Postoperative Morbidity In Patients Research Articles

Preoperative very low-energy diets for obese patients undergoing intra-abdominal colorectal surgery: a retrospective cohort study (RetroPREPARE).

Very low-energy diets (VLEDs) prescribed prior to bariatric surgery have been associated with decreased operative time, technical difficulty, and postoperative morbidity. To date, limited data are available regarding the impact ofVLEDs prior to colorectal surgery. We designed this study to determine whether preoperative VLEDs benefit patients with obesity undergoing colorectal surgery. This is a single-center retrospective cohort study. Individuals undergoing elective colorectal surgery with a body mass index (BMI) of greater than 30kg/m2 from 2015 to 2022 were included. The exposure of interest was VLEDs for 2-4weeks immediately prior to surgery. The control group consisted of patients prior to January 2018 who did not receive preoperative VLED. The primary outcome was 30day postoperative morbidity. Multivariable logistic regression modeling was used to determine associations with 30day postoperative morbidity. Overall, 190 patientswere included, 89 patients received VLEDs (median age: 66years; median BMI: 35.9kg/m2; 48.3% female) and 101 patients did not receive VLEDs (median age: 68years; median BMI: 32.1kg/m2; 44.6% female). One-hundred four (54.7%) patients experienced 30day postoperative morbidity. Multivariable regression analysis identified three variables associated with postoperative morbidity: VLEDs [odds ratio (OR) 0.22, 95% confidence intervals (CI) 0.08-0.61, P < 0.01], Charlson comorbidity index (OR 1.25, 95% CI 1.03-1.52, P = 0.02), and rectal dissections (OR 2.71, 95% CI 1.30-5.65, P < 0.01). The use of a preoperative VLED was associated with a significant reduction in postoperative morbidity in patients with obesity prior to colorectal surgery. A high-quality randomized controlled trial is required to confirm these findings.

Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

IntroductionDeep venous thromboembolisms (DVT) increase morbidity in postoperative patients, and no current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient ICP shifts which may impact skull base reconstruction. We seek to characterize if postoperative bedrest puts EEA patients at increased risk of developing thromboembolic complications. MethodsRetrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative CSF leak via EEA for any skull base pathology between July 2018 and May 2024 was performed yielding 221 patients who met inclusion criteria. Univariate and multivariable regression were performed with patient demographics, extent of approach, intraoperative leak flow rate, bedrest duration, presence and length of postoperative lumbar drainage (LD), and use of postoperative mechanical VT prophylaxis. ResultsThe mean age of included patients was 52.6 ± 16.8 years, 48% were male, and 3.6% of patients had DVTs. Age (OR 1.01, 95% CI 0.96-1.06, p=0.83), sex (OR 0.40, 95% CI 0.05-2.19, p=0.31), BMI (OR 0.98, 95% CI 0.87-1.07, p=0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, p=0.80), CSF leak flow rate (OR 5.71, 95% CI 0.77-118.90, p=0.14), bedrest duration (OR 1.06, 95% CI 0.77-1.27, p=0.60), and presence of LD (OR 1.10, 95% CI 0.55-2.02, p=0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis. ConclusionShort-term bedrest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

Impact of Multi-Institutional Enhanced Recovery after Surgery Protocol Implementation on Elective Colorectal Surgery Outcomes

