Postoperative Complications In Patients Research Articles

Retraction: Effects of an enhanced recovery after surgery nursing programme on surgical site wound infection and postoperative complications in patients undergoing total knee arthroplasty: A meta-analysis.

Lu H, Yu J, Hong H. Effects of an enhanced recovery after surgery nursing programme on surgical site wound infection and postoperative complications in patients undergoing total knee arthroplasty: a meta-analysis. Int Wound J. 2023; 21(3): e14485, doi: 10.1111/iwj.14485 The above article, published online on 16 November 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. It came to the publisher's attention from a third party that a number of articles shared concerning similarities in format and structure. Following an investigation by the publisher, the retraction of this article has been agreed on because the peer review and publishing process for this article were found to have been manipulated. The authors did not respond to our notice of retraction.

Re: Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

Re: Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

Effect of Preoperative Nursing Visit on Anxiety and Postoperative Complications in Patients Undergoing Radical Prostatectomy: A Retrospective Study.

This study aimed to explore the effect of preoperative nursing visit on anxiety and postoperative complications in patients undergoing radical prostatectomy and to provide a better perioperative management plan for patients with prostate cancer (PCa) undergoing surgical treatment. The medical records of 199 patients who underwent PCa treatment in our hospital from June 2021 to June 2023 were retrospectively analysed. The reference group received preoperative routine nursing, whereas the observation group implemented preoperative nursing visit. The stress indexes, quality of life, negative emotion level and incidence of complications were compared between the two groups. Before management, no significant difference in the levels of epinephrine, norepinephrine and cortisol was found between the two groups (p > 0.05). After management, the levels of the abovementioned stress indicators in the observation group were lower than those in the reference group (p < 0.001). Before management, no significant difference in Short-Form-36 Health Survey (SF-36) scores was observed between the two groups (p > 0.05). After management, the observation group had higher SF-36 score than the reference group (p < 0.001). Before management, no significant difference in Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores was found between the two groups (p > 0.05). After management, the observation group had lower HAMA and HAMD scores than the reference group (p < 0.001). Furthermore, no significant difference in the incidence of complications was found between the two groups (p > 0.05). Preoperative nursing visit can reduce the anxiety of patients with PCa to a certain extent. This scheme can promote the postoperative recovery of patients, and it has certain clinical application and promoting values.

Modified frailty index can help predict complications following tibial plateau fracture fixation: a NSQIP study involving 2213 patients.

The 5-item modified frailty index (mFI-5) has been established as a reliable indicator of poor postoperative outcomes following a variety of orthopaedic procedures. This study aims to determine whether the mFI-5 can be used by surgeons to predict the likelihood of postoperative complications in patients undergoing open reduction internal fixation (ORIF) for tibial plateau fractures. From 2006 to 2019, patients aged 50years or older undergoing ORIF for tibial plateau fracture were identified in the National Surgical Quality Improvement Program database. The mFI-5 was calculated based on the sum of the presence of 5 conditions: diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent functional status. Chi-squared tests and multivariable regression analysis were used to evaluate the association of different mFI-5 scores with postoperative complications. The study analyzed 2213 patients with an average age of 63years. Multivariable regression analysis demonstrated that in comparison to patients with a mFI-5 score of 0, those with a score of 1 had an increased risk of prolonged hospital stay (OR 1.31) and discharge to a non-home location (OR 1.50) while those with a score of 2 or greater were at an increased risk of readmission (OR 2.30), wound complication (OR 5.37), pulmonary complication (OR 4.56), urinary tract infection (OR 4.79), prolonged hospital stay (OR 1.89), and discharge to a non-home location (OR 3.01). The mFI-5 is a reliable instrument for determining the likelihood of postoperative complications following ORIF for tibial plateau fracture repair. III.

