Indicator Of Postoperative Complications Research Articles

Առավել հաճախ կիրառվող բարիատրիկ վիրաբուժական միջամտությունների ժամանակակից միջազգային փորձը

No more than 10% of patients with morbid obesity can achieve the desired treatment result using traditional therapy. Currently, for more than 10 years, bariatric surgery is the only widely used surgical approach that has proved its efficacy in reducing body weight in patients. The purpose of this literature review is a generalized analysis of the international experience of the most frequently used modern bariatric surgical interventions. We have undertaken a generalized presentation of data on the most popular bariatric procedures - laparoscopic Sleeve Gastrectomy and Roux-en-Y gastric bypass, available in the Russian and English literature, published over the past 10 years. The choice was made according to the principle of correspondence of the research topics with modern ideas about the indicated aspects of contemporary bariatric surgery. The evaluation of the published data showed that both studied techniques demonstrated significant effectiveness in treating morbid obesity. However, the researchers presented discrete results that prove the discrepancy between the indicators of postoperative complications, the rate of weight loss and regression of comorbidities. The analysis of the data led us to the conclusion that it is necessary to develop modification of the surgical technique to improve the efficiency of management of this contingent of patients.

Psoas Muscle Index – Could It Be an Indicator of Postoperative Complications in Colorectal Cancer? Case Presentation and Review of the Literature

Abstract Introduction: Colorectal cancer is the third most commonly diagnosed cancer worldwide, and its incidence is rising in developing countries. Studies have shown an association between sarcopenia and various poor short-term outcomes in cancer patients who underwent surgery. In this case study, we sought to highlight the importance of a modern prognostic factor, the psoas muscle index (PMI), in colorectal cancer. Case Presentation: We present the case of a 59-year-old male patient with sigmoid cancer. We calculated the PMI as the sum of the areas of the left and right psoas muscle at the level of the L3 vertebra, divided by the square of the patient’s height, using computed tomography measurements. We also measured the density of the proas muscles. Prior to surgery, the left psoas muscle had an area of 14.52 cm2, and the right 14.54 cm2, with a PMI of 9.4967 cm2/m2. The mean density of the psoas muscles was 43.60 UH. The surgery consisted in a rectosigmoid resection with termino-terminal colorectal anastomosis. The histopathological examination confirmed moderately differentiated adenocarcinoma, stage IIIB (pT3N1M0). The patient left the hospital eight days after surgery in good general condition. Long-term follow-up was performed by phone and CT scans at 1, 6, and 12 months. Conclusions: CT-measured PMI may be a potential prognostic imaging marker in patients with colorectal cancer that can be easily and routinely assessed preoperatively.

68. Frailty as an indicator of post-operative complications following surgical excision of non-melanoma skin cancer on the head and neck

Non-melanoma skin cancer (NMSC) predominantly affects those aged over 90 years with 85% of lesions arising on the head and neck. Frailty is a measure of physiologic age and can be used as a predictor of adverse treatment outcomes. The aim of this study was to determine if the Rockwood Frailty Index is predictive of complications following excision of NMSC.

Frailty as an indicator of postoperative complications following surgical excision of non-melanoma skin cancer on the head and neck.

Non-melanoma skin cancer (NMSC) predominantly affects those aged over 90years, with 85% of lesions arising on the head and neck, where surgical excision remains the treatment of choice. Frailty is a measure of physiologic age and can be used as a predictor of adverse treatment outcomes. The aim of this study was to determine if the Rockwood Frailty Index is predictive of complications following excision of NMSC. Data were collected prospectively for patients who underwent an excision of a suspected NMSC from the head or neck across a two-month period. Details of the patient, lesion and procedure were recorded alongside ASA grade and Rockwood's Frailty score. Postoperative complications were recorded four weeks later. There was a total of 125 patients: 74 (60%) male, 51 (40%) female; mean age was 78 (±9.8) years. Of the excised sites, 61% were closed primarily, 26% with a full thickness skin graft (FTSG), 13% with a local flap. Frailty ranged from 1 to 7 (median = 4). ASA ranged from 1 to 4 (median = 3). A total of 21 (17%) patients reported postoperative complications. Within this group, the median frailty and ASA grades were 5 and 3. Both frailty and ASA were positively significantly associated with age (p ≤ 0.001). There was no significant difference between the frailty or ASA grades of patients that experienced complications and those who did not. Patients who had a FTSG were significantly more likely to experience complications (p ≤ 0.05). Frailty is not predictive of postoperative complications following excision of NMSC on the head and neck. Postoperative complications are significantly more associated with FTSG.

