Marker For Postoperative Complications Research Articles

The phase angle as a predictor of postoperative complications in patients undergoing lung cancer surgery.

The phase angle (PhA), calculated by bioelectrical impedance analysis, is used as a nutritional risk indicator. A low preoperative PhA has been reported as a marker of postoperative complications in patients with cancer; however, the relationship between the PhA and postoperative complications in patients with lung cancer remains unknown. We conducted this study to assess the predictive ability of the preoperative PhA for postoperative complications in patients undergoing surgery for primary lung cancer. We reviewed the data on 240 patients who underwent surgery for primary lung cancer at our institution between August, 2019 and August, 2021. The PhA value in this study was 4.7 ± 0.7°. According to the Clavien-Dindo classification, grade ≥ II postoperative complications occurred in 53 patients (22.0%). Based on the multivariate logistic analysis, only the PhA (odds ratio, 0.51, 95% confidence interval, 0.29-0.90, p = 0.018) was an independent predictor of Clavien-Dindo grade ≥ II postoperative complications. The PhA may be a valuable marker for predicting the risk of postoperative complications following lung cancer surgery.

Clinical Significance of Nlr(Neutrophil Lymphocyte Ratio) and Plr(Platelet Lymphocyte Ratio) in Predicting Post Operative Complication in Major Abdominal Surgery

Background: The Expression Major abdominal surgery is defined as a lengthy surgical procedure that lasts more than 30 minutes. Gastrectomy, Pancreatectomy, Hepatectomy, Colectomy, Small Bowel Resection, Tumor Resection, And Laparoscopic Gastrointestinal Operations are among the procedures covered. The term "abdominal tumour resection" refers to a wide range of procedures used to remove benign and malignant intraabdominaltumours. There Is A Greater Tendency Of Systemic Inflammatory Reaction When The Abdomen Organs Are Exposed To The External Environment For A Long Period Of Time. As a result, the goal of this research was to concentrate on the clinical significance of the neutrophil lymphocyte ratio and platelet lymphocyte ratio in patients undergoing major abdominal surgery.
 This review included a total of 15 studies conducted between 2000 and 2021. The influence of Clinical Importance Of The Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio In Patients Undergoing Major Abdominal Surgery has been reviewed collectively.
 Results: 15 studies were included in this review were Iincluded. The present study evaluated the value of nlr and PLR as predictive markers of post operative complications in major abdominal surgeries. In the current study, we investigated the value of nlr and PLR for predicting post operative complications in patients undergoing major abdominal surgeries.
 Conclusions: In Cases of Major Abdominal Surgeries, The nlr and PLR Ratio Is An Important Inflammatory Predictive Value In Assessing Post-Operative Morbidity. The platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) are two affordable, reproducible, and quantitative measures of systemic inflammation.

Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty.

Revision total hip arthroplasty (rTHA) is increasingly performed but may carry a high rate of complication. This aim of the study was to determine if a decreased eGFR increases risks of postoperative complications following rTHA. A retrospective cohort study using the American College of Surgeons National Quality Improvement Program Database was conducted. Patients undergoing rTHA between 2007 and 2014 were identified and stratified by glomerular filtration rates (eGFR): eGFR > 125mL/min, eGFR 90-125mL/min, eGFR 60-90mL/min, eGFR 30-60mL/min, and eGFR < 30mL/min. The incidence of postoperative adverse events within 30days, including cardiac, pulmonary, renal, septic, thromboembolic, urinary tract, and wound complications, blood transfusion, death, length of stay > 7days, and unplanned return to the operating room, was assessed. The complication rates following rTHA were assessed with univariate and multivariate analysis with a significance set at p < 0.05. In total, 8898 revision THA procedures were included for analysis. 28.4% of patients that underwent rTHA developed a complication following surgery. Following adjustment, an eGFR of less than 30mL/min independently increased the odds of any complication (OR 1.447; 95% C.I. 1.010-2.074; p = 0.044), cardiac complications (OR 3.344; 95% C.I. 1.040-10.752; p = 0.043), blood transfusion (O.R. 1.623; 95% C.I. 1.122-2.352; p = 0.010), and extended length of stay (O.R. 2.392; 95% C.I. 1.526-3.759; p < 0.001) when compared to normal renal function. Diminished eGFR of less than 30mL/min increased the odds of total complications, cardiac complications, blood transfusions, and extended length of stay compared to normal renal function.

