Major Surgery Research Articles

Effect of Sarcobesity Index and Body Adipose Tissue Variables on Cardiopulmonary Exercise Testing Performance in Colorectal Surgery Setting: A Retrospective Cohort Study.

Aims/Background The prognostic significance of body composition variables has become a popular area of research over the recent years. This study aimed to determine whether adipose tissue variables and sarcobesity index measured by computed tomography (CT) could predict cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery. Methods The Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) statement standards were followed to conduct a retrospective cohort study of consecutive patients who had CPET prior to major colorectal surgery between January 2011 and January 2017. Receiver Operating Characteristic curve analysis was conducted to assess the discriminative performances of adipose tissue variables. The association between CT-derived adipose tissue variables (sarcobesity index, visceral adipose tissue, subcutaneous adipose tissue, and total adipose tissue) and CPET performance and mortality were assessed using regression analyses. Results 457 patients were included. Total adipose tissue evaluated via 2-dimensional (2D) and 3-dimensional (3D) approaches predicted oxygen uptake (V̇O2) Rest, V̇O2 anaerobic threshold (AT), ventilatory equivalents for carbon dioxide (V̇E/V̇CO2) AT, ventilatory equivalents for oxygen (V̇E/V̇O2) AT, V̇O2 peak, exercise time, maximum work, peak metabolic equivalents (METS), peak respiratory rate (RER), and peak oxygen pulse. Sarcobesity index (2D and 3D) predicted V̇O2 Rest, V̇O2 AT, V̇E/V̇CO2 AT, V̇O2 peak, maximum work, peak METS, maximum heart rate, and peak RER. Neither total adipose tissue nor sarcobesity index (2D and 3D) predicted 1-year, 3-year, or 5-year mortality. There was no difference in the discriminative performance of adipose tissue variables in predicting mortality. Conclusion The CPET performance may be predicted by radiologically measured adipose tissue variables and sarcobesity index. However, the prognostic value of the variables may not be significant in this setting.

An immune signature of postoperative cognitive decline: A prospective cohort study.

Postoperative cognitive decline (POCD) is the predominant complication affecting patients over 60 years old following major surgery, yet its prediction and prevention remain challenging. Understanding the biological processes underlying the pathogenesis of POCD is essential for identifying mechanistic biomarkers to advance diagnostics and therapeutics. This study aimed to provide a comprehensive analysis of immune cell trajectories differentiating patients with and without POCD and to derive a predictive score enabling the identification of high-risk patients during the preoperative period. Twenty-six patients aged 60 years old and older undergoing elective major orthopedic surgery were enrolled in a prospective longitudinal study, and the occurrence of POCD was assessed seven days after surgery. Serial samples collected before surgery, and one, seven, and 90 days after surgery were analyzed using a combined single-cell mass cytometry and plasma proteomic approach. Unsupervised clustering of the high-dimensional mass cytometry data was employed to characterize time-dependent trajectories of all major innate and adaptive immune cell frequencies and signaling responses. Sparse machine learning coupled with data-driven feature selection was applied to the pre-surgery immunological dataset to classify patients at risk for POCD. The analysis identified cell-type and signaling-specific immune trajectories differentiating patients with and without POCD. The most prominent trajectory features revealed early exacerbation of JAK/STAT and dampening of inhibitory κB and nuclear factor-κB immune signaling responses in patients with POCD. Further analyses integrating immunological and clinical data collected before surgery identified a preoperative predictive model comprising one plasma protein and ten immune cell features that classified patients at risk for POCD with excellent accuracy (AUC=0.80, P=2.21e-02 U-test). Immune system-wide monitoring of patients over 60 years old undergoing surgery unveiled a peripheral immune signature of POCD. A predictive model built on immunological data collected before surgery demonstrated greater accuracy in predicting POCD compared to known clinical preoperative risk factors, offering a concise list of biomarker candidates to personalize perioperative management.

