Intraoperative Risk Factors Research Articles

Individualized prediction for the occurrence of acute kidney injury during the first postoperative week following cardiac surgery

Study objectiveTo develop individualized dynamic predictions for the occurrence of acute kidney injury (AKI) during the first postoperative week after cardiac surgery. DesignObservational retrospective cohort study. SettingSingle university teaching hospital in Madrid, Spain. Patients3960 cases of major cardiac surgery performed from January 2002 to December 2013. MeasurementsBaseline demographic and clinical characteristics, intraoperative risk factors, and repeated postoperative estimated glomerular filtration rates (eGFR). The primary outcome was AKI during the first postoperative week (stage 1 or higher of the Acute Kidney Injury Network). The dataset was split in two random samples (exploratory and validation). By combining time-to-event outcomes (AKI), and longitudinal data (repeated postoperative eGFR), we developed two different joint models for patients with normal and high baseline levels of serum creatinine (sCr). Main resultsAKI occurred in 1105 patients (31%, 95% confidence interval [CI] 29.5–32.5) in the exploratory sample and 128 (32.2%, 95% CI 27.6–36.8) in the validation sample. For high baseline sCr patients, the risk of an AKI event was associated with the eGFR trajectory (hazard ratio [HR] 0.91, 95% CI 0.90–0.92), as well as with age, and cardiopulmonary bypass time. The normal baseline sCr model incorporated the same covariates and intraoperative transfusion. In this second model, the risk of an AKI event was associated with both the eGFR trajectory (HR 0.91, 95% CI 0.91–0.92, for the current value of eGFR), and with its slope at that point (HR 0.96, 95% CI 0.94–0.99). So AKI risk decreased when the eGFR values increased, in accordance with the speed of this rise. Internal validation showed good discrimination and calibration of both joint models. The AUCs were always higher than 0.7. ConclusionsThe joint models obtained combining both patient risk factors and postoperative eGFR values, are useful to predict individualized risk of cardiac surgery-associated AKI. Predictions can be updated as new information is gathered.

Impact of demographic and perioperative risk factors on complication rates in skin-sparing/nipple-sparing mastectomy with implant-based reconstruction using titanized polypropylene mesh (TiLOOP® Bra)

BackgroundSkin/nipple-sparing mastectomies (SSM/NSSM) have been reported to have acceptable complication rates and good aesthetic outcomes with high patient satisfaction.However, in this relatively young and rapidly expanding field of reconstructive plastic surgery, differences in perioperative management are noted between breast centers. Prospective studies of complication rates using a titanized polypropylene mesh (TiLOOP® Bra) are currently lacking. MethodsA prospective subgroup analysis was performed based on the data set of the prospective, single-arm, multicenter observational study (PRO-BRA). Early complication rates after skin/nipple-sparing mastectomy with implant-based immediate or secondary reconstruction using a titanized polypropylene mesh (TiLOOP® Bra) subpectorally were investigated in relation to demographic factors, as well as intra-and postoperative management. The subgroup consists of 258 patients. Complications were categorised into necrosis, infection, postoperative bleeding or hematoma, seroma, wound healing delays and R1-situations. ResultsEarly complication rates of SSM/NSSM using titanium-based meshes are comparable to complication-rates using ADM's. Logistic regression shows significantly higher risk for wound healing delays, necrosis and seroma with increasing BMI, abladat- and implant-weight (OR 1,17 -1,66, p-value < 0,001). Smokers have significantly higher necrosis rates (20.7%) compared to non-smokers (5.5%) (p-value = 0.002). Discharge with drainage results in a trend toward higher rates of wound healing complications. ConclusionThe use of TiLOOP® Bra meshes was shown to have acceptable complication rates. Complication rates depend on certain demographic and intraoperative risk factors and should be considered in indications and information of patients.

Pathophysiology, Risk Factors, and Prevention of Wound Dehiscence Following Dermatologic Procedures

Skin cancer is the most common malignancy in the United States and has been increasing in incidence, affecting approximately one in five Americans. As the number of skin cancers have increased, so have the number of dermatologic procedures including biopsies and excisions. Behind surgical site infection, wound dehiscence is the second most common postoperative complication of dermatologic procedures. There are many preoperative, intraoperative, and postoperative risk factors for wound dehiscence. The current literature on the risk factors of dehiscence within the field of dermatology is scarce. To our knowledge, there have not been any comprehensive reviews on this topic. Our research article aims to serve as a comprehensive and concise review with the goal of educating providers and increasing awareness of the risk factors associated with wound dehiscence.

Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China.

Objective: Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD.Methods: Consecutive 313 patients with ATAAD who underwent emergency surgery at our hospital from February 2012 to February 2017 were enrolled in our study. Univariate and multivariate logistic regression analysis were performed to identify the pre-operative and intra-operative risk factors for in-hospital mortality.Results: Of the 313 patients, 32 patients (10.2%) died. Compared with survivors, non-survivors had higher heart rate, serum potassium level and EuroSCORE II, and higher incidence of moderate to severe pericardial effusion, supra-aortic vessels involvement, myocardial ischemia and lower-extremity ischemia. As for surgery-related factors, the duration of surgery and cardiopulmonary bypass time were longer in non-survivors than survivors. In addition, non-survivors were more likely to undergo coronary-artery bypass graft compared with survivors. On multivariate analysis, elevated plasma potassium level (OR: 43.0, 95% CI: 3.8–51.5, p < 0.001), high incidence of supra-aortic vessels involvement (OR: 4.4, 95% CI: 1.5–7.0, p = 0.008) and lower-extremity ischemia (OR: 4.9, 95% CI: 1.6–6.9; p = 0.009), and longer duration of surgery (OR 6.0, 95% CI: 1.8–18.7, p = 0.000) and cardiopulmonary bypass time (OR: 3.7, 95% CI: 1.3–9.3, p = 0.001) were independently predictive of higher mortality in patients with ATAAD.Conclusions: Supra-aortic vessels involvement, lower-extremity ischemia and elevated plasma potassium level are independent predictors of mortality in patients with ATAAD. A significant decrease in duration of surgery and cardiopulmonary bypass time is helpful to improve survival of patients.

Primary graft dysfunction: what we know.

Many advances in lung transplant have occurred over the last few decades in the understanding of primary graft dysfunction (PGD) though effective prevention and treatment remain elusive. This review will cover prior understanding of PGD, recent findings, and directions for future research. A consensus statement updating the definition of PGD in 2016 highlights the growing complexity of lung transplant perioperative care taking into account the increasing use of high flow oxygen delivery and pulmonary vasodilators in the current era. PGD, particularly more severe grades, is associated with worse short- and long-term outcomes after transplant such as chronic lung allograft dysfunction. Growing experience have helped identify recipient, donor, and intraoperative risk factors for PGD. Understanding the pathophysiology of PGD has advanced with increasing knowledge of the role of innate immune response, humoral cell immunity, and epithelial cell injury. Supportive care post-transplant with technological advances in extracorporeal membranous oxygenation (ECMO) remain the mainstay of treatment for severe PGD. Future directions include the evolving utility of ex vivo lung perfusion (EVLP) both in PGD research and potential pre-transplant treatment applications. PGD remains an important outcome in lung transplant and the future holds a lot of potential for improvement in understanding its pathophysiology as well as development of preventative therapies and treatment.

Frequency and Risk Factors for Post Mastectomy Pain Syndrome [PMPS] in Female Breast Cancer patients

Post mastectomy pain syndrome is one of the most common complications after axillary surgery for breast cancer. PMPS is considered a neuropathic pain and is thought to be caused by a variety of pre-operative, intraoperative and postoperative risk factors. In this study all post operative patients for breast cancer were interviewed at follow-up visits for symptoms of pain according to DN4 neuropathic pain score questionnaire and VAS scale for pain intensity. A total of 97 patients were included according to inclusion criteria. Among them 24(24.74%) patients were having PMPS and 73(77.06%) were having no PMPS. Among risk factors, ALND was found to be the most important risk factor for development of PMPS. In most patients the pain was mild in intensity according to VAS scale. And site of the pain was mostly found to be ipsilateral chest wall and axilla and majority of patients pin responded to simple NSAIDS and Arm exercises. Keywords: Breast cancer, mastectomy, pain

Risk factors for blood loss in liver resection surgery: An Institutional Review.

