; OR 2.092, 95%CI 1.386–3.156, P < 0.001; OR 1.859, 95% CI 1.106–3.124, P = 0.019; respectively). Subgroup analysis of HBV-related HCC patients yielded similar findings, and MAFLD patients with type 2 diabetes mellitus (T2DM) exhibited a higher incidence of postoperative complications compared to those without T2DM (all P < 0.05).ConclusionsConcurrent MAFLD was associated with an increased incidence of complications after radical resection in patients with HCC, especially MAFLD with T2DM.

Positive end-expiratory pressure and the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia.

To evaluate the effect of intraoperative positive end-expiratory pressure and driving pressure on the development of postoperative pulmonary complications. The prospective study included 83 patients undergoing abdominal surgery and receiving general anaesthesia. Patients were divided into two groups: with low intraoperative positive end-expiratory pressure (0-2cm H2O) and with high intraoperative positive end-expiratory pressure (8-10cm H2O). The primary endpoint is the development of postoperative pulmonary complications during follow-up. The incidence of postoperative pulmonary complications in the group of low intraoperative positive end-expiratory pressure was 9.8%, while in the group of high positive end-expiratory pressure was 7.1% (p = 0.6), demonstrating that high positive end-expiratory pressure used during general anaesthesia does not affect the frequency of complications (odds ratio = 0.71, p = 0.6). In the multivariate analysis that controls for all confounders, driving pressure resulted in a significant and independent risk factor for complications. High intraoperative positive end-expiratory pressure does not affect the frequency of postoperative pulmonary complications. The increase in driving pressure is a risk factor for complications. Positive end-expiratory pressure is easily implemented, and its use does not result in significant economic costs.

Gynecomastia Surgery in 4996 Male Patients Over 14 Years: A Retrospective Analysis of Surgical Trends, Predictive Risk Factors, and Short-Term Outcomes.

The high prevalence of benign male breast tissue enlargement (gynecomastia) has resulted in a marked increase of gynecomastia cases. While about one third of male adults experience some form of gynecomastia, gynecomastia surgery (GS) outcome research is limited to small study populations and single-center/-surgeon databases. In this study, we aimed to access the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify preoperative risk factors for complications and investigate postoperative outcomes of GS. In this retrospective study, we queried the ACS-NSQIP database from 2008 to 2021 to identify male adult patients who underwent GS. Postoperative outcomes involved the occurrence of any, surgical and medical complications, as well as reoperation, readmission, and mortality within a 30-day postoperative time period. Univariable and multivariable assessment were performed to identify risk factors for complications while adjusting for possible confounders. The study included 4,996 GS patients with a mean age of 33.7 ± 15 years and BMI of 28.2 ± 5.1 kg/m2. White patients constituted 54% (n = 2713) of the cohort, and 27% (n = 1346) were obese. Except for 2020, there was a steady increase in GS cases over the study period. Outpatient surgeries were most common at 95% (n = 4730), while general surgeons performed the majority of GS (n = 3580; 72%). Postoperatively, 91% (n = 4538) of patients were discharged home; 4.4% (n = 222) experienced any complications. Multivariable analysis identified inpatient setting (p < 0.001), BMI (p = 0.023), prior sepsis (p = 0.018), and bleeding disorders (p = 0.047) as independent risk factors for complications. In this study, we analyzed 4996 male adult GS patients from the ACS-NSQIP database, revealing an increased caseload and significant general surgeon involvement. Risk factors like bleeding disorders, inpatient status, and prior sepsis were linked to postoperative complications, while BMI was crucial for predicting adverse events. Overall, our findings may aid in enhancing patient care through advanced preoperative screening and closer perioperative management. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Patients with chronic kidney disease can expect significant improvement in pain and function after shoulder arthroplasty

BackgroundChronic kidney disease (CKD) is associated with negative outcomes after hip and knee arthroplasty due to higher rates of infection, aseptic loosening, and transfusion. The purpose of this study was to compare clinical outcome scores and complication rate after shoulder arthroplasty (SA) for patients with and without CKD. MethodsWe conducted a retrospective cohort study of prospectively collected data and reviewed all patients who underwent primary SA from January 2015 to December 2019 by one surgeon at one institution. Revision arthroplasty patients were excluded. We evaluated results from patients with CKD (glomerular filtration rate [GFR] ≤ 59) and without CKD (GFR ≥ 60). Outcome measures including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores were compared between cohorts. Minimum clinically important difference (MCID) and substantial clinical benefit also were determined for this cohort. Univariate and multivariable regression was performed to assess the influence of CKD on outcome measures and risk of complications. Results518 patients met inclusion criteria; 4 patients did not have recorded GFR, leaving 514 patients for analysis. 389 patients had normal GFR; 125 had CKD. Patients with CKD had lower overall preoperative and postoperative ASES, SST, and SANE scores but demonstrated similar levels of clinical improvement from preoperative to postoperative time points (Δ ASES 41.4 ± 21.8 vs. 42.9 ± 21.4, P = .55), (Δ SST 4.8 ± 3.4 vs. 4.9 ± 3.3, P = .08), (Δ SANE 40.7 ± 29.1 vs. 42.4 ± 26.5, P = .77). Both cohorts achieved MCID for ASES, SST, and SANE scores. Univariately, patients with CKD were at high risk to require transfusion (OR 16.2 (1.9, 139.7), P = .01) despite similar intraoperative estimated blood loss (156.9 ± 132.5mL vs. 153.8 ± 89.7mL, P = .77). CKD patients also were at higher risk for intraoperative fracture (OR 5.4 (1.3, 23.0), P = .02). CKD patients were not at higher risk for prosthetic joint infection (OR 3.2 (0.2, 50.8), P = .42), medical complications (OR 0.9 (0.2, 4.4), P = .89), or revision (OR 1.9 (0.7, 4.9), P = .19) in this cohort. Multivariable analysis of any complication after SA demonstrated that renal disease was not an independent risk factor for overall complication risk in this cohort (OR 1.1 (0.7, 1.8) P = .650). ConclusionSurgeons can be assured that patients who have CKD achieve similar gains in clinical outcomes as other patients. Despite experiencing a higher risk for transfusion and intraoperative fracture, renal disease was not an independent risk factor for complications after SA in this small cohort.

Incidence and predictors of complications in Gram-negative bloodstream infection.

The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90days of GN-BSI. Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. Among 752 patients with GN-BSI, median age was 66years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90days of GN-BSI. The median time to identification of these complications was 5.2days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08-2.78), injection drug use (HR 6.84, 95% CI 1.63-28.74), non-urinary source (HR 1.98, 95% CI 1.18-3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05-3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03-1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26-6.99). Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors.

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.

Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center.

To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations. Retrospective cohort study. Level 1 trauma center. Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation. Complications include infections, wound healing problems, nonunion, malunion, and posttraumatic arthrosis (PTA), and secondary unplanned procedures after a minimum of 2-year radiographic follow-up. Mean age of the included 118 patients was 40 years (range, 18-73 years) and 96 (74%) were male. Comorbidities included obesity (n = 32; 40%), diabetes mellitus (n = 12; 9%), and tobacco use (n = 67; 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). Sixty-seven complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury ( P = 0.028, CI = 1.22-30.63, OR = 6.12) and concomitant forefoot injury ( P = 0.03, CI = 1.12-9.76, OR = 3.31) were independent risk factors for complication. Open Lisfranc injuries were associated with complications, with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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.