Background: Enhanced Recovery After Surgery (ERAS) protocols aim to improve surgical patient outcomes, although their effectiveness may vary. This study assessed the impact of multi-institutional ERAS implementation on postoperative morbidity in patients undergoing elective colorectal surgery. Methods: We conducted a multicenter retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. We analyzed patient outcomes before (2012-2014) and after (2015-2020) ERAS implementation across four hospitals. Multivariable logistic regression was used to determine the impact of ERAS program on certain outcomes. Results: A total of 8,930 cases were analyzed: 3,573 in the pre-ERAS and 5,357 in the ERAS cohort. The ERAS cohort demonstrated significant reductions in superficial surgical site infection (SSI) (7.5% vs 2.5%, p&lt;0.001), deep SSI (0.6% vs 0.2%, p=0.016), urinary tract infection (3.3% vs 1.5%, p&lt;0.001), pulmonary embolism (0.7% vs 0.4%, p=0.022), deep vein thrombosis (1.4% vs 0.9%, p=0.020), sepsis (3.0% vs. 2.1%, p=0.006), and other complications. Median length of stay decreased from 5 to 4 days (p&lt;0.001), and 30-day readmission rate dropped from 11.3% to 9.8% (p=0.022). Overall, ERAS implementation was associated with a 35% decrease in the odds of all 30-day complications (OR 0.65, 95%CI: 0.59-0.73). There was no effect on 30-day (p=0.962) or overall mortality rates (p=0.732). Conclusion: A standardized ERAS protocol, used across multiple institutions, significantly improves elective colorectal surgery outcomes, reducing complications, length of hospital stay, and readmissions. These findings support the broader implementation of ERAS to enhance patient care and reduce healthcare costs.

Does computed tomography-derived volumometry and densitometry of psoas muscle really correlate with complications in rectal cancer patients after elective surgery?

Although sarcopenia is recognized as one of the risk factors for increased morbidity after resection for colorectal cancer, the question of the most appropriate way to identify and quantify it is still unresolved. This is a retrospective unicentric study following patients undergoing elective resection of the rectum for carcinoma with available staging computed tomography (CT) of the trunk. Psoas muscle density (PMD) and its area relative to patient height psoas muscle index (PMI) at the level of inferior vertebral end plate of third lumbar vertebra (L3) were assessed using an initial staging CT scan of the trunk. Post-operative complications, evaluated according to the Clavien-Dindo classification, and blood samples on post-operative days (POD) 3 and 5 were also recorded in the study population. Patients were divided into groups with complicated and uncomplicated post-operative course, and observed parameters were then statistically compared. The correlation of PMI values with the development of post-operative complications was not confirmed in a data set of 206 patients. PMD values were found to be borderline statistically significant in patients with complicated post-operative course, while in the group of patients with severe complications (Clavien-Dindo III-IV), there was no statistically significant difference in PMI or PMD values. The same results were obtained when comparing patients with anastomotic leak (AL). It was confirmed that operations on the lower rectum are riskier for the development of post-operative complications. The secondary objective of our study regarding serum C-reactive protein (CRP) levels of 3rd and 5th POD gave us the answer in the form of cutoff values of 115.7 mg/L (3rd POD) and 76 mg/L (5th POD). PMD appears to be a promising tool for predicting post-operative morbidity in patients after rectal resection, but a clear consensus on the method of measurement, interpretation of results and cutoff values is needed. Lower rectal resections are burdened with a higher risk of post-operative complications, especially AL. Monitoring of CRP levels remains an important marker in the prediction of AL due to its negative predictive value.

Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: A meta-analysis.

Complicated appendicitis is associated with high morbidity, mortality, and healthcare costs. However, the relationship of preoperative in-hospital delay >24 hours with complicated appendicitis and postoperative morbidity remains unclear. This meta-analysis investigated the effects of preoperative in-hospital delay on complicated appendicitis and postoperative morbidity in patients with acute appendicitis. This study adheres to the PRISMA 2020 and AMSTAR 2 guidelines. The PubMed, Embase, Cochrane Library, and Web of Science databases up to October 14, 2023 (updated on March 16, 2024) were searched for randomized controlled trials (RCTs) and observational studies that evaluated the effect of preoperative in-hospital delays of >24 hours on acute appendicitis. Odds ratios (OR) and 95% confidence intervals were also determined. We yielded 18,130 records, of which 28 studies (512,881 patients) were included in the meta-analysis. The risk of bias was considered serious, moderate, and low for 24, 3, and 1 study, respectively. Although preoperative in-hospital delays of >24 hours were not associated with a higher risk of surgical site infection (OR 1.04, 95% CI 0.97, 1.12, P=0.25), in-hospital delays of >24 hours was a risk factor for complicated appendicitis (OR 1.60, 95% CI 1.25, 2.05, P=0.0002), and postoperative complications (OR 1.51, 95% CI 1.30, 1.75, P<0.00001). In addition, an in-hospital delay of >24 hours before surgery increased the OR of postoperative mortality (OR 1.81, 95% CI 1.33, 2.45, P=0.0001). The sensitivity analyses also confirmed the robustness of our results. An in-hospital delay of >24 hours is a risk factor for complicated appendicitis, postoperative complications, and mortality. Given the subsequent adverse outcomes of in-hospital delays, appendectomy should not be delayed for >24 hours.