Background: Surgical resection of the primary or metastatic liver lesions is the treatment of choice for patients with resectable tumors. Identifying and managing preoperative and intraoperative risk factors responsible for increased blood loss during liver resection is extremely important. Therefore, the present study aims to identify preoperative and intraoperative risk factors associated with blood loss during liver resection.&#x0D; Methodology: A retrospective cross-sectional study was conducted on 72 patients who underwent liver resection for resectable primary and metastatic liver lesions at the Department of Surgical Oncology Hepatobiliary Unit, Shaukat Khanum Memorial Cancer Hospital, and Research Center Lahore. The study continued from October 2014 to July 2017, and data were collected from hospital records, including demographic, biochemical, and perioperative variables.&#x0D; Results: Out of the total 38 patients, 52.8% were female, with a mean age of 40.59 ± 21.66 years at the time of surgery. The results after multivariate analysis conclude two independent risk factors responsible for significant blood loss of more than 1000 milliliters during liver resection. These factors include liver cirrhosis, where the odds ratio is 7.96 with 95% CI (1.00-63.31) and P-value of 0.05 and operative time of 390 minutes where odds ratio is 8.94 with 95% CI (2.28-36.48) and P-value of 0.02.&#x0D; Conclusion: The risk factors associated with increased intraoperative blood loss during liver resections in our population are mainly associated with preoperative parameters, including positive viral serology and radiologically proven liver cirrhosis. In contrast, intraoperative factors were intravenous fluid administration and operative time.

Incidence, and preoperative and intraoperative prognostic factors of deep venous thrombosis in patients with glioma following craniotomy

ObjectivesThe aim of this study was to investigate the incidence of deep vein thrombosis (DVT) and the preoperative and intraoperative risk factors associated with DVT in glioma patients MethodsWe conducted a retrospective analysis of data obtained from glioma patients at Sanbo Hospital (Beijing, China) between 2018 and 2021. Symptomatic DVT was confirmed by Doppler ultrasonography. Multivariable logistic regression analysis was used to identify preoperative and intraoperative characteristics associated with DVT. Basic clinical variables and laboratory results were analyzed. ResultsA total of 492 glioma patients were included. Of these, 73 (14.84%) developed DVT, and three (0.61%) developed DVT and pulmonary embolism (PE). Multivariate analyses revealed that the following factors were highly predictive of post-operative DVT: older age ranges of 46––55 years (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 1.41––6.13; p = 0.004), 56––65 years (OR: 7.86; 95% CI: 3.63––17.03; p < 0.001), and > 65 years (OR: 4.94; 95% CI: 1.83––13.33; p = 0.002); partial thromboplastin time (APTT; OR: 0.91; 95% CI: 0.84––1.00; p = 0.040); D-dimer (OR: 2.21; 95% CI: 1.28––3.82; p = 0.005); and surgery duration (OR: 2.87; 95% CI: 1.6 ––5.07; p < 0.001) ConclusionsOlder age, preoperative APTT, D-dimer, and surgery duration independently increased the risk of developing postoperative DVT. These findings may facilitate the development of a thrombosis risk score that will allow physicians to develop individualized strategies to prevent DVT as early as possible.

Risk Factors Associated with Adnexal Torsion after Hysterectomy

<h3>Study Objective</h3> To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery. <h3>Design</h3> Retrospective nested case-control study. <h3>Setting</h3> Large urban medical system. <h3>Patients or Participants</h3> Eighty-nine female patients ages 17-51. <h3>Interventions</h3> Patients underwent ovarian-sparing hysterectomy. <h3>Measurements and Main Results</h3> The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8,538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic approach to hysterectomy vs any other approach (OR 3.73 [95% CI: 0.95, 14.59]); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR 3.78 [95% CI: 1.39, 10.27]); and a gynecologic history significant for endometriosis (OR 4.46 [95% CI: 1.07, 18.67]). <h3>Conclusion</h3> There is an association between laparoscopic approach to hysterectomy and risk of subsequent adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.

Effects of physical prehabilitation on markers of endothelial function in patients undergoing elective coronary artery bypass grafting