A retrospective study of predisposing factors and management of incisional hernia in a tertiary care hospital

Background: An incisional hernia is characterized as any defect in the abdominal wall, with or without a noticeable bulge, in the region of a postoperative scar, identifiable through clinical examination or imaging. This condition can be detected through clinical examination or imaging and affects approximately 10-20% of patients who undergo abdominal operations. Aims and objectives of the study was to evaluate various precipitating factors, clinical presentations, management and post-operative complications in patients with incisional hernia. Methods: A retrospective study of 150 patients conducted at a tertiary care teaching hospital. Results: In this study, incisional hernia was more common in obese, elderly, and female patients. The incidence was higher with Pfannenstiel incision followed by lower midline incisions. Incisional hernia was common between 1-5 years of index surgery and it was observed that more the risk factors and complications associated with index surgery, earlier was the onset of incisional hernia. Patients had a defect of size &lt;4x4 cm were 58.66%. Open onlay mesh repair was done in 36.66% patients, preperitoneal mesh repair in 13.33%, retro rectus mesh repair in 13.33%, laparoscopic mesh repair in 28.66% and anatomical repair alone in 7.99% patients. Duration of laparoscopic surgery was longer compared to open. Most common post- operative complication was seroma (4.66%) followed by wound infection (2.66%). Conclusions: Incisional hernias occur more in females as they commonly undergo lower abdominal surgeries. Subcutaneous suction drain decreased the incidence of post-operative wound complications.

Comparison of perioperative and subacute postoperative complications between LDR and HDR monotherapy brachytherapy for prostate cancer

We aim to investigate perioperative and subacute postoperative complications in patients undergoing LDR or HDR monotherapy for prostate cancer. We hypothesize a low rate of complications, and a favorable toxicity profile in patients treated with HDR compared to LDR. A prospectively collected institutional database was queried for patients treated with HDR or LDR prostate monotherapy between 1998 and 2021. Toxicities were determined per CTCAE. Claims based billing codes were obtained to identify additional events. Events occurring within 4 months of treatment were defined as perioperative or subacute postoperative complications. 759 patients were identified, 446 received LDR with 125I, and 313 received HDR with 192Ir. HDR patients had higher risk features: 75.7% with Gleason score 7+ versus 2.4% of LDR, and 16% with initial PSA 10+ ng/mL versus 2.7% of LDR. Toxicities were mild with the most common being grade 1 GU frequency and nocturia at ∼50%. HDR patients had significantly less grade 2 dysuria (2.6% vs. 9.0%), frequency (4.8% vs. 9.4%), hematuria (1.0% vs. 5.2%), nocturia (3.8% vs. 9.4%), and urinary obstructive symptoms (7.3% vs. 11.2%), all statistically significant. 11 (1.4%) patients had infection requiring antibiotics: 8 (1.8%) from the LDR group and 3 (1%) from the HDR group. Cardiopulmonary events were low at <2% overall, without difference between HDR and LDR. Overall toxicity rates support the safety of prostate brachytherapy. HDR monotherapy is associated with significantly less perioperative and subacute postoperative GU events when compared to LDR monotherapy. Cardiopulmonary events were equally rare in both groups.

Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health-Care System

Living conditions and socioeconomic status are known to impact individual health and access to medical care. Prior research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage for a given locality. Living in a neighborhood with a higher ADI score has been associated with increased rates of hospital readmission due to complications following surgery. We set forth to identify the possible associations between a patient's ADI score and post-operative endovascular aneurysm repair (EVAR) outcomes in the Veterans Health Care Administration (VHA). We retrospectively analyzed the outcomes of patients who underwent EVAR from January 2010 to December 2021 at a Level 1A VHA Hospital. Patient demographics and intra-operative variables were obtained. ADI score was calculated based on home addresses and resulted in a local score on a scale of 1-10 and a national percentile on a scale of 1-100. We then further stratified these patients into local and national quintile groups. Local ADI 1 included scores of 1-2, and local ADI 5 included scores of 9-10. National ADI 1 comprised scores 1-20, and national ADI 5 scored 81-100. The other scores were equally divided into ADI 2, 3, and 4. Higher ADI scores were associated with lower socioeconomic status. We identified clinical outcomes, including wound infection, respiratory failure, urinary tract infection, acute kidney injury, limb stenosis, readmission, length of stay, and subsequent re-intervention rates. 241 patients underwent EVAR over the time period examined. 57.3% (n=138) of patients were in quintiles 4 and 5 for local ADI; when national ADI percentiles organized these same patients, 47.3% (n=114) were in quintiles 4 and 5. Patient demographics did not vary between the local and national groups. We saw no statistically significant difference in intra-operative variables, postoperative complications, readmission, loss to follow-up, or 1-year mortality rates across ADI quintiles at the local or national level. Binary Logistic Regression showed no statistical significance for local and national ADI quintiles for hospital readmission and overall postoperative complications. We found that there was no statistical significance between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles. This suggests that the VHA resources and multidisciplinary support may improve care across neighborhoods. This comprehensive care provided at VHA may mitigate post-operative complications in patients undergoing EVARs. Further research is warranted to investigate the role of area deprivation in healthcare and EVAR outcomes in a veteran population.