Analysis of ERAS protocol adherence and postoperative outcomes after major colorectal surgery in a community hospital

Despite widespread adoption, the efficacy of Enhanced Recovery After Surgery (ERAS) protocols in community hospital settings remains understudied. This retrospective analysis conducted at a high-volume community hospital aimed to evaluate adherence to ERAS protocols and analyze postoperative outcomes following colorectal surgery. A total of 278 adult patients undergoing elective colorectal surgery between January 2022 and January 2024 were included. Data analysis revealed time to first mobilization proved to be satisfactory in accordance with ERAS hospital guidelines (mean 1.0 ​± ​0.05 days, range 0.1–13.8 days), and furthermore demonstrated a strong positive correlation with both time to first bowel function (r ​= ​0.69, p ​< ​0.0001) and length of stay (r ​= ​0.25, p ​< ​0.0001). Time to urinary catheter removal occurred slightly after guideline-directed removal (mean 1.1 ​± ​0.05 days, range 0.5–12.9 days), however did exhibit a significant positive correlation with length of stay (r ​= ​0.33, p ​< ​0.0001). 10.9 ​% of patients experienced a postoperative complication, while the average length of stay across all procedures was 3.1 ​± ​0.17 days (range 0.9–23.3 days), and the overall 30-day readmission rate stood at 10.43 ​%. This study underscores the need for ongoing evaluation and refinement of ERAS protocols in community hospital settings to enhance surgical care and patient satisfaction.

PERINATAL OUTCOME IN SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN SECTION

Successful vaginal birth has been reported in 60%–80% of cases reported in published studies of women attempting vaginal birth after a previous Cesarean section. The recommended criteria for selecting candidates suitable for VBAC are potentially applicable in tertiary centers in developing countries, but there are many inadequacies in meeting them in our environment. VBAC avoids major abdominal surgery, lowers the women’s risk of postpartum morbidities like fever, blood transfusion, infections, and shorter hospital stay, and encourages earlier breastfeeding and better bonding between mother and neonate. Objectives: To determine the frequency of perinatal outcomes in successful vaginal birth after cesarean section (VBAC). Methods: Descriptive, case series study in the Department of Obstetrics &amp; Gynecology, Lady Reading Hospital, Peshawar from August 2020 to February 2021. A total of 207 pregnant women with singleton pregnancy of cephalic presentation with successful vaginal birth after cesarean of gestational age 37-41 weeks were included. Patients with multiple pregnancies, ruptured uterus, placenta previa, and fetal malpresentation were excluded. After taking informed consent, all women were followed till delivery and perinatal outcome i.e. low birth weight, Apgar score&lt;7 at 1 minute, and NICU admission was noted. Results: The age range in this study was from 18 to 40 years with a mean age of 29.32 ± 4.57 years. The majority of the patients 104 (50.24%) were between 31 to 40 years of age. The mean gestational age was 38.33 ± 1.17 weeks. The mean parity was 2.11 ± 0.82. In my study, the frequency of perinatal outcome in successful vaginal birth after the cesarean section was as follows; low birth weight in 15.94%, APGAR score&lt;7 at 1 minute in 9.67%, and NICU admission in 14.01% neonates. Conclusion: This study concluded that the frequency of perinatal outcome in successful vaginal birth after cesarean section was as follows; low birth weight in 15.94%, APGAR score&lt;7 at 1 minute is 9.67%, and NICU admission in 14.01% neonates.

Free fillet flap: Outcomes in emergency microsurgical reconstruction of upper and lower limb

INTRODUCTIONDespite its infrequency, “spare-part surgery” represents a reconstructive strategy that uses segments of amputated limbs as donor tissue to preserve function in other injured anatomical regions. The purpose was to review our 14-year experience in emergency microsurgical reconstruction of traumatised limbs using free fillet flaps obtained from non-salvageable amputated parts. MATERIALS AND METHODSA retrospective observational study was conducted on patients who underwent urgent free fillet flap transfer for upper or lower limb reconstruction between 2007 and 2021. The characteristics and levels of injury, as well as the flap designs, functional outcomes and complications were documented. RESULTSA series of eight clinical cases is presented. One osteo-tendino-cutaneous and seven fasciocutaneous flaps were filleted from non-replantable amputated limbs for free transfer. Stable coverage of the dorsal aspect of the hand and fingers was achieved in three patients, and limb shortening was avoided in five patients. An open fracture of the thumb with bone defect, three below-knee stumps and one trans-metatarsal level were preserved. The mean Q-DASH score for upper limb reconstructions was 16.75 points. In all cases of lower limb reconstruction, the nerves were repaired, resulting in a protective sensitivity (S3 level) with no pressure ulcer development during the follow-up period. All patients were able to return to normal prosthetic ambulation with a mean Amputee Mobility Predictor Pro score of 45 points. Two haematomas, one surgical wound dehiscence, and two immediate revisions of venous anastomoses were registered. CONCLUSIONSThe microvascular filleted flap demonstrated versatility in the emergency reconstruction of complex limb injuries, providing stable coverage and optimised limb length preservation within a single major surgical procedure while eliminating morbidity from any other uninjured donor site.