Frailty is a useful predictive marker of postoperative complications after pancreaticoduodenectomy

BackgroundFrailty results in a high risk for disability, hospitalization, and mortality. This study aimed to investigate perioperative details of frail patients who underwent pancreatectomy and whether frailty can be a predictive factor of postoperative complications, especially of clinically relevant postoperative pancreatic fistula (CR-POPF).MethodsThis retrospective study included patients who underwent pancreatectomy in our hospital between August 2016 and March 2019. The patients were divided into frail and pre-/non-frail groups. The diagnostic criteria were based on the Japanese version of the Cardiovascular Health Study.ResultsOf 93 patients, 11 (11.8%) and 82 (88.2%) were frail and pre-/non-frail patients, with median ages of 82 and 72 years, respectively (p = 0.041). Postoperative complications (Clavien-Dindo ≧ IIIa) were found in 8 and 32 patients (p = 0.034), CR-POPF in 3 and 13 patients (p = 0.346), and postoperative hospital stays were 21 and 17 days (p = 0.041), respectively. On multivariate analysis, frailty was an independent predictive factor (odds ratio [OR] 5.604, 95.0% confidence interval [CI] 1.002-30.734; p = 0.047) of postoperative complications (Clavien-Dindo ≧ IIIa) after pancreaticoduodenectomy. On multivariate analysis, a soft pancreas (OR 5.696, 95.0% CI 1.142-28.149; p = 0.034) was an independent and significant predictive factor of CR-POPF after pancreaticoduodenectomy.ConclusionsFrailty may be a useful predictive factor of postoperative complications in patients undergoing pancreaticoduodenectomy.

Diagnostic Abilities for Determining the Level of Blood Cryoglobulins in the Choice of Tactics for Operations on the Small Intestine.

The study of the incidence of cryoglobulinemia is relevant in patients with an intestinal anastomotic leak. This study aims to determine a laboratory marker of the risk of small intestine anastomotic leak. The study was based on 96 patients who were subjected to resections of segments of the small intestine with the formation of intestinal anastomoses at the State Institution “Zaytsev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine”. Of all the operated patients, there were 55.2% women and 44.8% men. Of the 96 patients examined, cryoglobulinemia was detected in the majority – 62.5% of patients, of which 4 were later proved to have inactive hepatitis C; the remaining 38.5% had no cryoglobulinemia. According to the existing theory of the autoimmune mechanism of postoperative surgical complications formation, the revealed decrease in the level of cryoglobulins on the second day could be related to their fixation in the microcirculatory bed and the development of immunocomplex inflammation. While the increase in the content of cryoglobulins in serum on the third day can be caused by their entry into the circulatory bed from deposition or fixation sites and the development of a secondary immune response. In patients with intestinal anastomosis failure after resection of intestinal segments, cryoglobulinemia rates increased more than 80 mg/l; this indicator could be used as a marker of postoperative complications.

Preoperative Estimated Glomerular Filtration Rate Is a Marker for Postoperative Complications Following Revision Total Knee Arthroplasty

BackgroundRevision total knee arthroplasty (TKA) is an increasingly common procedure, but complication rates are higher than for primary TKA. A requirement for dialysis has been shown to predict postoperative complications in this patient population, but the impact of less severe, but clinically significant, renal impairment has not been addressed. MethodsA retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program Database. All patients who underwent revision TKA between 2007 and 2014 were identified and the estimated glomerular filtration rate (eGFR) was calculated for each patient. The incidence and predictors of adverse events following surgery were evaluated with univariate and multivariate analyses where appropriate. ResultsPatients with lower eGFRs (<60 mL/min) were found to develop more postoperative complications, including return to the operating room, postoperative pneumonia, urinary tract infection, sepsis, septic shock, and death. Decreased renal function was shown to be an independent risk factor for development of renal insufficiency, renal failure, and extended length of stay. ConclusionPatients with decreased eGFRs have greater risk for many postoperative complications, but this increased risk is generally related to the greater number of comorbidities in this patient population. When controlling for these comorbidities, poor renal function is an independent risk factor for extended length of stay as well as postoperative renal injury and renal failure, and patients may benefit from perioperative measures to limit this excess renal risk.

Thrombocytosis as a Marker for Postoperative Complications in Colorectal Surgery.