No Difference in Short-Term Surgical Outcomes from Semaglutide Treatment for Type 2 Diabetes Mellitus after Cervical Decompression and Fusion: A Propensity Score-Matched Analysis.

Retrospective cohort. To evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the risk of short-term (<6 months) postoperative complications in patients undergoing primary cervical spine decompression and fusion (CSDF). Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c and obesity are linked to fewer positive results after undergoing spine surgery, particularly cervical decompression and fusion. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications, including surgical site infection, wound complications, and reoperation within 6 months, which were aggregated into a composite measure. The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM who underwent CSDF for degenerative pathology. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, employing age, gender, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used to investigate the impact of semaglutide treatment on postoperative surgical complications. The propensity score-matched cohort included 596 patients (semaglutide cohort: 298, control cohort: 298). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index CSDF (OR 1.26, 95% CI 0.83-1.93, P=0.331). Similarly, both 30-day (OR 0.83, 95% CI 0.49-1.42, P=0.589) and 90-day readmission rate (OR 0.89, 95% CI 0.56-1.42, P=0.724) were similar between both cohorts. This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of short-term adverse events after CSDF. The effect of semaglutide use on long-term outcomes remains unknown.

Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis

Abstract Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA). Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications. Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p &lt; 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p &lt; 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673). Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.

Aminoglycoside antibiotics as first-line treatment of acute appendicitis and cholecystitis

We analyzed the efficacy and safety of aminoglycosides in a retrospective study of 415 patients with acute appendicitis and 277 patients with acute cholecystitis. The following variables increased the incidence of postoperative complications, defined as surgical site infection, recurrent intraabdominal infection, non-infectious post-operative complication, or death: age (p = 0.016 and 0.011), kidney disease (p = 0.019 and <0.001), and ASA Score (p < 0.001). The type of antibiotic therapy did not have a statistically significant effect on the incidence of postoperative complications in patients with acute appendicitis and cholecystitis (p = 0.561 and 0.547, respectively). A linear regression model showed a higher complication rate in patients with kidney disease (p = 0.014) and neoplasms (p = 0.013); the type of antibiotic therapy did not have a significant effect on the outcome (p = 0.765). There was no statistically significant difference in the post-treatment levels of creatinine in patients treated with aminoglycosides (gentamicin 3 mg/kg once daily) and in those who received other antibiotics (p = 0.75).

Minimally Invasive Management of Postoperative Complications in Patients with Cholangiocarcinoma

AbstractCholangiocarcinoma is a rare, aggressive biliary tract malignancy representing only 3% of digestive cancers worldwide. Late diagnosis is common, which results in less than one-third of patients being eligible for surgical resection or liver transplantation. Surgery, however, is not without associated morbidity and mortality. This article seeks to review minimally invasive techniques for the management of complications following liver transplantation and hepatic resection for patients with cholangiocarcinoma.

Neuronavigation-assisted pituitary neuroendocrine tumor resection: a systematic review and meta-analysis.

The advancement of pituitary surgery has rendered it a secure and efficient treatment method; nevertheless, the potential for incomplete tumor removal and cerebrospinal fluid (CSF) leak remains. Neuronavigation-assisted pituitary neuroendocrine tumor (PitNET) resections have been driving a rising number of attentions in recent years. However, there is currently a lack of comprehensive quantitative evaluation of the effectiveness of neuronavigation-assisted pituitary tumor resection. We aimed to assess the curative effects and complications with or without the use of an image-based neuronavigation in PitNET resection. A systematic review and meta-analysis was performed by searching PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus from inception until May 1, 2024 in English to identify any studies reporting gross total resection (GTR) or postoperative complications in patients who underwent neuronavigation-assisted PitNET resection, excluding conference abstracts and studies with fewer than five subjects. We also searched the reference lists of previous systematic reviews and other relevant publications in databases. We reviewed and analyzed the studies that investigated the operative effects and complications of neuronavigation in PitNET resection. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was evaluated by funnel plot. Review manager 5.3 was employed for meta-analysis. The results were expressed as odds ratio (OR) with 95% confidence interval (CI) of image-assisted techniques for the incidence of GTR and complications. A total of 42 publications that fulfilled the established searching criteria were obtained from the above-mentioned databases, all of which with the Newcastle-Ottawa Scale scores ≥ six ★. Among the included publications, 37 studies indicated that the OR of image-based neuronavigation was 2.29 (95% CI: 2.02-2.60, P<0.00001, I2=24%) for GTR. The other five studies compared the neuronavigation group (experimental group) and non-neuronavigation group (control group), exhibiting high heterogeneity (I2=91%). After sensitivity analysis, the results showed that the rate of the CSF leak of the neuronavigation group was slightly lower than that of the non-neuronavigation group (OR: 0.84, 95% CI: 0.73-0.97, P=0.01, I2=43%). According to the existing data, neuronavigation-assisted PitNET resection can increase the rates of GTR and reduce the incidence of postoperative complications. Our results provide a reference for the selection of surgical methods for PitNET resection in future clinical practice.