Effect of intravenous versus inhaled anesthetics on blood-brain barrier dysfunction and neuroinflammation in elderly patients undergoing major surgery: study protocol of a randomized controlled trial

BackgroundPostoperative cognitive dysfunction (POCD) is one of the major complications after surgery, with devastating clinical outcomes. Although POCD is a condition with a multifactorial pathophysiology, blood-brain barrier (BBB) dysfunction and neuronal injury have been shown to play a critical role, especially in the elderly. Previous studies have demonstrated that the choice of anesthetics affect BBB permeability and neuroinflammation. However, most studies are carried out on animals, with limited research undertaken on humans. Therefore, we will compare the effect of intravenous anesthetics and inhaled anesthetics on BBB dysfunction and the change of inflammatory markers after surgery.MethodsOne hundred and fifty-four patients who are 60 years of age or older undergoing major surgery for more than 2 h will be randomly allocated to two anesthetics groups (intravenous, inhaled) in a 1:1 ratio. In the intravenous anesthetics group (group P), propofol will be infused with a target-controlled infusion (TCI) system throughout the entire surgery. In the inhaled anesthetics group (group G), bolus injection of propofol will be administered for loss of consciousness, and simultaneously sevoflurane will be initiated for the maintenance of anesthesia. The primary outcome is the change in serum S100 calcium binding protein β (S100β) at four time points: before induction of anesthesia, at the end of surgery, 4 h after surgery, postoperative day 1. Secondary outcomes include changes in the inflammatory markers, serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, and C-reactive protein; the incidence of delirium; and the change in the cognitive function between groups. In patients pre-scheduled for postoperative intensive care unit admission, the cerebrospinal fluid/serum albumin quotient (Qalb) between the two groups will be compared before and after surgery, and change in inflammatory markers in serum and CSF will be analyzed in relation to the Qalb.DiscussionThe current study will compare the effect of intravenous versus inhaled anesthetics on blood-brain barrier permeability and, as a result, the difference in neuroinflammation in elderly patients. Also, the study results will provide additional information to develop intraoperative anesthetic strategies to reduce POCD.Trial registrationThe trial was prospectively registered at Clinical Trials protocol registration with identifier 2310-117-126 on April 9, 2024.

Adiponectin deficiency is a critical factor contributing to cognitive dysfunction in obese mice after sevoflurane exposure

BackgroundThe number of major operations performed in obese patients is expected to increase given the growing prevalence of obesity. Obesity is a risk factor for a range of postoperative complications including perioperative neurocognitive disorders. However, the mechanisms underlying this vulnerability are not well defined. We hypothesize that obese subjects are more vulnerable to general anaesthesia induced neurotoxicity due to reduced levels of adiponectin. This hypothesis was tested using a murine surgical model in obese and adiponectin knockout mice exposed to the volatile anaesthetic agent sevoflurane.MethodsObese mice were bred by subjecting C57BL/6 mice to a high fat diet. Cognitive function, neuroinflammatory responses and neuronal degeneration were assessed in both obese and lean mice following exposure to 2 h of sevoflurane to confirm sevoflurane-induced neurotoxicity. Thereafter, to confirm the role of adiponectin deficiency in, adiponectin knockout mice were established and exposed to the sevoflurane. Finally, the neuroprotective effects of adiponectin receptor agonist (AdipoRon) were examined.ResultsSevoflurane triggered significant cognitive dysfunction, neuroinflammatory responses and neuronal degeneration in the obese mice while no significant impact was observed in the lean mice. Similar cognitive dysfunction and neuronal degeneration were also observed in the adiponectin knockout mice after sevoflurane exposure. Administration of AdipoRon partially prevented the deleterious effects of sevoflurane in both obese and adiponectin knockout mice.ConclusionsOur findings demonstrate that obese mice are more susceptible to sevoflurane-induced neurotoxicity and cognitive impairment in which adiponectin deficiency is one of the underlying mechanisms. Treatment with adiponectin receptor agonist ameliorates this vulnerability. These findings may have therapeutic implications in reducing the incidence of anaesthesia related neurotoxicity in obese subjects.

