Perioperative Predictive Factors Research Articles

Perioperative Predictive Factors for Tumor Regression and Survival in Non-Small Cell Lung Cancer Patients Undergoing Neoadjuvant Treatment and Lung Resection.

Our study aimed to identify predictors for the effectiveness of tumor regression in lung cancer patients undergoing neoadjuvant treatment and cancer resections. Patients admitted between 2016 and 2022 were included in the study. Based on the histology of the tumor, patients were categorized into a lung adenocarcinoma group (LUAD) and squamous cell carcinoma group (SQCA). Ninety-five patients with non-small-cell lung cancer were included in the study. A total of 58 (61.1%) and 37 (38.9%) patients were included in the LUAD and SQCA groups, respectively. Additionally, 9 (9.5%), 56 (58.9%), and 30 (31.6%) patients were categorized with a tumor regression score of I, II, and III, respectively. In multivariable analyses, histology of the primary tumor (SQCA), lymph node size in the preoperative CT scan (>1.7 cm), and absolute tumor size reduction after neoadjuvant treatment (>2.6 cm) independently predict effectiveness of tumor regression (OR [95% confidence interval, p-value] of 6.88 [2.40-19.77, p < 0.0001], 3.13 [1.11-8.83, p = 0.0310], and 3.76 [1.20-11.81, p = 0.0233], respectively). Age > 70 years, extended resection > one lobe, and tumor recurrence or metastasis were identified as significant independent predictors of reduced overall survival. Assessment of tumor size before and after neoadjuvant treatment might help to identify high-risk patients with decreased survival and to improve patient management and care.

Perioperative predictive factors of failure to rescue following highly advanced hepatobiliary-pancreatic surgery: a single-institution retrospective study

BackgroundFailure to rescue (FTR), defined as a postoperative complication leading to death, is a recently described outcome metric used to evaluate treatment quality. However, the predictive factors for FTR, particularly following highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been adequately investigated. This study aimed to identify perioperative predictive factors for FTR following highly advanced HBPS.MethodsThis single-institution retrospective study involved 177 patients at Gifu University Hospital, Japan, who developed severe postoperative complications (Clavien–Dindo classification grades ≥ III) between 2010 and 2022 following highly advanced HBPS. Univariate analysis was used to identify pre-, intra-, and postoperative risks of FTR.ResultsNine postoperative mortalities occurred during the study period (overall mortality rate, 1.3% [9/686]; FTR rate, 5.1% [9/177]). Univariate analysis indicated that comorbid liver disease, intraoperative blood loss, intraoperative blood transfusion, postoperative liver failure, postoperative respiratory failure, and postoperative bleeding significantly correlated with FTR.ConclusionsFTR was found to be associated with perioperative factors. Well-coordinated surgical procedures to avoid intra- and postoperative bleeding and unnecessary blood transfusions, as well as postoperative team management with attention to the occurrence of organ failure, may decrease FTR rates.

Peri-operative predictive factors of failure to rescue after highly advanced hepatobiliary-pancreatic surgery.

39 Background: Failure to rescue (FTR), defined as postoperative complications leading to mortality, is a recently described outcome metric to evaluate the quality of treatment. However, predictive factors of FTR, particularly after highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been adequately investigated. Thus, it remains unclear. The object of this study is to identify the perioperative predictive factors of FTR after highly advanced HBPS. Methods: This single-institution retrospective study included 177 patients who developed severe postoperative complications (Clavien-Dindo classification≧grade3a) after highly advanced HBPS from 2010 to 2022 at Gifu University Hospital. We statistically analyzed pre-, intra-, and post-operative risks for FTR using logistic regression. Results: Nine postoperative mortalities occurred, for overall mortality rate of 1.3% (9 / 686) and FTR rate of 5.1% (9 /177). In univariate analysis, liver disease comorbidity, intra-operative blood loss, intra-operative blood transfusion, post-operative liver failure, post-operative respiratory failure, and post-operative bleeding were significantly correlated with FTR. A multivariate analysis revealed that intra-operative blood loss (&gt;1600ml; odds ratio [OR] 77255486; 95% confidence interval [CI] 18.26–; p &lt;0.0001) and post-operative respiratory failure (OR 43422062; 95% CI 9.83–; p &lt;0.0005) were independently associated with FTR. Conclusions: FTR have been shown to be associated with hospital factors. This study showed that FTR may be also associated with peri-operative factors. Prevention of massive intra-operative blood loss and postoperative respiratory failure may be able to decrease FTR.