The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer

Background: Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear. Methods: This study included 115 patients with thoracic esophageal squamous cell cancer who underwent MIE between January 2018 and January 2020. We retrospectively evaluated the association between perioperative fluid balance from during surgery to postoperative day (POD) 2, and postoperative complications. Results: The patients were divided into lower group and higher group based on the median fluid balance during surgery and at POD 1 and POD 2. We found that the higher group at POD 1 (≥3000 mL) was the most important indicator of postoperative complications, such as acute pneumonia within 7 days after surgery, and anastomotic leakage (p = 0.029, p = 0.024, respectively). Moreover, the higher group at POD 1 was a significant independent factor for acute postoperative pneumonia by multivariate analysis (OR: 3.270, 95% CI: 1.077–9.929, p = 0.037). Conclusion: This study showed that fluid overload at POD 1 had a negative influence on postoperative complications in patients with esophageal cancer. The fluid balance must be strictly controlled during the early postoperative management of patients undergoing esophageal cancer surgery.

Monitoring and personalization in treatment of breast cancer patients with metastatic bone lesions

The aim. To increase the efficiency of treatment of BC patients with metastatic lesions of long tubular bones by using, Multidetector computed tomography (MDCT) and bone marrow markers for diagnostics and monitoring the clinical course of the oncologic process, accompanied by surgical intervention with endoprosthetics along with the treatment of polymorbid pathology in a specific patient.
 Materials and methods. Authors provide systemic personification including visualization of the tumor site and its vascularization; printing out the 3D model; surgical planning, including optimal surgical access to the tumor site considering the volume and topographic and anatomical location and dissemination of the tumor, the convenience of intraoperative tasks (removal of the tumor, bone grafting or endoprosthetics), preoperative planning of bone resection lines with maximum preservation of intact bone tissue.
 Results. Personalization of the treatment of breast cancer patients with metastatic bone lesions contributes to a significant reduction in postoperative complications of endoprosthetic replacement of large joints (up to 15.2 %) and increases the overall three-year survival rate (up to 40.6 %), as well as significantly improves their quality of life.
 Conclusions. The personalization of treatment of patients with tumor lesions of the skeletons contributes to a significant decrease in the indicator of postoperative complications of endoprosthetics of great joints and to an increase in the total three-year survival rate, as well as to the improvement of the quality of life after the conducted treatment.

Leveraging Machine Learning to Predict 30-Day Hospital Readmission After Cardiac Surgery

BackgroundHospital readmission within 30 days of discharge is a well-studied outcome. Predicting readmission after cardiac surgery, however, is notoriously challenging; the best-performing models in the literature have areas under the curve around .65. A reliable predictive model would enable clinicians to identify patients at risk for readmission and to develop prevention strategies. MethodsWe analyzed The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database at our institution, augmented with electronic medical record data. Predictors included demographics, preoperative comorbidities, proxies for intraoperative risk, indicators of postoperative complications, and time series-derived variables. We trained several machine learning models, evaluating each on a held-out test set. ResultsOur analysis cohort consisted of 4924 cases from 2011 to 2016. Of those, 723 (14.7%) were readmitted within 30 days of discharge. Our models included 141 STS-derived and 24 electronic medical records-derived variables. A random forest model performed best, with test area under the curve 0.76 (95% confidence interval, 0.73 to 0.79). Using exclusively preoperative variables, as in STS calculated risk scores, degraded the area under the curve, to 0.64 (95% confidence interval, 0.60 to 0.68). Key predictors included length of stay (12.5 times more important than the average variable) and whether the patient was discharged to a rehabilitation facility (11.2 times). ConclusionsOur approach, augmenting STS variables with electronic medical records data and using flexible machine learning modeling, yielded state-of-the-art performance for predicting 30-day readmission. Separately, the importance of variables not directly related to inpatient care, such as discharge location, amplifies questions about the efficacy of assessing care quality by readmissions.