A nomogram for predicting low cardiac output syndrome in older patients undergoing acute type A aortic dissection surgery.

Low cardiac output syndrome (LCOS) is a dangerous postoperative complication in patients with acute type A aortic dissection (ATAAD). This study aims to develop and evaluate a nomogram model that can reliably identify risk variables for postoperative LCOS in elderly patients suffering from ATAAD. In this retrospective study, a total of 310 elderly patients with ATAAD admitted to Fujian Medical University Union Hospital were included and categorized into the LCOS and non-LCOS groups. Stepwise logistic regression was used to analyze independent predictors of LCOS, and a nomogram was constructed. The best clinical decision points were found using decision analysis and a clinical impact curve. Postoperative LCOS occurred in 22 (7.1%) of elderly patients with ATAAD. Independent risk factors for postoperative LCOS were age, smoking history, aortic cross-clamp (ACC), coronary heart disease (CHD), and preoperative shock. The nomogram constructed based on the identified risk factors showed good performance. Our results suggest that preventive treatment can be administered when needed when the risk of LCOS in older patients with ATAAD after surgery is >60%. This study contributes to developing a methodology that may improve therapeutic decision-making in older patients and provides insights for assessing the risk of LCOS.

Patients aged 55 or older undergoing around the knee osteotomy have a higher rate of deep vein thrombosis but not overall early post-operative complications.

Osteotomies around the knee have been established as an effective method for treating varus or valgus malalignment associated with other knee pathologies in young and middle-aged patients. There is limited literature regarding the risks and complications based on patient age. The purpose of this study is to determine whether age influences as a risk factor for developing intraoperative and early post-operative complications in patients undergoing osteotomies around the knee. A consecutive series of patients over 18 years old who underwent distal femoral osteotomy (DFO) or high tibial osteotomy (HTO) with a minimum follow-up period of 90 days were included. Demographic characteristics, surgical technique, intraoperative and post-operative complications up to 90 days were identified. A statistical comparison based on age younger than 55 years or 55 years and older was conducted to determine if patient age acted as a risk factor in the development of complications. A total of 159 osteotomies were included, of which 129 were HTOs. The average age was 46.16 years, and 118 patients were younger than 55 years. Seven hinge fractures were identified as the only intraoperative complication, while the overall early post-operative complication rate was 11.32%. The most frequent was deep venous thrombosis (DVT) in 5.66% of cases, followed by deep infection with a total rate of 2.52%. When performing the subgroup analysis by age, we observed a significantly higher rate of DVT in the group aged 55 years and older (p 0.036) (odds ratio 3.96 95% confidence interval 1.009-15.533; p 0.048); however, no significant differences were observed in the overall complication rate according to the age group of the patients. This study reveals that in patients undergoing osteotomies around the knee, the most common post-operative complication was DVT. The rate of DVT was significantly higher in patients aged 55 years and older, although no differences were observed in the overall complication rate according to the patients' age range. Level III (retrospective cohort study).