Retroperitoneal end colostomy for hernia prevention after laparoscopic abdominoperineal excision: a retrospective study

AIM: to compare the hernia rate and the post-operative morbidity in patients after retroperitoneal and traditional (direct) colostomy during laparoscopic APR.PATIENTS AND METHODS: the retrospective study included patients with rectal and anal cancer after laparoscopic APE in 2019-2022. Direct or retroperitoneal end colostomy were the surgeon’s choice. Primary endpoints were the hernia rate after ≥ 1 year by abdominal CT and post-operative morbidity (Clavien-Dindo).RESULTS: fifty patients were included in the study (30 patients with retroperitoneal colostomy and 20 patients with direct colostomy). There were no significant differences in parameters that could affect the results. Four (13.3%) vs 8 (40%) patients developed parastomal hernias in the retroperitoneal and direct colostomy group, accordingly (p = 0.045). No post-operative morbidity grade 4–5 and no other complications that could be attributed to retroperitoneal colostomy occurred. Post-operative morbidity grade 3 developed in 3 (10%) patients in the retroperitoneal colostomy group and in 1 (5%) — in the direct one (p = 0.64).CONCLUSION: retroperitoneal colostomy in laparoscopic APE may reduce the parastomal hernia rate. It is important to conduct prospective comparative studies.

Identifying Independent Predictors of Short-Term Postoperative Morbidity in Patients Undergoing Cranioplasty.

The present study intends to identify independent predictors of short-term postoperative complications and health utilization in patients undergoing cranioplasty. Demographic, clinical, and intraoperative characteristics were collected for each patient undergoing cranioplasty in the National Surgery Quality Improvement Program database from 2011 to 2020. The 30-day outcomes analyzed were medical complications, wound complications, return to the operating room, extended hospital stay, and non-home discharge. Bivariate analyses were initially used to identify variables that yielded a P value less than 0.2 which were subsequently analyzed in a multivariate logistic regression to identify independent predictors of the aforementioned outcomes. In total, 2316 patients undergoing cranioplasty were included in the analysis. Increased operative time and totally dependent functional status significantly increased odds of returning to the operating room. Increased age, operative time, cranioplasty size >5cm, and various comorbidities were associated with increased odds of non-home discharge. Bleeding disorders were independently associated with increased odds of wound complications. Increased age, operative time, cranioplasty size >5cm, and several medical history features predisposed to medical complications. Demographic characteristics, including age and race, along with various operative and medical history characteristics were associated with increased odds of extended length of stay. Identification of risk factors can help guide preoperative risk management in cranioplasty.

Correlation between preoperative cardiopulmonary exercise testing and six-minute walk test, five-times sit to stand test and Short Form-36 physical component score in patients undergoing cytoreductive surgery