Background Blood platelet measurement is a widely available and inexpensive test that is performed routinely. Platelets are thought to act by inducing inflammation and play a role in clotting and antimicrobial defence. A postoperative rise in the platelet count (thrombocytosis) is often dismissed as an incidental finding, but there is growing evidence to suggest that it may act as an indicator to underlying pathology. It correlates with significant pyogenic infections as well as multiple malignancies. In addition to this, recent research indicates that thrombocytosis may be a useful prognostic indicator for postoperative outcomes in patients with malignancies. In patients undergoing surgery for gastric cancer, a combination of platelet count and neutrophil-to-lymphocyte (NLR) ratio collected preoperatively was shown to correlate with postoperative survival. Objective To evaluate whether there is a positive correlation between pre- and postoperative thrombocytosis and the risk of complications following colorectal surgery. Methods This was a retrospective observational study based in Morriston Hospital, Swansea. Patients undergoing elective colorectal surgery for an 18-month period between 2014 and 2016 were included. Data on patient demographics, pre- and postoperative platelet count, the first date at which the highest platelet count was recorded, length of stay, type of operation, and postoperative complications using the Clavien-Dindo classification was obtained from the theatre booking software (TOMS) and Welsh Clinical Portal. Pearson's chi-square test was used for the analysis of the categorical variables. Results Of the 201 patients studied, 75 (37%) had postoperative thrombocytosis (platelets ≥ 500 × 109/L, range 501–1136), 120 (59%) had postoperative normocytosis (platelets < 500 × 109/L, range 107–499), and 6 (2.9%) patients were excluded due to insufficient data. Peak platelet level was seen at a median of 8 days postoperatively but ranged from days 1 to 49. In patients with thrombocytosis, the mean time to peak platelet count was 9.5 days and ranged 1 to 49 days. 101/195 (52%) patients had a Clavien-Dindo III/V postoperative complication: 63% patients with postoperative normocytosis and 24% with postoperative thrombocytosis. In the thrombocytosis group, 16/75 (21%) were found to have postoperative pelvic collections compared to 1/120 (0.8%) of the normocytic patients. The total percentage of medical complications (44% versus 20%, p = 0.006) and surgical complications (64% versus 15.8%, p = 0.0001) was higher in the thrombocytosis group compared to the normocytosis group. Conclusion In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.

Thrombocytosis as a marker for post-operative complications in colorectal surgery

Thrombocytosis as a marker for post-operative complications in colorectal surgery

C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial

BackgroundIn search of improvement of patient assessment in the postoperative phase, C-reactive protein (CRP) is increasingly being studied as an early marker for postoperative complications following major abdominal surgery. Several studies reported an attenuated immune response in minimally invasive surgery, which might affect interpretation of postoperative CRP levels. The aim of the present study was to compare the value of CRP as a predictor for major postoperative complications in patients undergoing open versus laparoscopic colorectal surgery.MethodsA subgroup analysis from a randomized clinical trial (LAFA-trial) was performed, including all patients with non-metastasized colorectal cancer. In the LAFA trial, patients were randomized to open or laparoscopic segmental colectomy. In a subgroup of 79 patients of the LAFA trial, postoperative assessment of CRP levels was conducted routinely preoperatively and 1, 2, 24 and 72 h after surgery.ResultsThirty-seven patients were randomized to the open group and 42 patients to the laparoscopic group. Major complications occurred in 19% of laparoscopic procedures and 13.5% of open procedures (p = 0.776). CRP levels rise following surgical procedures. In uncomplicated cases, the rise in CRP levels was significantly lower at 24 and 72 h following laparoscopic resection in comparison to open resection. No differences in CRP levels were observed when comparing open and laparoscopic resection in patients with major complications.ConclusionIn patients with an uncomplicated postoperative course, CRP levels were lower following minimally invasive resection, possibly due to decreased operative trauma. No differences in CRP were observed stratified for surgical technique in patients with major complications. These results suggest that CRP may be applied as a marker for major postoperative complications in both open and minimally invasive colorectal surgery. Future research should aim to assess the role of standardized postoperative CRP measurements.

C-Reactive Protein as a Marker for Postoperative Complications. Are There Differences in Emergency and Elective Colorectal Surgery?