Effect of Traditional Chinese Medicine nursing on functional rehabilitation and postoperative complications in patients undergoing percutaneous transforaminal endoscopic surgery for lumbar disc herniation

Effect of Traditional Chinese Medicine nursing on functional rehabilitation and postoperative complications in patients undergoing percutaneous transforaminal endoscopic surgery for lumbar disc herniation

Retrospective analysis of surgical treatment of adult patients with trauma and posttraumatic deformities of the middle zone of the facial skeleton

The issues of diagnosis, planning, timing and tactics of surgical treatment, possible risks of postoperative complications in patients with trauma of the middle zone of the facial skeleton have remained relevant for many years. Due to the prevalence and complexity of solving a number of problems facing specialists arising from post-traumatic deformities (PTD) in this area, the problem of treating this category of patients is not only medical, but also socio-economic. Purpose. To carry out a retrospective analysis of the data of medical documentation of adult patients with trauma and PTD of the middle zone of the facial skeleton. Material and methods. We analyzed statistical data on the provision of specialized medical care to patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. A sample of 32 495 medical records of patients who were hospitalized at the State Budgetary Healthcare Institution of the Department of Healthcare of the Moscow “Maxillofacial Hospital for War Veterans” was conducted from March 2015 to December 2023. Statistical processing of the obtained data from the study group of patients was carried out. Results. Information is presented on the specialized care provided to adult patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. Our study included 233 patients with trauma and PTD of the midfacial skeleton who underwent surgical treatment. Of these, 84.12% (n=196) were men and 15.88% (n=37) women. The average age of the patients was 35.74±11.11 years. The study group was divided into two subgroups: the 1st – patients with injuries to the bones of the midface (n=157, 67.38%), the 2nd – with PTD of the bones of the midface (n=76, 32.62%). The article presents the main characteristics of these patients. The methods of their examination at the prehospital stage are analyzed in detail; the time from the moment of injury to the moment of seeking specialized medical care; channels of hospitalization; causes of injuries; aesthetic and functional disorders as a result of injuries; types of injuries; applied methods and tactics of surgical treatment. Conclusions. The results of the study present a modern characterization of adult patients with trauma and PD of the middle zone of the facial skeleton. Recommendations are given on the use of four main fixation points during operations of metallosteosynthesis of the bones of the zygomatic complex, the need to reduce the time from the moment of injury to the moment of specialized medical care, the need for an integrated approach and treatment of patients with injuries and PTD of the bones of the middle zone of the face in specialized centers of maxillofacial-facial surgery.

Serum IL-6 as a Surrogate Biomarker of Post-operative Complications in Invasive Orthopaedic Surgeries: A Prospective Observational Study.

Interleukin-6 (IL-6) is a cytokine released in response to tissue injury. Elevated serum IL-6 levels in trauma patients have been linked with increased risk of complications such as inapparent hypoxia (SpO2 < 94%), acute respiratory distress syndrome, fat embolism syndrome (FES), systemic inflammatory response syndrome, multiple organ dysfunction syndrome and sepsis. This study aims to determine the role of serum IL-6 as surrogate biomarker of post-operative complications after invasive orthopaedic surgeries. Thirty-seven adults between 18 and 65years of age undergoing invasive orthopaedic surgeries were included in this hospital-based study. Serum IL-6 levels were estimated serially in the pre-operative period, after 24h and 7days post-operatively. Cases were monitored for post-operative complications. Serum IL-6 levels showed maximum rise in the first 24h post-operatively especially among older patients (> 60years). Older patients undergoing bipolar hemiarthroplasty for neck of femur fracture showed highest median post-operative IL-6 level of 258pg/ml. Serum IL-6 level > 130pg/ml measured 24h after surgery was predictive of post-operative complications (sensitivity of 75%). Among the cases with post-operative complications, inapparent hypoxia was the most common complication/event observed. Cases with sub-clinical FES had highest level of serum IL-6 in first 24h following surgery with median IL-6 level of 300pg/ml (range 155-444 pg/ml). Monitoring serum IL-6 level may help in both anticipation and early detection of post-operative complications in patients undergoing invasive orthopaedic surgeries; potentially enhancing patient safety.

Is a high preoperative HbA1c level a risk factor for postoperative complications in patients with non-small-cell lung cancer?