IntroductionAssessment of preoperative function is important for determining fitness for surgery, preoperative optimisation and predicting postoperative morbidity in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). This study explored correlations between preoperative cardiopulmonary exercise testing (CPET) variables, and six-minute walk test (6MWT), five-times sit to stand test (5STS) and Short Form-36 (SF-36) physical component score in patients scheduled for elective CRS-HIPEC. MethodsThis study included patients who underwent preoperative CPET, 6MWT, 5STS and responded to the SF-36 survey prior to elective CRS-HIPEC at Royal Prince Alfred Hospital in Sydney. CPET was performed using a cycle ergometer and measured peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). The associations between preoperative CPET variables and preoperative 6MWT, 5STS and SF-36 were assessed using correlation test. ResultsA total of 133 patients scheduled for elective CRS-HIPEC were included in this study. The median VO2, AT and VE/VCO2 were 20.3 [6.5] ml/kg/min, 13.1 [4.9] ml/kg/min and 29 [4.5], respectively. The median 6MWT, 5STS and SF-36 physical component score were 525 m, 9.2 s and 50.2, respectively. CPET variables were significantly correlated with 6MWT (VO2 r = 0.51; AT r = 0.35; VE/VCO2 r = −0.25; p < 0.01), 5STS (VO2 r = −0.32; AT r = −0.27; VE/VCO2 r = 0.24; p < 0.01) and SF-36 (VO2 r = 0.42; AT r = 0.38; VE/VCO2 r = −0.23; p < 0.01). Conclusions6MWT, 5STS and SF-36 are at best moderately correlated with CPET variables, which suggests that these tests may serve as adjuncts rather than a replacement to CPET in the clinical setting.

Prevalence of Postoperative Morbidity in Patients Undergoing Elective Open Major Thoracoabdominal Oncosurgery and Their Correlation with Perioperative Management

Background and Aims: Due to rapidly advancing surgical techniques and perioperative management, more patients with comorbidities and poor physical condition are considered for surgical treatment for thoracoabdominal cancers, leading to an increased incidence of postoperative morbidity. We evaluated postoperative morbidity’s prevalence, types and risk factors after thoracoabdominal oncosurgery. Methods: Patients scheduled for elective major thoracoabdominal oncosurgery with an expected duration of more than 2 h and/or predicted blood loss of more than 500 mL were included. On the 3rd and 5th postoperative days (PODs), a postoperative morbidity survey (POMS) was administered by questioning the patients and their caregivers, examining the patients and reviewing patients’ charts, investigations and other records. Results: A total of 323 patients were enroled in the study. POMS-defined morbidity was present in 60.4% of patients on POD 3 and 18.9% of patients on POD 5. The most common morbidity on POD 3 was pain (34.8%), followed by gastrointestinal (GI) (24.2%) and pulmonary (14.3%) complications. On POD 5, the three most common complications were GI (7.8%), pulmonary (6.2%) and pain (5.9%). In multivariate analysis, female gender, hypertension, duration of surgery, intraoperative urine output and delayed extubation were found as independent predictors of POMS-defined morbidity on POD 3. However, on POD 5, multivariate analyses showed that intraoperative inotrope requirement, delayed extubation and intensive care unit stay were independent predictors of POMS-defined morbidity. Conclusion: Postoperative morbidity was present in 60.4% and 18.9% of patients on the 3rd and 5th PODs, respectively, after major thoracoabdominal oncosurgery. Pain and GI complications were the most common morbidity on the 3rd and 5th PODs, respectively.

Operative Volumes and Postoperative Outcomes After Elective Resection of Congenital Lung Malformations in Infants.

To determine whether hospital- and surgeon-level operative volumes are associated with differences in postoperative outcomes among infants undergoing elective lung surgery for a congenital lung malformation (CLM). Infant lung surgery is a relatively uncommon procedure performed by pediatric surgeons nationwide. The relationship between surgical volume and postoperative outcomes remains unknown. A retrospective cohort study of asymptomatic infants who underwent elective lung resection of a CLM was conducted using the Pediatric Health Information System database (2016-2020). Multivariable linear and poisson regressions were performed based on annual lung resection tertiles. There were 1420 infants managed by 48 hospitals and 309 primary surgeons. Institutions that performed seven or fewer CLM resections per year (56%) were associated with significantly higher postoperative complication rates compared to medium- and high-volume hospitals (low: 134 [34%], medium: 110 [21%], high: 144 [29%]; P<0.001). Surgeons who performed one or fewer CLM resections per year (82%) were associated with significantly higher complication rates compared to medium- and high-volume surgeons (low: 171 [31%], medium: 75 [26%], high: 119 [24%]; P=0.02). Multivariable analyses confirmed that low-volume hospitals were associated with higher complications (OR 1.81, CI 1.38-2.37; P<0.001), and low-volume surgeons had an increased risk of complications (overall: OR 1.37, CI 1.01-1.84; P=0.04). In this cohort study of infants undergoing elective lung resection for a CLM, lower volume providers were associated with higher postoperative patient morbidity. These findings represent an opportunity to inform quality improvement initiatives on pediatric lung resection and the debate on surgical subspecialization for this unique patient population.