Perioperative Predictive Factors for Positive Outcomes in Spine Fusion for Adult Deformity Correction.

Purpose: Identifying perioperative factors that may influence the outcomes of long spine fusion for the treatment of adult deformity is key for tailored surgical planning and targeted informed consent. The aim of this study was to analyze the association between demographic or perioperative factors and clinical outcomes 2 years after long spine fusion for the treatment of adult deformity. Methods: This study is a multivariate analysis of retrospectively collected data. All patients who underwent long fusion of the lumbar spine for adult spinal deformity (January 2016–June 2019) were included. The outcomes of interest were the Oswestry disability index (ODI), visual analogic scale (VAS) preoperatively and at 1 and 2 years’ follow up, age, body mass index, American Society of Anaesthesiologists (ASA) score, upper and lowest instrumented vertebrae (UIV and LIV, respectively), length of surgery, estimated blood loss, and length of hospital stay. Results: Data from 192 patients were available. The ODI at 2 years correlated weakly to moderately with age (r = 0.4), BMI (r = 0.2), ASA (r = 0.3), and LIV (r = 0.2), and strongly with preoperative ODI (r = 0.6). The leg VAS at 2 years moderately correlated with age (r = 0.3) and BMI (r = 0.3). Conclusion: ODI and VAS at 2 years’ follow-up had no to little association to preoperative age, health status, LIV, or other peroperative data, but showed a strong correlation with preoperative ODI and pain level.

Arthroscopic rotator cuff repair: Is healing enough?

Hypothesis/backgroundArthroscopic rotator cuff repair most commonly results in good clinical outcomes, however understanding of predictive factors influencing the final clinical outcome is limited. AimThe purpose of our study was to evaluate clinical outcomes of patients with healed supraspinatus tendon after arthroscopic rotator cuff repair and to identify its pre- and peri-operative predictive factors of good clinical results. MethodsA multi-center prospective study followed up 188 patients, who had a healed tendon after an arthroscopic repair of isolated supraspinatus tear. Inclusion criteria were: age under 70 years old, isolated supraspinatus tear, stage 0 or I of fatty infiltration, healed supraspinatus tendon at one year postoperatively and the same arthroscopic double row rotator cuff repair used in all patients. Clinical assessment used Constant Murley Score (CMS) and Subjective Shoulder Value (SSV) preoperatively and at one year postoperatively. Ultrasound (US) control checked tendon repair quality based on Sugaya classification. Types I-II-III were considered as healed. ResultsThe average age of our cohort was 57.57 (range; 41 to 70) years and the female to male ratio was 1.14 (range; 100 to 87). The average preoperative CMS was 53.75±13.50 (mean±SD; range; 16 to 83). At final follow up, the average postoperative CMS was 79.95±12.05 (mean±SD; range; 28 to 100). 12.22% (23/188) of patients, who had a CMS score below 70, had a clinically significant difference compared to the average CMS, due to the fact that the minimal clinically significant difference (MCID) in CMS is 10. A statistical analysis has shown that in patients with lower scores there was only a significant dominance of females (p-value=0.001). No difference was found in regards to age, preoperative CMS, fatty degeneration and other factors. ConclusionOur study showed that despite all patients had a healed repair of supraspinatus, not all of them experienced a good final clinical outcome. The only factor negatively influencing the final clinical outcome was a female gender. No other structural factors seemed to influence the final clinical results. Futures studies should focus more on analyzing which personality traits and other psychosocial factors play an important role in determining the final outcome after arthroscopic rotator cuff repair. Level of evidenceIII; retrospective cohort study.