Abstract Purpose To evaluate the effects of preoperative exercise training on the perioperative serum levels of asymmetric dimethylarginine (ADMA) and endothelin-1 (ET-1) in patients with stable coronary artery disease (CAD). Methods 78 male patients with stable coronary artery disease referred to elective on-pump CABG were screened and randomized either to receive prehabilitation, or routine preoperative management without training. Group 1 (n=43, age 61.5 [55; 65] years) patients underwent preoperative exercise training (treadmill sessions at 80% of peak oxygen uptake (VO2peak) intensity for 5–10 days), whereas group 2 (n=35, age 63.0 [56; 66] years) received routine preoperative management without training. Levels of endothelial function (ADMA and ET-1) were measured using enzyme immunoassay in the preoperative period of CABG before exercise training, the day before surgery, and in the postoperative period on days 5–7. Logistic regression analysis was used to determine significant risk factors contributing to postoperative complications in the early postoperative period. Statistical analysis was performed using the Statistica 10.0 software (Statsoft, USA). Results Patients from both study groups did not differ in the main preoperative clinical and demographic parameters. They had similar comorbid profile and were also comparable in terms of the intraoperative parameters. No differences in baseline echocardiography and cardiopulmonary exercise testing were reported. By the end of the exercise training, group 1 patients had a significantly lower level of ADMA than patients from group 2 without prehabilitation (p=0.01). Correlation analysis reported a direct correlation between the levels of ADMA and ET-1 the day before surgery (ρ = 0.28, P=0.04) in the absence of significant intergroup differences in ET-1 levels. Stepwise logistic regression adjusted for comorbidities (chronic bronchopulmonary disease) and intraoperative risk factors (aortic cross-clamp time) reported a correlation of the pre-existing diabetes with an increased risk of complications in the early postoperative period (OR 12.3, 95% CI [1, 18–127.6], p=0.03). Elevated ET-1 levels also increased the risk of complications (OR 10.7, 95% CI [1.1–105.2], p=0.03), whereas preoperative exercise training reduced the risk of postoperative complications (OR 0.1, 95% CI [0.01–0.82], p=0.02). Conclusion Our findings indicate favorable effects of prehabilitation on the improvement of endothelial function and prevention of the complications in the early postoperative period. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fundamental topic No. 0546-2019-0003

The multivariable prognostic models for severe complications after heart valve surgery

BackgroundTo provide multivariable prognostic models for severe complications prediction after heart valve surgery, including low cardiac output syndrome (LCOS), acute kidney injury requiring hemodialysis (AKI-rH) and multiple organ dysfunction syndrome (MODS).MethodsWe developed multivariate logistic regression models to predict severe complications after heart valve surgery using 930 patients collected retrospectively from the first affiliated hospital of Sun Yat-Sen University from January 2014 to December 2015. The validation was conducted using a retrospective dataset of 713 patients from the same hospital from January 2016 to March 2017. We considered two kinds of prognostic models: the PRF models which were built by using the preoperative risk factors only, and the PIRF models which were built by using both of the preoperative and intraoperative risk factors. The least absolute shrinkage selector operator was used for developing the models. We assessed and compared the discriminative abilities for both of the PRF and PIRF models via the receiver operating characteristic (ROC) curve.ResultsCompared with the PRF models, the PIRF modes selected additional intraoperative factors, such as auxiliary cardiopulmonary bypass time and combined tricuspid valve replacement. Area under the ROC curves (AUCs) of PRF models for predicting LCOS, AKI-rH and MODS are 0.565 (0.466, 0.664), 0.688 (0.62, 0.757) and 0.657 (0.563, 0.751), respectively. As a comparison, the AUCs of the PIRF models for predicting LOCS, AKI-rH and MODS are 0.821 (0.747, 0.896), 0.78 (0.717, 0.843) and 0.774 (0.7, 0.847), respectively.ConclusionsAdding the intraoperative factors can increase the predictive power of the prognostic models for severe complications prediction after heart valve surgery.

Retroprosthetic Membrane Formation in Boston Keratoprosthesis Type 1: Incidence, Predisposing Factors, Complications, and Treatment.

The purpose of this study was to evaluate the incidence, rate of formation, and risk factors of retroprosthetic membrane (RPM) after Boston type 1 keratoprosthesis (BKPro) as well as identify secondary complications linked to its formation and describe its treatment. This was a retrospective cohort study. One hundred thirty-three eyes of 115 patients who underwent BKPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1-year follow-up. Charts were reviewed, and data were collected, including incidence of RPM formation, preoperative and intraoperative risk factors, postoperative complications, and treatment modalities. The mean follow-up was 5.5 years, and 39% (n = 52) of eyes developed RPM. No etiologies were found to be significantly associated with RPM development. Simultaneous lensectomy and simultaneous intraocular lens extraction were respectively positively and negatively correlated with RPM development [odds ratio (OR): 0.3590, 95% CI: 0.1629-0.7570, P = 0.0097; OR = 2.646, 95% CI: 1.273-5.585, P = 0.0086, respectively]. As for postoperative complications, the strongest correlation was between RPM and retinal detachment (OR = 6.16, 95% CI: 2.14-16.14; P = 0.0004). RPM development was also positively associated with the development of hypotony and corneal melt. Nd:YAG membranectomy was the most common treatment, performed in 83% of eyes with RPM (n = 24), with 58% resolution. More than one third of patients who undergo BKPro will develop RPM, requiring close monitoring for retinal detachment. Simultaneous intraocular lens extraction seems protective, whereas simultaneous lens extraction increases the rate of RPM formation significantly. Nd:YAG membranectomy can be used as an initial noninvasive approach.

Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study).

Acute kidney injury (AKI) represents a frequent complication after orthotopic liver transplantation (OLT). This study aimed to evaluate early postoperative AKI incidence during the first 72 h after OLT, perioperative risk factors, and AKI impact on survival. From January 2011 to December 2013, 1681 patients underwent OLT in 19 centers and were enrolled in this prospective cohort study. According to RIFLE criteria, AKI occurred in 367 patients, 21.8% (R: 5.8%, I: 6.4%, F: 4.8%, L: 4.8%). Based on multivariate analysis, intraoperative risk factors for AKI were: administration of 5-10 RBCs (OR 1.8, 95% CI 1.3-2.7), dopamine use (OR 1.6, 95% CI 1.2-2.3), post-reperfusion syndrome (OR 1.5, 95% CI 1.0-2.3), surgical complications (OR 2.0, 95% CI 1.3-3.0), and cardiological complications (OR 2.2, 95% CI 1.2-4.0). Postoperative risk factors were: norepinephrine (OR 1.4, 95% CI 1.0-2.0), furosemide (OR 4.2, 95% CI 3.0-5.9), more than 10 RBCs transfusion, (OR 3.7, 95% CI 1.4-10.5), platelets administration (OR 1.6, 95% CI 1.1-2.4), fibrinogen administration (OR 3.0, 95% CI, 1.5-6.2), hepatic complications (OR 4.6, 95% CI 2.9-7.5), neurological complications (OR 2.4, 95% CI 1.5-3.7), and infectious complications (OR 2.7, 95% CI 1.8-4.3). NO-AKI patients' 5-year survival rate was higher than AKI patients (68.06, 95% CI 62.7-72.7 and 81.2, 95% CI 78.9-83.3, P<0.001). AKI still remains an important risk factor for morbidity and mortality after OLT. Further research to develop new strategies aimed at preventing or minimizing post-OLT AKI is needed.

Cognitive Dysfunction in Older Patients Undergoing Orthopedic Surgery: Analysis of Demographic, Clinical, and Intraoperative Risk Factors

Cognitive Dysfunction in Older Patients Undergoing Orthopedic Surgery: Analysis of Demographic, Clinical, and Intraoperative Risk Factors

Preoperative Urine Analysis is An Effective Tool to Predict Fever After Miniaturized Percutaneous Nephrolithotomy on Large Renal Stones.

To investigate the preoperative and intraoperative potential risk factors associated with miniaturized percutaneous nephrolithotomy (mPCNL) fever in the treatment of patients with large renal stones. All patients with renal stones larger than 2.5 cm, who had undergone mPCNL, were included in the period between April 2018 and September 2019. Logistic regression analyses were performed to identify clinical variables associated with post-operative fever (>38°C). A total of 53 patients were enrolled for whom the median maximal stone length was 3.08 cm. 24 (45%) patients had a fever after mPCNL. Significantly more patients with urine WBC ≥ 27(/HPF) had a fever after surgery (p = 0.004). No significant between-group differences in urine cultures were found for the fever and non-fever groups (p = 0.094). Stepwise and multivariable logistic regression analyses all revealed that urine WBC ≥ 27(/HPF) is the only risk factor for developing post-mPCNL fever. Based on the highest body temperature, all of the patients were assigned into no fever, mild fever (37.5 ≤ Temp < 38.0), and fever groups, and an ordinal logistic regression analysis still supported the premise that the result of urine analysis is strongly associated with post-mPCNL fever. Large renal stones are challenging to treat and associated with severe complications. Approximately 45% of large renal stone patients treated via mPCNL developed a fever. Urine WBC can easily and directly predict the risk of fever.