Esophageal surgical Apgar score (eSAS): A predictor for postoperative morbidity in patients undergoing neoadjuvant therapy and esophagectomy.

The surgical Apgar score (SAS) quantifying three intraoperative indexes has been confirmed to be significantly associated with postoperative morbidity and prognosis in many surgical specialties. However, there are great limitations in its application for esophageal cancer (EC). This study aimed to assess the predictive capability of esophagectomy SAS (eSAS) in determining postoperative morbidity and overall survival (OS) in EC patients who had undergone neoadjuvant therapy. A retrospective evaluation was conducted on a cohort of 221 patients in which surgery- and tumor-related data were extracted and analyzed. Major morbidity was defined as complications meeting the criteria of Clavien-Dindo classification III or higher during hospitalization. Univariate and multivariate analyses were performed to identify potential risk factors for major morbidity. Kaplan-Meier analysis was utilized to calculate the OS and relapse-free survival (RFS). The results exhibited that eSAS demonstrated potential predictive value for postoperative morbidity with an optimal cutoff value of 6. The eSAS and diabetes mellitus were two independent risk factors for the major morbidity; however, no correlation between the eSAS and the OS or RFS was detected. The eSAS could be used as a predictor of major morbidity, while it was not correlated with OS and RFS.

Abdominal Wall Tension and Early Outcomes after Posterior Component Separation with Transversus Abdominis Release: Does a "Tension-Free" Closure Really Matter?

Ventral hernias result in fibrosis of the lateral abdominal wall muscles, increasing tension on fascial closure. Little is known about the effect of abdominal wall tension on outcomes after abdominal wall reconstruction. We aimed to identify an association between abdominal wall tension and early postoperative outcomes in patients who underwent posterior component separation (PCS) with transversus abdominis release (TAR). Using a proprietary, sterilizable tensiometer, the tension needed to bring the anterior fascial elements to the midline of the abdominal wall during PCS with TAR was recorded. Tensiometer measurements, in pounds (lb), were calibrated by accounting for the acceleration of Earth's gravity. Baseline fascial tension, change in fascial tension, and fascial tension at closure were evaluated with respect to 30-day outcomes, including wound morbidity, hospital readmission, reoperation, ileus, bleeding, and pulmonary complications. A total of 100 patients underwent bilateral abdominal wall tensiometry, for a total of 200 measurements (left and right side for each patient). Mean baseline anterior fascial tension was 6.78 lb (SD 4.55) on each side. At abdominal closure, the mean anterior fascial tension was 3.12 (SD 3.21) lb on each side. Baseline fascial tension and fascial tension after PCS with TAR at abdominal closure were not associated with surgical site infection, surgical site occurrence, readmission, ileus, and bleeding requiring transfusion. The event rates for all other complications were too infrequent for statistical analysis. Baseline and residual fascial tension of the anterior abdominal wall do not correlate with early postoperative morbidity in patients undergoing PCS with TAR. Further work is needed to determine if abdominal wall tension in this context is associated with long-term outcomes, such as hernia recurrence.

The value of a risk model combining specific risk factors for predicting postoperative severe morbidity in biliary tract cancer.