C-reactive protein levels are frequently raised in patients with major complications following elective colorectal surgery and used as a predictor for complications. The significance of raised C-reactive protein levels to predict outcome in emergency colorectal surgery is unclear, because preoperative C-reactive protein levels are often raised. The aim of this study was to determine whether serum C-reactive protein is an adequate predictive marker for major postoperative complications after colorectal surgery in an acute setting. This is an observational cohort study of all patients undergoing colorectal surgery. Consecutive patients undergoing colorectal surgery with reconstruction via anastomosis and/or stoma from January 2009 to March 2014 were included. This study was conducted at VU University Medical Center, Amsterdam. Postoperative C-reactive protein levels, operative details, and postoperative complications were recorded to determine the differences in C-reactive protein as a marker for complications in emergency and elective colorectal surgery. A total of 724 patients underwent colorectal resection, 559 elective cases and 165 emergency cases. A major complication was observed in 176 of 724 patients (24.3%). Major complications were observed more often in patients who underwent emergency surgery, 37% versus 20.9% after elective resections. C-reactive protein levels were significantly higher preoperatively in patients operated on in an acute care setting and on the first two postoperative days; from the third postoperative day, no statistically significant differences were found in C-reactive protein levels. This study was limited by its observational nature. Although acute colorectal surgery is associated with higher C-reactive protein levels in the first 2 postoperative days, this study shows that postoperative C-reactive protein levels may be used as a predictor for complications in both acute and elective surgery from the third postoperative day onward. It is hypothesized that the stimulus for C-reactive protein production is removed during surgery, and, with a short-half-life of 19 hours, C-reactive protein levels drop to similar levels as seen in patients undergoing elective surgery.

STREM-1 as a Prognostic Marker of Postoperative Complications in Cardiac Surgery

Cell-activating receptor TREM-1 (triggering receptor expressed on myeloid cells 1) regulates congenital immune response and contributes to systemic inflammatory response syndrome (SIRS) development. It is able to multiply cytokine production while stimulated together with the main receptors of the congenital immune system. The purpose of the paper is to study the potential use of soluble TREM-1 (sTREM-1) as a marker of intensive SIRS and a criterion for postoperative complications prediction following on-pump coronary artery bypass surgery (CABG). Results show that early postoperative sTREM-1 concentrations demonstrate their potential prognostic value regarding SIRS-associated complications.

Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications

Objective. We have previously presented microdialysis findings of early intraperitoneal (ip) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate ip glycerol and l/p ratio after major surgery with and without complications. Material and methods. Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (sc) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated. Results. Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the ip l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073). Conclusions. In this study, ip glycerol levels were lower and ip l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early ip disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.

Surgery for Esophageal Cancer: Quality of Life Matters

Esophageal cancer and its treatment have a profound impact not only on a patient’s length of life, but quality of life as well. Dysphagia, weight loss, and eating restrictions are frequent sequelae of both the disease and its treatment. In this issue, investigators from the Academic Medical Center in Amsterdam examined quality of life before and after resection for distal esophageal cancers. 1 They found that among preoperative patients, the quality-of-life physical symptom scale predicted postoperative overall survival independent of the tumor length and endoscopic ultrasound T-stage. After surgical resection, the quality-of-life pain scale, social function, and activity level predicted overall survival independent of pathological T-stage and N-stage. Clearly, self-reported health-related quality of life (HRQoL) adds predictive value to our best available preoperative and postoperative prognosticators. The challenge is how to use this information. One important benefit of quality-of-life research is to help evaluate the outcomes of different therapies, such as the analysis by the same investigators who examined quality of life after transhiatal compared with transthoracic esophagectomy. 2 It is intriguing to speculate about what mechanisms may underlie the effects of HRQoL on overall and diseasespecific survival. These speculations may help to generate hypotheses for further investigation that may help further understand tumor biology. One mechanism of these interactions may be that quality of life is a marker for occult metastatic disease. Recent advances in serum proteonomics in gastrointestinal cancer patients suggest that even among patients thought to have localized disease, cancer-associated proteins can be detected within the serum. 3 It would be reasonable to assume that even localized tumors, in patients with imaging negative for distant disease, might elaborate serum factors that would adversely affect quality of life. As this field grows and specific proteins are identified, it will be interesting to see whether the age-old problem of cancerassociated cachexia can be more fully understood. Health-related quality of life may also be a window into the patient’s host response to their neoplasm. Social function, activity level, and pain may be surrogates for their ability to recover from surgery and the presence of major or subclinical surgical complications. Postoperative decrements in quality of life may also be a marker for postoperative complications, which are known to affect quality of life and alter prognosis, even subsequent to the perioperative period. 4,5 On the other hand, social function and activity level may be related to cancer-related alterations in circadian rhythms. Circadian rhythm alterations and social function are related in complex ways: social cues help to reset the biological clock, while disruptions in circadian and sleep cycle patterns tend to affect social interactions. It been shown, for instance, that cancer patients exhibit abnor

Procalcitonin in elective colorectal surgery and its predictive value for an early discharge of fast-track patients

Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate whether PCT could serve as a negative predictive marker for postoperative complications, and whether in patients with elevated PCT levels a preemptive treatment with the third-generation cephalosporin ceftriaxone is superior to antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection.