Clinical Factors Contributing to Anastomotic Leak After Mid-to-High Colorectal Anastomosis.

Low colorectal anastomoses carry a high anastomotic leak (AL) rate (up to 20%) and thus are commonly diverted. Much less is known about mid-to-high colorectal anastomosis, which carries a leak rate of 2-4%. The objective of this study was to determine our AL rate after mid-to-high colorectal anastomosis and associated risk factors. A single center retrospective cohort study of patients undergoing left colonic resections with mid-to-high colorectal anastomosis (≥7cm from the anal verge) from January 2008 to October 2017 was utilized. Main outcome, AL, defined as clinical suspicion supported by radiological or intraoperative findings, was calculated and risk factors assessed using multivariable logistic regression analysis. 977 patients were included; 487 (49.9%) were male, with a mean age of 59.8 (+/-12.1) years. Mean BMI was 27.5 (+/-5.5) kg/m2. Diverticular disease (67.5%), malignancy (17.4%), and inflammatory bowel disease (2.2%) were the main indications for resection. Mean length of stay was 6.7 (+/-4.5) days. 455 (46.8%) colonic resections were performed by laparoscopy, 283 (29.1%) by hand assisted surgery, 219 (22.5%) by laparotomy, and 16 (1.6%) by robotics. Majority of patients had complete donuts (99.6%) and a negative air leak test (97.7%). 149 patients (15.3%) underwent construction of a diverting stoma. The overall AL rate was 2.1% (n = 20). Increased BMI (>30kg/m2), P = .02, was an independent risk factor for AL and a trend observed for positive air leak tests (P = .05), with other factors failing to achieve statistical significance. Patients with mid-to-high colorectal anastomosis have a 2% AL risk. Increased BMI was a risk factor for AL.

OS10.3.A Predicting delirium after craniotomy in neuro-oncology

Abstract BACKGROUND Post-operative delirium (POD) is a frequent and severe complication after neurosurgical operations. Good prediction of POD after craniotomy in neuro-oncologic patients is important to install prophylactic measures, increase recognition and apply early treatment. Hence, we compared logistic regression with machine learning to build an accurate predictive model in a large dataset. MATERIAL AND METHODS POD was defined in case of a Delirium Observation Scale (DOS) ≥ 3 or start of antipsychotic treatment for delirium within 10 days after surgery. Adult patients undergoing a craniotomy for a neuro-oncologic disease in the Erasmus Medical Centre in Rotterdam were retrospectively included. The cohort was split into a training (75%), after three-fold cross validation, and test set (25%). Logistic regression and Lasso Elastic-Net Regularized Generalized Linear Models (GLMNet) were trained based on 19 pre- and intra-operative features and risk factors were identified based on the superior model. RESULTS We included 1025 neuro-oncologic craniotomies between June 2017 and September 2020. Overall incidence of POD was 18.6% (95%CI 17.4–19.8). Compared to logistic regression, Lasso GLMNet performed superior (AUC 0.73 vs. 0.76) based on the optimal tuning parameters (α=1, λ=0.014). Several non-modifiable risk factors such as age (OR1.01), prior delirium (OR1.04), memory problems (OR1.12), surgery duration (OR1.01) and modifiable risk factors, such as low potassium (OR0.97) levels and opioid administration (OR1.03), were identified. CONCLUSION POD is a frequent complication after craniotomy in neuro-oncologic patients. Lasso GLMNet was useful in predicting POD in this cohort. Validation in a prospective cohort of this model should be applied to further evaluate its value in diminishing POD.

Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center.

Background.Biliary leaks and anastomotic strictures comprise the majority of biliary complications (BCs) following liver transplantation (LT). Currently, there are few large contemporary case series of BCs in adult deceased donor liver transplant (DDLT) recipients in the literature. The purpose of this study was to examine the pretransplant and intraoperative risk factors associated with BCs at a high-volume tertiary care center and determine the impact of these BCs on their posttransplant course and long-term transplant outcomes.Methods.We retrospectively reviewed all adult patients undergoing a DDLT from a donor after brain death (DBD) at Emory University between January 2015 and December 2019.Results.A total of 647 adult patients underwent DDLT from a DBD during the study period and were included in analyses. The median length of follow-up posttransplant was 2.5 y. There were a total of 27 bile leaks (4.2%) and 69 biliary strictures (10.7%). Recipient age and cold ischemic time were identified as risk factors for biliary leak, whereas alcoholic cirrhosis as transplant indication was a risk factor for biliary stricture. Placement of a biliary stent was associated with the development of both biliary leaks and anastomotic strictures. Posttransplant, biliary leaks were a significant risk factor for future episodes of acute rejection but did not impact overall survival. In contrast, biliary strictures were associated with a significantly reduced overall survival at 1- and 4-y post DDLT.Conclusions.BCs are a major source of morbidity and mortality following DDLT, with strictures and leaks associated with distinct posttransplant complications.