High-Density Lipoprotein Anti-Inflammatory Capacity and Acute Kidney Injury After Cardiac and Vascular Surgery: A Prospective Observational Study.

Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery. Prospective observational study. Quaternary medical center. One hundred adults with chronic kidney disease on long-term statin therapy undergoing major elective cardiac and vascular surgery. None. Apolipoprotein B-depleted serum collected at anesthetic induction was incubated with tumor necrosis factor alpha stimulated human endothelial cells. Reverse transcriptase-polymerase chain reaction was used to measure intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assay assays were used to measure apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in patient plasma. HDL concentration did not correlate with HDL ICAM-1 suppression capacity (Spearman R = 0.05; p = 0.64). Twelve patients (12%) were found to have dysfunctional, pro-inflammatory HDL. Patients with pro-inflammatory HDL had a higher rate of postoperative AKI than patients with anti-inflammatory HDL (p = 0.046). After adjustment for AKI risk factors, a higher preoperative HDL capacity to suppress endothelial ICAM-1 was independently associated with lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80-0.98; p = 0.016). The association between HDL anti-inflammatory capacity and postoperative AKI was independent of HDL concentration (p = 0.018). Further, a higher long-term statin dose was associated with higher HDL capacity to suppress endothelial ICAM-1 (p = 0.045). Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity.

The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle

Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.

Primary care follow-up improves outcomes in older adults following emergency general surgery admission

BACKGROUND While preoperative optimization improves outcomes for older adults undergoing major elective surgery, no such optimization is possible in the emergent setting. Surgeons must identify postoperative interventions to improve outcomes among older emergency general surgery (EGS) patients. The objective of this cohort study was to examine the association between early follow-up with a primary care physician (PCP) and the risk of nursing home acceptance or death in the year following EGS admission among older adults. METHODS Using population-based administrative health data in Ontario, Canada (2006–2016), we followed all older adults (65 years or older) for 1 year after hospital admission for EGS conditions. A multivariable Cox model was used to identify the association between early postdischarge follow-up with a patient's PCP and the time to nursing home acceptance or death while adjusting for confounders. RESULTS Among 76,568 older EGS patients, 32,087 (41.9%) were seen by their usual PCP within 14 days of discharge, and 9,571 (12.5%) were accepted to a nursing home or died within 1 year. Primary care physician follow-up was associated with a 13% reduced risk of nursing home acceptance or death compared with no follow-up (hazard ratio 0.87; 95% confidence interval 0.84–0.91). This effect was consistent across age and frailty strata, patients managed operatively and nonoperatively, and patients who had both high and low baseline continuity of care with their PCP. CONCLUSION Early follow-up with a familiar PCP was associated with a reduced risk of nursing home acceptance or death among older adults following EGS admission. Structures and processes of care are needed to ensure that such follow-up is routinely arranged at discharge. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

Risk factors for postoperative acute kidney injury after radical cystectomy for bladder cancer in the era of ERAS protocols: A retrospective observational study.