Several surgical risk models are widely utilized in general surgery to predict postoperative morbidity. However, no studies have been undertaken to examine the predictive efficacy of these models in biliary tract cancer patients, and other perioperative variables can also influence morbidity. As a result, the study's goal was to examine these models alone, as well as risk models combined with disease-specific factors, in predicting severe complications. A retrospective study of 129 patients was carried out. Data on demographics, surgery, and outcomes were gathered. These model equations were used to determine the morbidity risks. Severe morbidity was defined as the complication comprehensive index ≥ 40. Severe morbidity was observed in 25% (32/129) patients. Multivariate analysis demonstrated that four parameters [comprehensive risk score ≥1, T stage, albumin decrease value, and international normalized ratio (INR)] had a significant influence on the probability of major complications. The area under the curve (AUC) of combining the four parameters was assessed as having strong predictive value and was superior to the Estimation of Physiologic Ability and Surgical Stress System (E-PASS) alone (the AUC value was 0.858 vs. 0.724, p = 0.0375). The AUC for the modified E-PASS (mE-PASS) and Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) in patients over the age of 70 was classified as no predictive value (p = 0.217 and p = 0.063, respectively). The mE-PASS and POSSUM models are ineffective in predicting postoperative morbidity in patients above the age of 70. In biliary tract cancer (BTC) patients undergoing radical operation, a combination of E-PASS and perioperative parameters generates a reasonable prediction value for severe complications.

Veno-venous extra-corporeal membrane oxygenation in complex tracheobronchial resection.

Elective extra-corporeal membrane oxygenation (ECMO) is rarely used in thoracic surgery, apart from lung transplantation. The purpose of this study was to summarize our institutional experience with the intraoperative use of veno-venous (VV) ECMO in selected cases of main airway surgery. We retrospectively analyzed the data of 10 patients who underwent main airway surgery with the support of VV-ECMO between June 2013 and August 2022. Surgical procedures included: three carinal resection and reconstruction with complete preservation of the lung parenchyma, one right upper double-sleeve lobectomy and hemi-carinal resection, and one sleeve resection of the left main bronchus after previous right lower bilobectomy, for thoracic malignancies; four tracheal/carinal repair for extensive traumatic laceration; one extended tracheal resection due to post-tracheostomy stenosis in a patient who had previously undergone a left pneumonectomy. The median intraoperative VV-ECMO use was 162.5 minutes. In three cases with complex resection and reconstruction of the carina and in one case of extended post-tracheostomy stenosis and previous pneumonectomy, high-flow VV-ECMO allowed interruption of ventilation for almost 3 hours. In four patients, VV-ECMO was prolonged in the postoperative period to ensure early extubation. There were no perioperative deaths, no complications related to the use of ECMO and no intraoperative change in the planned type of ECMO. Significant complications occurred only in one patient who developed a small anastomotic dehiscence that led to stenosis and required placement of a Montgomery tube. At the median follow-up of 30 months, all 10 patients were still alive. The use of intraoperative VV-ECMO allows safe and precise performance of main airway surgery with minimal postoperative morbidity in patients requiring complex resections and reconstructions and in cases that cannot be managed with conventional ventilation techniques.

Subscapularis tendon tears: A narrative review

The subscapularis muscle, which is the strongest muscle of the rotator cuff, plays important roles in shoulder biomechanics and stability. The emergence of a significant percentage of subscapular tendon tears in rotator cuff tears with advancing arthroscopic techniques has brought the importance of subscapular repair to the agenda along with different dynamics to the arthroscopic perspective. Patient training will reduce postoperative patient morbidity in addition to physical examination, imaging, and medical and surgical approaches to the treatment.

Prognostic factors of postoperative morbidity in surgery for resectable pancreatic cancer. Regional institute of neoplastic diseases 'Dr. Luis Pinillos Ganoza' IREN Norte. 2007-2022.