A SCORING SYSTEM TO PREDICT THE RISK OF SURGICAL SITE INFECTIONS AFTER SPINAL SURGERY

ABSTRACT Objective This retrospective clinical study was carried out to generate and cross-validate a scoring system for the identification of patients at risk of SSIs after spinal surgery. Methods A retrospective study was conducted, which included patients who underwent spinal surgery. The potential variables for SSIs were extracted from the database, including preoperative, intraoperative and postoperative risk factors for univariate and multivariate regression analyses. Results A total of 2347 patients were included in this retrospective clinical study. Postoperative SSIs were observed in 53 patients (2.2%). The multivariate logistic regression analysis revealed the following risk factors for SSIs after spinal surgery: diabetes mellitus ( P =0.029), body mass index ( P =0.008), low serum calcium concentration ( P =0.012), low pre- and postoperative albumin ( P =0.023, P =0.037), more than three operated segments ( P =0.008), operation time of more than 180 minutes ( P =0.019), estimated blood loss ( P =0.011), low postoperative hemoglobin ( P =0.017) and prolonged drainage time ( P =0.025). Each of these factors contributed 1 point to the risk score. The predicted rates of incidence for the low-, intermediate-, high-, and extremely high-risk categories in the validation set were 1.4%, 12%, 41.6%, and 66.6%, respectively. Conclusions Our scoring system allows for easy and validated risk stratification of SSIs after spinal surgery. Level of evidence III; Cross-sectional Observational Study.

Risk factors related to complications of the fingers and hand after arthroscopic rotator cuff repair - carpal tunnel syndrome, flexor tenosynovitis, and complex regional pain syndrome.

Hypothesis/BackgroundComplications involving the fingers and hand after arthroscopic rotator cuff repair (ARCR) include complex regional pain syndrome, carpal tunnel syndrome (CTS), and flexor tenosynovitis (TS). The aims of this study were to diagnose the complications after ARCR and investigate the risk factors that could predispose individuals to these finger and hand complications.MethodsFifty patients (50 shoulders) who underwent ARCR participated in this study. The patients’ ages ranged from 36 to 84 years (mean, 63 years). Before ARCR, we determined the disease history of the fingers and hand (CTS or TS) and subjectively assessed their symptoms using a questionnaire that included a scale ranging from 1 (no symptoms or no disability) to 5 (the worst symptoms or severest disability). ARCR was performed in all patients using suture anchors. The mean observation period after surgery was 15.5 months (range, 12-48 months). We diagnosed complications involving the fingers and hand after ARCR and investigated the preoperative, intraoperative, and postoperative risk factors that could predispose patients to these complications using univariable and multivariable analyses.ResultsAfter ARCR, 20 patients (20 hands) (40%) had complications of the fingers and hand. Among them, the diagnosis was CTS in 2 hands, TS in 15 hands, and both CTS and TS in 3 hands. None of the hands exhibited complex regional pain syndrome. These complications occurred at an average of 1.8 months (range, 0.1-4 months) after ARCR. In the 47 patients who did not have symptoms just before the operation, both univariable and multivariable analyses between the complication group (n = 17) and the no-complications group (n = 30) showed a significant difference in the presence of a past history of CTS or TS (complication frequency: past history: 88%, no past history: 25%) (P < .05) and the preoperative subjective assessment for edema of the fingers and hand (complication frequency: edema ≥ 2 points: 89%, edema < 2 points: 24%) (P < .05). There were no relationships between the other candidate intraoperative and postoperative factors and complications.ConclusionIn all 20 hands with complications of the fingers and hand after ARCR, the diagnosis was CTS or TS. Complications of the fingers and hand after ARCR easily occurred in patients with a past history of CTS or TS and in patients with edema as per a subjective assessment. We speculate that the ARCR triggered the occurrence of CTS and TS postoperatively in patients who had subclinical CTS or TS before surgery.