Radical cystectomy (RC) is a major surgery associated with a high morbidity rate. Perioperative fluid management according to enhanced recovery after surgery (ERAS) protocols aims to maintain patients in an optimal euvolemic state while exposing them to acute kidney injury (AKI) in the event of hypovolemia. Postoperative AKI is associated with severe morbidity and mortality. Our main objective was to determine the association between perioperative variables, including some component of ERAS protocols, and occurrence of postoperative AKI within the first 30 days following RC in patients presenting bladder cancer. Our secondary objective was to evaluate the association between a postoperative AKI and the occurrence or worsening of a chronic kidney disease (CKD) within the 2 years following RC. We conducted a retrospective observational study in a referral cancer center in France on 122 patients who underwent an elective RC for bladder cancer from 01/02/2015 to 30/09/2019. The primary endpoint was occurrence of AKI between surgery and day 30. The secondary endpoint was survival without occurrence or worsening of a postoperative CKD. AKI and CKD were defined by KDIGO (Kidney Disease: Improving Global Outcomes) classification. Logistic regression analyse was used to determine independent factors associated with postoperative AKI. Fine and Gray model was used to determine independent factors associated with postoperative CKD. The incidence of postoperative AKI was 58,2% (n = 71). Multivariate analysis showed 5 factors independently associated with postoperative AKI: intraoperative restrictive vascular filling < 5ml/kg/h (OR = 4.39, 95%CI (1.05-18.39), p = 0.043), postoperative sepsis (OR = 4.61, 95%CI (1.05-20.28), p = 0.043), female sex (OR = 0.11, 95%CI (0.02-0.73), p = 0.022), score SOFA (Sequential Organ Failure Assessment) at day 1 (OR = 2.19, 95%CI (1.15-4.19), p = 0.018) and delta serum creatinine D1 (OR = 1.06, 95%CI (1.02-1.11), p = 0.006). During the entire follow-up, occurrence or worsening of CKD was diagnosed in 36 (29.5%). A postoperative, AKI was strongly associated with occurrence or worsening of a CKD within the 2 years following RC even after adjustment for confounding factors (sHR = 2.247, 95%CI [1.051-4.806, p = 0.037]). A restrictive intraoperative vascular filling < 5ml/kg/h was strongly and independently associated with the occurrence of postoperative AKI after RC in cancer bladder patients. In this context, postoperative AKI was strongly associated with the occurrence or worsening of CKD within the 2 years following RC. A personalized perioperative fluid management strategy needs to be evaluated in these high-risk patients.

Inferring the Accurate Locations of Noise Records in Mobile Phone Location Data

ABSTRACTThe positioning uncertainty of mobile phone location (MPL) data greatly influences location services and crowd behavior analysis. Although many achievements have been made in controlling its main sources (signal drift and ping‐pong effects), several problems, such as single‐oscillation patterns, insufficient position optimization, and a lack of effective evaluation, remain. In this study, a set of MPL data quality optimization methods are proposed. First, the characteristics of drift records and the oscillation patterns of ping‐pong records are discussed. The quality of the MPL data is subsequently controlled with the proposed feature‐based drift‐record detection method, complex oscillation pattern‐based ping‐pong‐record detection method, and cumulative duration weighting‐based ping‐pong‐record optimization method. These methods are applied to the MPL dataset of a major operator in Nanjing city, and the optimization effect is evaluated with GPS data collected synchronously. The results show that the proposed detection and optimization methods can effectively improve the accuracy of MPL data.

CIGVis: an open-source python tool for real-time interactive visualization of multidimensional geophysical data

As Python’s role in processing and interpreting geophysical data expands, the need for a Python-based tool tailored for visualizing geophysical data has become increasingly criti- cal. In response, CIGVis was developed - a fully open-source Python tool optimized for researchers and licensed under the MIT. It specializes in real-time, interactive visualiza- tion of multidimensional geophysical data, including 3D seismic, faults, horizons, geological bodies, and well logs. CIGVis enables users to interact with data through operations such as rotation, movement, zooming, and dragging slices. It also supports a multi-canvas func- tionality, allowing simultaneous visualization across multiple sub-canvases with a unified camera perspective. Its ease of use allows for effective visualization with just a few lines of code across all major operating systems, and extends to both desktop and Jupyter environ- ments, facilitating code execution in various settings. The core functionalities of CIGVis are exemplified using straightforward datasets, such as the F3 dataset.