To determine the prognostic factors associated with postoperative morbidity for resectable pancreatic cancer at the Instituto Regional de Enfermedades Neoplásicas del Norte 'Dr. Luis Pinillos Ganoza' - IREN Norte. 2007-2022. A study was conducted with a case-based (22 patients) and control (14 patients) design nested in a cohort that included 36 patients who underwent proximal duodenopancreatectomy (Whipple) or distal pancreatectomy for pancreatic cancer. In the present study, it was found that the total number of living patients represents 86.1% of the total (36 patients). Of the total population, patients who presented only 1 complication were 13.6% and more than 1 complication were 86.4%. It was also found that the most frequent complication in the general population was gastric emptying syndrome, which was present in 50% of all patients. In the bivariate analysis, a highly significant association was observed between the low prognostic nutritional index (p < 0.001, OD = 20.400, CI = 95%: (3.377-123.245)), the type of pancreatic resection (p < 0.001, OR = 52.500, CI = 95%: (5.174-532.669)) and postoperative morbidity. In contrast, no significant association was found between age ≥65 (p = 0.062), diabetes mellitus (p < 0.908), Wirsung diameter (p < 0.432), hospital stay (p < 0.075) and postoperative morbidity. In the multivariate analysis, serum total bilirubin level ≥20 μmol/L (p = 0.778), use of preoperative biliary drainage (p = 0.176), type of pancreatojejunal anastomosis (p = 0.533) and pancreaticogastric anastomosis (p = 0.504) were not statistically significantly associated with postoperative morbidity. The type of pancreatic resection and the nutritional prognostic index <40.5 are prognostic factors of postoperative morbidity in postoperative patients for resectable pancreatic cancer.

Nomogram for predicting early complications after distal gastrectomy.

Reducing or preventing postoperative morbidity in patients with gastric cancer (GC) is particularly important in perioperative treatment plans. To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model. This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023. The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis. Based on the results obtained, a predictive nomogram was established. The nomogram was validated using internal and external (n = 45) datasets. Its sensitivity and specificity were established by receiver operating characteristic curve analysis. Decision curve (DCA) analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability. Multivariate logistic regression analysis showed that hypertension, diabetes, history of abdominal surgery, and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy. The modeling and validation sets showed that the area under the curve was 0.843 [95% confidence interval (CI): 0.746-0.940] and 0.877 (95%CI: 0.719-1.000), the sensitivity was 0.762 and 0.778, respectively, and the specificity was 0.809 and 0.944, respectively, indicating that the model had good sensitivity and specificity. The C-indexes of the modeling and validation datasets were 0.843 (95%CI: 0.746-0.940) and 0.877 (95%CI: 0.719-1.000), respectively. The calibration curve (Hosmer Lemeshow test: χ2 = 7.33) showed that the model had good consistency. The results of the DCA analysis indicated that this model offered good clinical benefits. The accuracy of 10-fold cross-validation was 0.878, indicating that the model had good accuracy and stability. The nomogram prediction model based on independent risk factors related to postoperative complications of distal gastrectomy can facilitate perioperative intervention for high-risk populations and reduce the incidence of postoperative complications.

Impact of postoperative morbidity on outcomes in patients with advanced epithelial ovarian cancer undergoing intestinal surgery at the time of primary or interval cytoreductive surgery: A Memorial Sloan Kettering Cancer Center Team Ovary study

ObjectiveTo assess the impact of short-term postoperative complications on oncologic outcomes for patients with epithelial ovarian cancer undergoing primary cytoreductive surgery (PCS) or interval cytoreductive surgery (ICS) with intestinal resection. MethodsA retrospective chart review was performed for patients with ovarian cancer who underwent PCS or ICS with at least one intestinal resection at our institution from 1/1/2015 to 12/31/2020. Progression-free survival (PFS) and overall survival (OS) were analyzed for the PCS and ICS cohorts separately. Short-term complications within 30 days of surgery (surgical secondary events [SSEs]) were graded by a validated institutional SSE system. ResultsAmong 437 patients who underwent intestinal resections during PCS (n = 289) or ICS (n = 148), 183 (42%) had one, 180 (41%) had two, and 74 (17%) had three intestinal resections. Six (1.4%) of 437 patients experienced an anastomotic leak postoperatively. There were no perioperative deaths. There was no difference in PFS and OS for patients who underwent PCS with any SSE vs. no SSE within 30 days of surgery (HR, 1.05; 95% CI: 0.76–1.47; p = 0.75 and HR, 0.79; 95% CI: 0.49–1.26; p = 0.32, respectively). There was no difference in PFS and OS for patients who underwent ICS with any SSE vs. no SSE within 30 days of surgery (HR, 1.43; 95% CI: 0.99–2.07; p = 0.055 and HR. 1.18; 95% CI: 0.72–1.93; p = 0.52, respectively. ConclusionShort-term postoperative morbidity for patients who underwent intestinal surgery during primary surgical management for advanced ovarian cancer did not impact oncologic outcomes.