Effect of the prognostic nutritional index on prognosis in patients undergoing gastric cancer surgery

Objective: The leading concern among cancer patients is posttreatment complications and survival, which are associated with patient-related, tumor-related and treatment-related factors. We present here an analysis of the Prognostic Nutritional Index (PNI) as a preoperatively improvable prognostic factor. Material and methods: A retrospective review was made of 228 patients operated on for gastric cancer between January 2011 and October 2019. The patients were divided into two groups based on PNI (PNI <45 and PNI ≥45). The clinicopathological characteristics and prognosis of the patients were recorded and analyzed. Results: PNI was ≥45 in 162 patients and <45 in 66 patients. An examination of the patients’ clinicopathological and demographic characteristics revealed a statistically significant difference in postoperative complications (p=0.014), age (p=0.054), tumor size (p=0.027), and Body Mass Index (BMI) (p=0.041) between the two groups. Using a Kaplan-Meier test, overall survival analysis revealed a difference between the two groups (p=0.001). A multivariate Cox regression analysis of the factors impacting overall survival revealed the T stage (p=0.031), N stage (p<0.001), and PNI (p=0.041) to be significant. Conclusion: The prognostic nutritional index is easy to calculate, a simple and practical approach to assessing nutritional status. Based on the present study's findings, the preoperative calculation of the prognostic nutritional index can serve as an indicator of postoperative complications and prognosis. The most important benefit of this marker is that it can be improved preoperatively.

Ureteral laparoscopic surgery in cancer patients

Objective: to improve the results of treatment of cancer patients with strictures and obliteration of the ureters after surgery and/or remote radiation therapy. Materials and methods . The study included 6 men and 12 women. The average age of men was 67 + 8.5 years (53—79years) and 46 + 15.8 years (28—74years) among women. According to the results of X-ray examinations, the average length of cicatricial narrowing of the ureter was determined, after which the tactics of surgical treatment were determined. Results. The duration of surgical treatment rangedfrom 97 to 380 minutes. Intraoperative blood loss in all groups was approximately the same and ranged from 20 to 160 ml. Intraoperative complications occurred in one patient (5.5 %), injury of the intestine. The described damage was repaired by the intracorporeal manual suture. All operations were completed laparoscopically. A generalized indicator of postoperative complications reached 16.7 %. All the complications that occurred had a slight effect on the the rehabilitation period. Conclusion. The results of this work indicate that ureteroplasty in patients after cancer treatment can be performed by laparoscopic access, which significantly reduces the invasiveness of surgery, reduces the length of hospital stay and rehabilitation of patients. Also, the possibilities of laparoscopic surgery allow you to achieve better visualization, to form more precise sutures.

Desaturation during the stair-climbing test for patients who will undergo pulmonary resection: an indicator of postoperative complications.

It is widely accepted that exercise tolerance tests are applicable in perioperative risk assessment for patients who undergo pulmonary resection; however, the relevance of desaturation during the test is unclear. The purpose of this study was to investigate whether the occurrence of desaturation during a stair-climbing test can be a predictor of postoperative complications among patients who will undergo pulmonary resection and are considered "normal risk" according to published guidelines. Desaturation was defined as a depression of more than 4% points on a pulse oximeter during stair climbing. Among 186 consecutive patients who underwent pulmonary resection, 162 patients who could climb to the 6th floor were selected for the study (excluding 21 patients who could not stair-climb and 3 patients who could not climb from the first floor to the sixth floor). The relationship of desaturation with postoperative complication was investigated using parameters of cardio-pulmonary status associated with additional foci of oxygen supply duration, intensive care unit stay duration, and hospital stay duration. The occurrence ratio of postoperative complications > grade 3 (Clavien-Dindo classification) was 0.75% (1/133) among patients without desaturation and 17.2% (5/29) in patients with desaturation (difference: p = 0.0002). In addition, DS was an indicator of prolonged oxygen supply duration, intensive care unit stay duration, and hospital stay duration. The occurrence of desaturation during a stair-climbing test for patients who will undergo pulmonary resection can be a predictor of postoperative complications among patients who are classified as having normal risk.