Ionized Hypomagnesemia Is Associated With Increased Incidence of Postoperative Atrial Fibrillation After Esophageal Resection: A Retrospective Study.

Introduction: Postoperative atrial fibrillation (POAF) is common after surgery for esophageal cancer and may prolong hospitalization and elevate mortality. POAF and hypomagnesemia are linked, but this is based on studies showing an association of POAF with serum total magnesium (tMg). In contrast, the relationship of POAF with ionized magnesium (iMg), which has physiological activity, has not been examined. In this study, the association between hypomagnesemia and POAF was investigated retrospectively to examine iMg as a possible predictive factor for POAF.Methods: The subjects were 151 patients who underwent right transthoracoabdominal subtotal esophagectomy at Saitama Medical Center between January 2011 and December 2020. The incidence of POAF and predictive factors were examined retrospectively. Perioperative predictive factors were subjected to univariate analysis, and items with P<0.1 were then included in multivariate analysis, along with five potential POAF predictors reported in the literature (age, gender, body mass index, hypertension, and diabetes mellitus). P<0.05 was regarded as significant in the multivariate analysis.Results: Of the 151 patients, 34 (23%) developed POAF. In univariate analysis, six factors with P<0.1 (oral statin, dyslipidemia, iMg level after anesthesia induction, maximum and minimum iMg during surgery, and iMg level immediately before admission to ICU) were identified. In multivariate analysis including these and the five literature factors as explanatory variables, iMg immediately before admission to ICU emerged as a predictive factor for POAF (iMg≥0.46 mmol/L, OR 0.32, 95%CI 0.14-0.74, p=0.01) (standard iMg range: 0.48-0.60 mmol/L).Conclusion: The iMg level immediately before admission to ICU may be associated with the development of POAF. A further study is needed to evaluate changes in iMg in the ICU and iMg at the time of onset of POAF.

Perioperative clinical parameters associated with short-term mortality after colorectal perforation.

PurposeAlthough early prediction of mortality is useful for the management of patients with colorectal perforations, no significant perioperative predictive factors have been identified. The purpose of this study was to identify useful prognostic factors for patients with colorectal perforation.MethodsThis single-center retrospective study included consecutive patients undergoing emergency surgery for colorectal perforation from January 2012 to December 2019. The primary outcome was combined 30 day and in-hospital mortality. Patient- and disease-related factors obtained perioperatively were evaluated for mortality prediction. A scoring system was developed to enhance clinical utility.ResultsOverall, 146 patients were included and 20 (14%) died after surgery. Multivariate logistic regression identified five predictive factors: age, hemodialysis, uncommon perforation etiology, plasma albumin level, and decreased platelet count. The area under the receiver operating curve for the scoring system using these parameters was 0.894 (95% CI 0.835–0.952). Patients at high-risk of mortality were classified by the proposed score with a sensitivity of 90.0% and negative predictive value of 98.0%.ConclusionThis study identified five perioperative factors significantly associated with mortality of patients with colorectal perforation. Although these parameters predict mortality of patients with colorectal perforation using a score with high discrimination, further study is required to confirm these findings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00068-021-01719-8.

Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis

Background: Anastomotic disruption after bowel resection anastomosis is a devastating and a feared complication, so it is of utmost importance to identify perioperative parameters predisposing to such complication.Methods: A prospective cohort study was performed in two institutes, and there were 287 patients eligible and included in the study which done from April 2017 to December 2018, 87 patients underwent intervention in the first institute in Zagazig University Hospitals, Egypt. And 200 patients underwent intervention in Riyadh, KSA. Statistical analysis used: Percent of categorical variables were compared using Pearson’s Chi-square test or Fisher's exact test when was appropriate. Risk estimation was done by Odds ratio (OR) calculation. All tests were two sided. A p-value &lt;0.05 was considered significant. All statistics were performed using SPSS 22.0 for Windows (SPSS Inc., Chicago, IL, USA) and MedCalc windows (MedCalc Software bvba 13, Ostend, Belgium).Results: Of the parameters analyzed risk factors for anastomotic leakage that studied in 287 patients, 6 perioperative parameters have significant statistical difference: hypo-albuminaemia (Odd ratio: 6.544 and p-value &lt;0.001), acute intra-abdominal contamination (Odd ratio: 3.921 and P-value &lt;0.004), High WBC'S with high presepsin with p-value &lt;0.001, hyponatremia p&lt;0.004, perioperative blood transfusion and anastomotic tension were found to be independent factors.Conclusions: Knowledge of independent perioperative predictive factors for leakage is of utmost importance for its early detection, decision making for surgical time,our study concluded the possibility to detect a subgroup of high-risk patients for anastomotic leakage after emergency bowel resection anastomosis.

Research on evaluation of perioperative brain function and postoperative cognitive dysfunction in elderly patients

Postoperative cognitive dysfunction (POCD) in elderly patients has drew increasing attentions due to the growth of aging population. Since there are no specific drugs for cognition improvement, perioperative predictive factors become particularly important. Evaluation of perioperative brain function in elderly patients can assist clinicians to identify those with high risks, so as provide theoretical guidance for further effective intervention. In the current study, potential predictors of POCD through different detection methods were analyzed, using neuropsychological tests, brain oxygen monitoring, nerve injury biomarkers detection, imaging examinations and electroencephalogram. Meanwhile, related literature was reviewed. Key words: Brain function; Postoperative cognitive dysfunction; Predictors

Factors Associated With Patient-Initiated Telephone Calls After Orthopaedic Trauma Surgery.

The primary aim of this study is to investigate the incidence of early patient-initiated postoperative telephone calls and reasons for those calls. Secondary goals are to determine perioperative predictive factors for calls including the procedures most frequently associated with them. Retrospective chart review. Academic Level-1 Trauma Center. Six hundred eighty-four patients who underwent surgical treatment by our orthopaedic trauma division between 01/01/2014 and 31/12/2014. Patient-initiated telephone call documented within 14 days after discharge. Twenty-nine percent (n = 199) of patients initiated a telephone call within 14 days after discharge. The most common reasons for telephone calls were pain control (22%), bathing/dressing/wound questions (16%), and questions regarding discharge medications (8%). The procedures associated with the highest percentage of telephone calls were tibial shaft intramedullary nailing (36.0%), calcaneus open reduction internal fixation (31.3%), and cephalomedullary nailing for proximal femur fractures (29.3%). Perioperative factors predictive of an increase in phone calls included discharge directly to home, higher baseline level of health of the patient (based on comorbidities and the American Society for Anesthesiologists score), and a more robust support network (based on marital and employment status). This study identifies the incidence and common reasons for patient-initiated calls after orthopaedic trauma surgery and an analysis of perioperative factors predictive of increased phone calls. These data give direction for communication at the time of discharge to improve efficiency, patient care, and patient satisfaction. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Utilization of the NSQIP-Pediatric Database in Development and Validation of a New Predictive Model of Pediatric Postoperative Wound Complications

Surgical wound classification, introduced in 1964, stratifies the risk of surgical site infection (SSI) based on a clinical estimate of the inoculum of bacteria encountered during the procedure. Recent literature has questioned the accuracy of predicting SSI risk based on wound classification. We hypothesized that a more specific model founded on specific patient and perioperative factors would more accurately predict the risk of SSI. Using all observations from the 2012 to 2014 pediatric National Surgical Quality Improvement Program-Pediatric (NSQIP-P) Participant Use File, patients were randomized into model creation and model validation datasets. Potential perioperative predictive factors were assessed with univariate analysis for each of 4 outcomes: wound dehiscence, superficial wound infection, deep wound infection, and organ space infection. A multiple logistic regression model with a step-wise backwards elimination was performed. A receiver operating characteristic curve with c-statistic was generated to assess the model discrimination for each outcome. A total of 183,233 patients were included. All perioperative NSQIP factors were evaluated for clinical pertinence. Of the original 43 perioperative predictive factors selected, 6 to 9 predictors for each outcome were significantly associated with postoperative SSI. The predictive accuracy level of our model compared favorably with the traditional wound classification in each outcome of interest. The proposed model from NSQIP-P demonstrated a significantly improved predictive ability for postoperative SSIs than the current wound classification system. This model will allow providers to more effectively counsel families and patients of these risks, and more accurately reflect true risks for individual surgical patients to hospitals and payers.