EEVALUATION AND QUANTITATIVE ANALYSIS OF OPERATING ROOM PERSONAL KNOWLEDGE, ATTITUDE, AND PRACTICE OF STERILE TECHNIQUES IN KHYBER TEACHING HOSPITAL PESHAWAR

The pivotal aspect of patient care within the operating room is the operating room personnel. Therefore, assessing their knowledge, attitudes, and practices concerning sterile techniques in the operating theatre is crucial, as infections pose a significant risk to post-operative patient morbidity and mortality. Wound infections are the second most prevalent type of hospital-acquired nosocomial infection in the United States. Recognizing that inadequate infection control and sterile technique practices in the operating room can contribute to wound infections, it is imperative to establish infection control principles and adhere to sterile technique standards. The primary aim of this study was to evaluate the knowledge, attitudes, and practices of operating room personnel with respect to sterile techniques at Khyber Teaching Hospital (KTH) in Peshawar. A cross-sectional descriptive study approach was employed to assess the knowledge, attitudes, and practices of operating room personnel in the operating theaters of KTH. One hundred and eighty operating room personnel from the selected hospitals were chosen from the population using a non-probability convenient sampling method. The self-administered questionnaires were used to gauge their understanding of, attitude toward, and adherence to sterile techniques. The study's findings revealed that most respondents (74%) were male, 44.2% fell within the age range of 25-30 years, and most (74.6%) had less than 10 years of experience. Many respondents exhibited good knowledge, a positive attitude, and solid practices regarding sterile techniques. In conclusion, the study found that operating room personnel displayed good knowledge, a positive attitude, and sound practices about sterile techniques. Furthermore, the study established a direct relationship between knowledge, attitude, and practice. As a result, it is recommended that operating room personnel should participate in additional workshops or seminars on sterile techniques to stay updated on new developments in this field.

An institutional study: Does Body Mass Index influence surgical approach, surgical morbidities, and outcomes in endometrial cancer patients?

Endometrial Cancer (EC), the most common genital tract malignancy in women, is recognised to be associated with a high Body Mass Index (BMI). The aim of the study was to evaluate the impact of obesity on intra and post-operative morbidity for patients treated for EC. This was a retrospective observational study including patients with EC that were surgically treated at Hospital de la Santa Creu i Sant Pau during nine consecutive years. The patients were divided in groups according to BMI: <30 Kg/m2, ≥30-<40 Kg/m2 and ≥40 Kg/m2. Demographic and pathological characteristics, surgical outcomes, perioperative complications and long-term outcomes were recorded. The study included 290 patients; 164 patients with BMI <30 Kg/m2(56.5%), 107 patients with ≥30-<40 Kg/m2 36.9%) and 19 patients with ≥40 Kg/m2(6.65%). Patients with BMI ≥40Kg/m2 were younger, presented a higher percentage of endometrioid histology (84.2%, p<0.01), well-differentiated tumours (73.7%, p<0.01) and were more frequently in the initial stages at diagnosis (94.7%) compared to the other groups. A significant percentage of the patients were operated on laparoscopically (88.7%, 88.8%, 94.7% respectively). No significant differences were found in the evaluation of the surgical outcomes. The results relative to complications showed an overall tendency toward increase in the ≥40 Kg/m2 BMI group but no statistical differences were identified among the groups in terms of complications or long-term outcomes. There was a rising trend towards increased complications with increasing BMI in the study population, however, this was found not to be statistically significant. Therefore, the optimisation of co-morbidities and the adaptation of surgical treatment is important for the management of obese patients with endometrial cancer. The study allows the comparison between groups with different BMI in patients with endometrial cancer. Different surgical outcomes, intra operative, early, and late complications are clearly identified, and survival outcomes are also investigated in our study.