The Post-Operative Complications as an Evaluation Indicator of Efficiency of Functioning of Three-Level System of Medical Care Support According to Urology Profile in the Voronezh Oblast

In the Voronezh Oblast, the modernization of system of medical care support of patients with urological pathology was implemented with the purpose of increasing efficiency of the urological service functioning. This action affected all levels: early active detection of urological pathology, standardization of examination and treatment, routing of patients, strict control by way of monthly reports of medical institutions of the Oblast at the level of hospital and out-patient services, supervisory visits of specialists to districts and efficient control on part of the Oblast Chief Out-of-Staff Urologist. In the course of study it is established that key indices characterizing efficiency of functioning of the regional system of urological care of population are admitted the levels of unreasonably prolonged conservative treatment and also reasonably application of low invasive and high-tech intervention, implementation of standardization of the curative diagnostic process, rate of post-operative complications, level of economic costs of diagnostic and treatment, level of medical competence of personnel and degree of early detection of urological pathology that is validated by statistically reliable positive effect at the expense of their adjustment. The detection of advanced forms of diseases results in increased disability, increased economic costs per each patient in need of several operative interventions and highly qualified care. The number of post-operative complications is considered as an indicator of timeliness and adequacy of provided medical care to patients. The article presents an analysis of efficiency of the three-level system of medical care support according indicator of post-operative complications.

Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula

BackgroundRecurrence rates after surgical repair of enterocutaneous fistula (ECF) have not changed substantially. Serum C-reactive protein (s-CRP) has been used as an indicator of postoperative complications in abdominal surgery. ​ The aim of this study was to determine the predictive value of preoperative s-CRP for recurrence after definitive surgical repair of ECF. MethodsFifty consecutive patients with ECF persistence submitted electively to definitive surgical repair (ECF resection with primary anastomosis) were included. Among several variables, preoperative s-CRP (primary independent variable) was assessed as a factor related to recurrence (dependent variable). Univariate and multivariate analyses were performed. ResultsECF recurred in 19 patients (38%). Univariate and multivariate analyses disclosed operative blood loss greater than 325 mL (P < .05) and preoperative s-CRP greater than .5 mg/dL (P < .01) as the only risk factors for recurrence. ECF recurrence rates were significantly higher for patients with preoperative s-CRP above this level (53% vs 11%, P < .01). After conservative and surgical management, overall ECF closure was attained in 40 patients (80%). ConclusionsOur results suggest that s-CRP may serve as a useful parameter to predict potential failure (recurrence) in patients submitted to definitive closure of ECF.

C-reactive protein in drainage fluid as a predictor of anastomotic leakage after elective colorectal resection.