Perioperative predictive factors of intracranial meningioma recurrence following surgical resection

Background: Meningiomas represent the commonest benign intracranial tumor and surgical resection is the first line treatment. Tumor recurrence after surgical resection is common. The aim of this study is to identify peri-operative predictors of meningioma recurrence following surgical resection Methods: This was a retrospective hospital-based study of all surgical cases between January 1990 and June 2014. Information regarding age, gender, peri-operative imaging parameters such as peri-tumoral edema or post-operative hemorrhage or residual, and grade were collected. Linear and volumetric measurements (of both tumor volume and volume of edema) were collected as well. Results: Overall, 464 patients were reviewed; n=154(34%) percent of patients were male. The grade distribution was: 296 (74.6%) were Grade I, 78 (19.6%) Grade II, and 23 (5.8%) Grade III. Post-operative tumor bed hemorrhage, noted in 119 (29.9%) of cases, and preoperative peri-tumoral edema volume were significant predictors of tumor recurrence following resection (P= 0.002 and 0.037, respectively). These parameters did not correlate with the MIB-1 index, tumour residual, grade of the tumour, or primary versus recurrent presentation. Conclusions: Pre-operative peri-tumoral edema and post-operative tumor bed hemorrhage are independent predictive of tumor recurrence. Identification of other molecular and/or radiological predictive of recurrence factors could add in our understanding of meningioma behavior.

Predictive factors of myasthenic crisis after extended thymectomy for patients with myasthenia gravis.

Postoperative myasthenic crisis (POMC) is one of the serious complications after extended thymectomy for patients with myasthenia gravis (MG). This study aims to clarify the risk factors of POMC occurrence. The clinical data of 55 MG patients (25 male, 30 female; median age, 51 years) who underwent extended thymectomy at Kyoto University from 2000 to 2013 were retrospectively reviewed. Surgical outcomes and pre- and perioperative predictive factors of POMC were analysed. The preoperative Myasthenia Gravis Foundation of America stage was I, II, III and IV in 24, 22, 8 and 1 patients, respectively. Ten patients (18.2%) developed POMC; 6 required prolonged intubation over 24 h and 4 required reventilatory support. All patients were weaned after 5.6 (2-26) days of ventilator support, and were discharged. Univariate analysis revealed a correlation with a high preoperative anti-acetylcholine receptor antibody titre (P = 0.009), history of myasthenic crisis (MC) (P = 0.0004) and unstable MG after preoperative medical therapy (P = 0.003). Multivariate logistic regression analysis showed history of MC (odds ratio, 11.84; 95% confidential interval, 1.05-372; P = 0.045) and unstable MG (odds ratio, 29.45; 95% confidential interval, 2.00-1063; P = 0.013) independently predicted POMC. The surgical response rate was not significantly different between the two groups (66.7% with POMC, 85.4% without POMC; P = 0.334). POMC occurred more frequently in unstable MG before surgery or in patients with a history of MC. Adequate preoperative medical therapy and perioperative care should be provided to these patients.