Profiling food waste in the retail sector of developing economies

ABSTRACT Food loss and waste (FLW) continues to have economic, environmental, and reputational risks for retailers. However, standardised baseline data to engage this challenge is often absent in developing economies. We quantify FLW for all the retail outlets from a major retailer operating in southern Africa by using the World Resources Institute’s FLW Accounting and Reporting Standard and its reporting template for three-month trial period. The data enabled us to reflect on the appropriateness of the Standard for retailers in these economies, which proved adequate subject to recommended changes to the template before implementation.

Description of Hypotension in Cesarean Section Patients Under Spinal Anesthesia Using Conventional and Enhanced Recovery after Surgery Methods

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative management aimed at faster recovery from major surgery, reducing the risk of complications, and shortening the length of stay compared to conventional perioperative methods. Hypotension is a side effect of a cesarean section with spinal anesthesia. This study aims to describe hypotension in patients undergoing cesarean sections with conventional spinal anesthesia methods and the Enhanced Recovery After Surgery (ERAS) method. This study used a quantitative research method with a descriptive design and a cross-sectional approach. The sampling technique was purposive sampling with a total of 40 cesarean section patients, consisting of 20 respondents in the conventional spinal anesthesia group and 20 respondents in the ERAS spinal anesthesia group. Blood pressure measurements were taken before and after spinal anesthesia using a bedside monitor. The data obtained included age and blood pressure, which were analyzed using statistics. The results showed that in the conventional spinal anesthesia group, 15 respondents experienced hypotension (75%), and 5 respondents did not experience hypotension (25%). In the Enhanced Recovery After Surgery (ERAS) spinal anesthesia group, 7 respondents experienced hypotension (35%), and 13 respondents did not experience hypotension (65%).

Breast Milk Feeding for Infants Who Required Major Surgery

ObjectiveTo identify barriers or facilitators that influenced mothers to provide mother’s own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery. DesignDescriptive qualitative. SettingAn 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States. ParticipantsFourteen mothers who provided MOM for their infants who required surgery within 1 week of age. MethodsWe conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method. ResultsEleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants’ comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances. ConclusionInternalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers.

Comment on “Older Adults’ Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery”: Opportunities for Nonpharmacologic Approaches

Comment on “Older Adults’ Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery”: Opportunities for Nonpharmacologic Approaches

Predictive Value of ARISCAT Risk Index in the Development of Postoperative Pulmonary Complications After Major Abdominal Cancer Surgery

Predictive Value of ARISCAT Risk Index in the Development of Postoperative Pulmonary Complications After Major Abdominal Cancer Surgery

Postoperative complications in the pediatric population. Malnutrition or phase angle? Which one do we use?

Malnutrition increases post-operative risks like infections and prolonged stays. Pediatric assessment challenges require using anthropometric measurements and phase angle, which reflects body cell mass and health outcomes. Phase angle varies by maturation stages, making it crucial for pre-surgical evaluations alongside BMI. This study aimed to determine the relationship between nutritional status, phase angle, and postoperative complications in pediatric patients who underwent surgery. Prospective study with patients aged 3-17 undergoing major non-ambulatory surgery. Anthropometric measurements (weight, height, BMI Z-scores) hand grip strength, dietary intake and body composition via bioimpedance to assess phase angle were recorded. Postoperative complications were monitored, including surgical site infections, morbidity (pneumonia, inotropic support, infections, thromboembolism), and mortality. Surgical risks and pre- and postoperative conditions were documented. After the application of the selection criteria, a total of 391 patients who underwent surgery were included; 60% (n = 235) were within the range of the preschool and school-age groups. During the follow-up period, 51 (13%) patients developed at least one postoperative complication, with surgical site infections being the most common. Moreover, as phase angle decreased, the length of stay (LOS) increased in all the participants. Among children aged ≤12 years old, malnutrition was a risk factor for complications [OR 3.86 (1.61-9.27 95%CI)], whereas among adolescents, phase angle served as a protective factor [OR 0.63 (0.42-0.94 95%CI)]. Significant associations were observed between nutritional status, by BMI z-score, and post-surgical complications in younger patients. Additionally, in adolescents, the phase angle emerged as a protective factor against these complications.

The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.

Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032). ■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission. ■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission. ■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary. ■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission. To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery. A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females. Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032). The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.