PurposeDiabetes mellitus (DM) is a common comorbidity of lung cancer. We hypothesized that severe DM is associated with increased complications after surgical resection of non-small-cell lung cancer (NSCLC).MethodsA review of our retrospective thoracic database identified 1139 consecutive surgical resections for NSCLC from 2002 to 2021. Our analysis included the exploration of clinicopathological features, perioperative variables, and surgical outcomes.ResultsIn addition to lung cancer, 170 patients (14.9%) had DM. The patients included 132 (77.6%) men and 38 (22.4%) women, with a median age of 72 (range, 51–93) years old. The median preoperative fasting blood glucose and HbA1c levels were 135 mg/dL (range, 57–303) and 6.9% (range, 5.1–14.8), respectively. Eighty-one patients had DM as a single comorbidity, and 89 patients had other comorbidities or a relevant medical history. A total of 144 patients were prescribed these drugs. There were 107 patients (62.9%) who consulted a specialist diabetes endocrinology department preoperatively and 118 patients (69.4%) who required sliding-scale insulin during the perioperative period. Forty-seven patients (27.6%) developed post-operative complications. No cases of bronchopleural fistula were noted. A univariate analysis showed that the sex (p = 0.017), body mass index (BMI) (p = 0.0032), surgical procedure (p = 0.017), surgical time (p = 0.002), and lymphatic invasion (p = 0.011) were significantly different among patients stratified by postoperative complications. A multivariate analysis showed that a low BMI (odds ratio [OR]: 0.413, 95% confidence interval [CI]: 0.196–0.870, p = 0.018), long surgical time (OR: 2.690, 95% CI: 1.190–6.082, p = 0.015), and presence of lymphatic invasion (OR: 2.849, 95% CI: 1.319–6.135, p = 0.007) were risk factors for postoperative complications. In contrast, severe preoperative DM did not have a significant negative effect on the incidence of postoperative complications.ConclusionIn modern respiratory surgery, severe DM does not affect the short-term outcomes under strict preoperative treatment.

Prognostic significance of Pleural Fluid triglyceride levels based on a low-Fat Diet Management Strategy in patients with Chylothorax following pulmonary resection

BackgroundChylothorax is a postoperative complication in patients with lung cancer. Diet-control approaches have been the mainstay for managing this condition. However, a surgical intervention is needed for the patients if conservative treatment is ineffective. Because of the lack of accurate indicators to assess the prognosis of the postoperative complication at an early stage, the criteria of surgical treatment were not consistent.MethodsWe reviewed 2942 patients who underwent pulmonary resection and lymph node dissection for primary lung cancer at our hospital between March 2021 and December 2022. The prognostic implications of clinical indicators were assessed in patients with postoperative chylothorax who were managed with a low-fat diet. Binary logistic regression was used to explore the predictive value of these indicators for patient prognosis.ResultsPostoperative chylothorax occurred in 108 patients and 79 patients were treated with a low-fat diet management while 29 patients were managed with TPN. In contrast to drainage volume, the pleural effusion triglyceride level after 2 days of low-fat diet exhibited enhanced predictive efficacy in predicting patient prognosis. When the pleural fluid triglyceride level of 1.33 mmol/L was used as the diagnostic threshold for prognosis, the sensitivity and specificity reached 100% and 80.6%, respectively.ConclusionsThe pleural effusion triglyceride level after 2 days of low-fat diet can serve as a valuable prognostic indicator in patients undergoing lung surgery and experiencing chylothorax. This predictive approach will help thoracic surgeons to identify patients with poor prognosis in a timely manner and make decision to perform necessary surgical interventions.

Electroencephalographic insights into the pathophysiological mechanisms of emergence delirium in children and corresponding clinical treatment strategies.

Emergence delirium is a common postoperative complication in patients undergoing general anesthesia, especially in children. In severe cases, it can cause unnecessary self-harm, affect postoperative recovery, lead to parental dissatisfaction, and increase medical costs. With the widespread use of inhalation anesthetic drugs (such as sevoflurane and desflurane), the incidence of emergence delirium in children is gradually increasing; however, its pathogenesis in children is complex and unclear. Several studies have shown that age, pain, and anesthetic drugs are strongly associated with the occurrence of emergence delirium. Alterations in central neurophysiology are essential intermediate processes in the development of emergence delirium. Compared to adults, the pediatric nervous system is not fully developed; therefore, the pediatric electroencephalogram may vary slightly by age. Moreover, pain and anesthetic drugs can cause changes in the excitability of the central nervous system, resulting in electroencephalographic changes. In this paper, we review the pathogenesis of and prevention strategies for emergence delirium in children from the perspective of brain electrophysiology-especially for commonly used pharmacological treatments-to provide the basis for understanding the development of emergence delirium as well as its prevention and treatment, and to suggest future research direction.