Prognostic Factors of Morbidity in Patients Undergoing Percutaneous Nephrolithotomy

To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Clavien's classification. We performed a retrospective chart review of patients who underwent PCNL between January 2005 and January 2012. Preoperative and postoperative factors, such as age, obesity, surgical risk, Charlson comorbidity index, stone complexity, access calix, type of dilator used, and surgery time, were evaluated as predictors of complications. A total of 354 patients were included in the study. Of these, 56% were women, with the average age of 47±12.5 years. Stone-free rate for noncomplex calculi was 85% and for complex calculi it was 68%. A total of 103 complications were recorded (29.3%). According to the modified Clavien classification system, 32 (9%) were grade 1, 39 (11%) were grade 2, 16 (4.5%) were grade 3A, 8 (2.3%) were grade 3B, 3 (0.8%) were grade 4A, 1 (0.3%) was grade 4B, and 4 (1.1%) were grade 5. In multivariate analysis female gender (odds ratio [OR] 3.1, confidence interval [CI] 1.1-8.0), Charlson score of ≥3 (OR 23.2, CI 3.5-151.1), complex stone (OR 4, CI 1.6-9.6), and duration of surgery of ≥120 minutes (OR 2.9, CI 1.2-6.9) were associated with major complications. PCNL is a safe procedure with acceptable efficacy for the resolution of renal calculi. The safety of the procedure should improve, especially to reduce the presence of severe complications (Clavien ≥3). We identified factors that are associated with severe complications: female gender, high Charlson, complex calculi, and surgical length ≥120 minutes.

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura Introduction. Immune thrombocytopenic purpura (ITP) is one of the most commonly known and widely researched haematological diseases. ITP manifests as decrease in platelet count of various degrees, which can even cause fatal bleeding from 0.4 - 13% annually. Glucocorticoids (GC) and intravenous immunoglobulin (IgG) are used as the first line of treatment, 20-50% of drug therapy is ineffective and splenectomy is "the second stage" of treatment. Various sources of literature mention the range of ITP remission following splenectomy from 49 - 93%. Current studies are looking for prognostic factors, which would ensure complete ITP remission following splenectomy. Aim of the Study. To analyse possible perioperative prognostic factors in ITP patients for achieving remission following splenectomy. Materials and methods. The retrospective study included 13 patients diagnosed with immune thrombocytopenic purpura (ITP), who underwent surgery in the period from 2002 to 2009 at the Riga Eastern Clinical University Hospital "Linezers". From laboratory tests - full blood-count 1 - 2 days before the operation, on the 5th - 7th day following the operation, 1 month after the operation, one year after the operation and during the last follow-up found in the patient's out-patient file. The size of the spleen before the surgery was determined by ultrasonography. The access to the abdominal cavity and the spleen - conventional or laparoscopic surgery, the duration of the operation, perioperative blood loss, post-operative complications and the patient's day of discharge following the surgery was analysed. Results. In the period from January 2002 to January 2009 at RECUH clinic "Linezers" 13 ITP patients underwent surgery. As to the gender the average age for both genders was similar (men 39.0 ± 14.1 and women 39.0 ± 16.0). The mean value of the duration of the disease in women (8.0 ± 9.0 months) and men (68.1 ± 58.7 months) has a statistically significant difference, using the independent pair selection t-test (t = 2.38; p = 0.047). In one US case and in one CT case accessory spleens were detected. The pre-operative mean value of PLT count had increased in a statistically significant way in accordance with the independent pair selection t-test (t = 3.087; p = 0.009), and in accordance with Wilcoxon signed-rank test (z = 2,202; p = 0,028) compared to the mean value of PLT count, which was detected during the last follow-up visit on average 35.9 ± 35.9 months after the surgery. Analysis of variance (ANOVA) shows that the average age of cured patients 34.6 ± 9.8 is statistically less significant than for those patients, who continue treatment and whose disease has transformed (F = 7.327; p = 0.011). Conclusions. The performed research allows concluding that the decisive factors in successful ITP outcome after the operation are the following: 1) in patients, who have undergone the operation in a relatively younger age (34.6 ± 9.8 years) the disease outcome is more successful during the follow - up period - 35.9 ± 35.9 months (F = 7.327; p = 0.011); 2) the visualisation and removal of the accessory spleen decreases the probability of relapse.

Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction.

The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case-controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri-operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (greater than 300 l) and age (greater than 60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.