Procalcitonin is useful whereas C-reactive protein is not, to predict complications following coronary artery bypass surgery

The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period. Thirty-two patients, in whom an uneventful immediate postoperative course was anticipated, were prospectively enrolled and followed-up to the 7th postoperative day. At the end of the follow-up, patients were divided into two groups. Group A were patients with an uncomplicated postoperative course and Group B were patients with a complicated postoperative course. Serum samples were drawn for PCT and CRP determination after induction of anesthesia (baseline), at the end of surgery and daily until postoperative day 2. Baseline serum PCT concentrations were 0.11 +/- 0.09 and 0.20 +/- 0.21 ng/mL in Groups A and B, respectively (NS). Serum PCT concentration increased compared with baseline in both groups during the first two days after surgery. The increase in serum PCT concentration was significantly greater in Group B than A patients (p < 0.0002). Considering a perioperative abnormal cut-off value of >0.5 ng/mL, there were none in Group A versus 57% in Group B (p < 0.0001). Baseline serum CRP concentrations were 1.44 +/- 1.30 and 1.58 +/- 1.35 ng/mL in Groups A and B, respectively (NS). After surgery, CRP increased significantly compared with baseline in both groups. When changes in time-varying variables were included in a logistic model, complications were predicted by changes (between baseline and end of surgery values) of PCT (coefficient = 9.410; t = 2.18) and heart rate (coefficient = 0.075; t = 1.57), whereas changes of CRP, white blood cells, mean blood and central venous pressures did not contribute statistically. The model constant was -4.827 (t = -2.43) and the ROC curve area was 0.8971. Thus, absolute PCT changes of 0.20, 0.40 and 0.60 ng/mL carry an approximate risk of 5, 26 and 69%, respectively, of postoperative complications in the time frame of this study. A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.

Procalcitonin as a marker of postoperative complications

Objective. Procalcitonin (PCT) is a 116 amino acid peptide that functions as a pro‐hormone for calcitonin in the C cells of the thyroid gland. Large quantities of intact PCT are present in the blood of patients with sepsis, particularly when organ dysfunction occurs. PCT has been proposed as an early marker of postoperative complications. The aim of this study was to examine the diagnostic accuracy of PCT as a marker of postoperative complications by systematically reviewing the existing literature.Material and methods. The databases PubMed, Embase and the Cochrane Library were searched to find studies on the diagnostic accuracy of PCT in the postoperative phase. Primary studies were retrieved using specific inclusion and exclusion criteria.Results. A total of nine studies were included. These studies were heterogeneous regarding the spectrum of patients, complications, design and methodological quality according to QUADAS (quality assessment of studies of diagnostic accuracy). This could explain the marked variation in diagnostic accuracy. Considering all types of complications the sensitivity ranged from 37% to 100% and the specificity from 70% to 100%. On examining the infectious complications separately, it was found that the sensitivity ranged from 70% to 86% and the specificity from 45% to 98%.Conclusions. Owing to a pronounced heterogeneity among the existing studies, the diagnostic accuracy of PCT as a marker for postoperative complications is not yet sufficiently clarified.

Postoperative Altered Plasma Growth Hormone Levels - A Predictor for Postoperative Complications? A Case Report

SUMMARYWe compared the onset of predictors for postoperative complications (lactate, total T3 (tT3), total T4 (tT4) and cortisone) retrospectively with the onset of altered growth hormone (GH) concentration in a patient who had had a lethal postoperative outcome and in 13 patients who were without postoperative complications for a period of 24 hours postoperatively.Compared with the values of the patients without postoperative complications, GH values were elevated (68-fold) 1 h after surgery to 103 ng/ml and lactate was increased (12-fold) to 12.7 mmol/l at 6 h postoperatively in the patient with the lethal outcome. The other parameters measured (tT3, tT4 and cortisone) showed no rapid alteration during the first hours postoperatively.This case report suggests that the rapid postoperative onset of raised GH concentration in plasma may be an earlier marker for postoperative complications than the 'established' predictors.