C-reactive protein (CRP) is considered to be an indicator of postoperative complications in. abdominal surgery. The aim of this study was to determine the significance of serial measurement of CRP in drainage fluid in the detection of anastomotic leakage (AL) in patients with colorectal resection. CRP values in serum and drainage fluid, respectively, were measured on the first, third, fifth, and seventh postoperative day (POD) in 150 patients with colorectal resection and primary anastomosis. The values obtained were compared between the groups of patient without complications of surgical treatment and those with AL. Clinically evident AL was observed in 15 patients--in two (4.2%) patients with left colonic surgery, and 13 (12.6%) patients with colorectal anastomosis. Mean values of CRP were higher in the patients with AL than in the patients without complications, both in serum and drainage fluid, with the most significant differences recorded on the PODs 5 and 7 (p < 0.001). Correlation analysis showed a positive correlation between serum and drainage fluid CRP levels in both groups of patients. Serum and drainage fluid CRP values on the PODs 5 and 7 are most important in the detection of AL. In 80% of patients with CRP values in the drainage fluid of 53 mg/L for the POD 5 and 42 mg/L for the POD 7 AL was observed. The method specificity was 77% for the POD 5, and 83% for the POD 7. All the patients with CRP values in drainage fluid above 108 mg/L on the POD 5 and 93 mg/L on the POD 7 had AL. Serial measurement of CRP in drainage fluid can reliably be used in the detection of AL in patients with colorectal resection. The most significant values obtained on the PODs 5 and 7 were positively correlated with the values registered in

Postoperative changes in serum CO2 as an indicator of postoperative complications after radical cystectomy.

The purpose of this article was to review the relationship of postoperative CO2 levels to the risk of complications after radical cystectomy. In this review, we summarize the existing body of literature on the topic as well as metabolic complications after urinary diversion. Currently, there are no studies that specifically examine CO2 levels in the context of complications after radical cystectomy; therefore, we also present our own institutional data which demonstrate that a drop in postoperative CO2 levels is highly predictive of complications, the most common of which is failure to thrive. These data indicate that significant changes in CO2 levels prior to discharge after a radical cystectomy may be a harbinger of forthcoming complications.

Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery

BackgroundC-reactive protein (CRP) has been used as an indicator of postoperative complications in abdominal surgery. Its short half-life makes it a reliable marker of the systemic inflammatory response secondary to a surgical procedure or to the appearance of complications, rapidly returning to normal values with the recovery of the patient. AimTo demonstrate the value of sequential serum determinations of postoperative C-reactive protein (CRP) and white blood cell counts (WBC) in the identification of increased risk of anastomotic leakage after colorectal surgery. MethodsWe reviewed the daily postoperative serum CRP and white blood cell counts in 173 patients who underwent surgery for colorectal disease with anastomosis, between January 2008 and October 2009. Patients with anastomotic leakage (Group A, n = 24) were compared to patients without leakage (Group B, n = 149). Patients with ongoing infections before surgery or with acquired postoperative infections other than leakage were excluded. Mean pre- and postoperative values of CRP and WBC were compared. ResultsThe diagnosis of anastomotic leakage was made between the 4th and 11th postoperative day (POD; mean 7th POD). The daily average values of serum CRP were significantly higher in group A starting at the 2nd POD and remained significantly elevated until the diagnosis of leakage (p = 0.003). The cut-off value of 140 mg/L on the 3rd POD maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage. Comparison of postoperative serum WBC values did not show any significant differences between the two groups until the 6th POD. ConclusionAccording to these results, an early and persistent elevation of CRP after colorectal surgery with anastomosis, is a marker of anastomotic leakage. A cut-off value > 140 mg/L on POD3 maximizes sensitivity and specificity.

Increased Serum Levels of C‐Reactive Protein Precede Anastomotic Leakage in Colorectal Surgery

Anastomotic leakage (AL) is a severe complication following colorectal surgery. C-reactive protein (CRP) is considered to be an indicator of postoperative complications. Between August 2002 and August 2005 342 colorectal resections with primary anastomosis were performed at the Department of General and Vascular Surgery. Johann Wolfgang Goethe-University Frankfurt. For this retrospective study serum CRP was measured daily until postoperative day 7, and in cases of AL it was excluded from statistical analysis beginning with the day on which the AL was diagnosed. Twenty-six of 342 (7.6%) patients developed AL at a mean of 8.7 days postoperatively. The in-hospital mortality was 3.5% for all patients and was significantly higher in the AL group (11.5 versus 2.8%). The CRP level in the two groups showed a peak on day 2.5 and day 2.2, respectively. In case of postoperative AL the CRP level did not show a marked decline during the next few days. Compared to the cases where AL did not develop, there was a significantly higher increase in CRP from the preoperative level to the levels measured on postoperative day 3, 5, 6 and 7. Higher CRP levels were observed in patients experiencing pneumonia or urinary tract infection, but the decrease of CRP values was not as slow as in cases of AL. This study shows serum CRP level to be a relevant marker in detecting postoperative complications in colorectal surgery. Prolonged elevation and a missing decline in CRP level precede the occurrence of AL.

Procalcitonin Levels after Different Types of Conventional Thoracic Surgery

Procalcitonin (PCT) is currently discussed as an indicator of postoperative complications following thoracic surgery. Serum levels of PCT are different after thoracoscopic and conventional surgical approaches. We conducted this study to test the hypothesis that different types of conventional thoracic surgery are associated with different postoperative serum levels of acute-phase proteins or pro-inflammatory mediators. Serum levels of interleukin (IL)-6, C-reactive protein (CRP), lipoprotein-binding protein (LBP) and PCT were measured preoperatively (pre), immediately after surgery (0 h), 6 hours after surgery (6 h), and on the 1st (d1), 3rd (d3) and 5th (d5) postoperative days in 48 patients undergoing elective conventional pneumonectomy (n = 6), lobectomy (n = 20) or wedge resection (n = 22). In all study groups, IL-6 and PCT increased after surgery, peaking at 6 h and on d1, respectively. The time courses of IL-6, CRP, LBP and PCT release were not influenced by the type of surgical procedure. All parameters increased more markedly after lobectomy and wedge resection than after pneumonectomy. Surgical trauma and lung ischaemia/reperfusion injury could be the main factors determining the release of IL-6 and PCT after surgery. From an immunological point of view, pneumonectomy is less severe than wedge resection or lobectomy in terms of tissue injury. Different types of conventional thoracic surgery are associated with differences in postoperative PCT and IL-6 synthesis. For this reason, expected ranges of PCT and IL-6 levels should be established for the various surgical procedures before these parameters can be used as indicators of postoperative complications.

The Mandible Injury Severity Score: Development and Validity

To develop and validate a clinical method for characterizing and scoring mandible injury severity. Constituent fracture variables (fracture type, location, occlusion, soft tissue involvement, infection, and interfragmentary displacement [FLOSID]) were used to develop the FLOSID taxonomy for characterizing injury. Each component was assigned an empirical weight to help derive a summary measure of injury severity called the UCLA Mandible Injury Severity Score (MISS). Subsequently, MISS values were calculated for a group of 336 patients treated for mandible fractures. The validity of the summary score was evaluated by relating the MISS measure to the treatment modality used and to various variables, related as well as unrelated to injury outcomes. Each of the FLOSID components correlated significantly with the MISS (P < .001). Unrelated variables, including ethnicity, education, and gender, had no correlation to the MISS. On average, patients treated with rigid internal fixation had a higher MISS than patients treated with maxillomandibular fixation (P < .001). The MISS had a statistically significant association with surrogate markers of injury severity such as sensory nerve deficit, need for hospitalization, and pain at 1-month follow-up (P < .001). However, there was no significant association between MISS and indicators of postoperative complications (infection, nonunion, malunion, malocclusion). The FLOSID taxonomy offers a useful alternative to narrative summarization of mandible injury. The MISS is readily derived from clinical parameters obtained at the initial patient encounter and appears to be a valid index of mandible injury severity across important clinical domains.

Indicators of post-operative complications in G.I.-cancer patients : [formula omitted], Veen H, Kester A, Buil-Maaessen R, Soeters PB, von Meyenfeldt MF. Dept of Surgery, Dept of Med. Statistics University Hospital Maastricht, PO BOX 1918, The Netherlands

Indicators of post-operative complications in G.I.-cancer patients : [formula omitted], Veen H, Kester A, Buil-Maaessen R, Soeters PB, von Meyenfeldt MF. Dept of Surgery, Dept of Med. Statistics University Hospital Maastricht, PO BOX 1918, The Netherlands