Potential Perioperative Complications Research Articles

The association of vaping and electronic cigarette use with postoperative hypoxemia and respiratory complications: a retrospective cohort analysis.

Initially introduced as a safer alternative to smoking, electronic cigarettes (e-cigarettes) and vaping have since been associated with lung injury. Nevertheless, there is limited perioperative data on their potential contribution to the harmful effects of mechanical ventilation on the lungs. We hypothesized that, in adults undergoing noncardiothoracic surgeries, preoperative vaping/e-cigarette use is associated with hypoxemia during the first postoperative hour, and with an increased incidence of intraoperative and postoperative pulmonary complications. We conducted a retrospective cohort study in which we included patients reporting as vapers/e-cigarette users within one year before surgery as the exposure group, and nonvapers as the control group. The primary outcome was the time-weighted average (TWA) SpO2/FIO2 ratio in the postanesthesia care unit during the first postoperative hour. The secondary outcome was a composite of intraoperative and postoperative pulmonary complications until discharge. We used entropy balancing to adjust for confounding, and fit weighted linear regression and logistic regression models to estimate treatment effects. A total of 110,940 patients met the inclusion criteria, and 1,941 of these were vapers/e-cigarette users. The average treatment effect on the treated for TWA SpO2/FIO2 ratio (N = 109,217) was estimated to be a mean difference of 4 (95% confidence interval [CI], 1 to 8; P = 0.007). This is equivalent to a 4% change in SpO2 at a 30% FIO2 (or at a fixed FIO2). The difference was statistically significant. The average treatment effect on the treated for experiencing intraoperative and postoperative pulmonary complications (N = 110,940) was an odds ratio of 1.04 (95% CI, 0.71 to 1.54; P = 0.84). Vaping/e-cigarette use was neither associated with clinically significant hypoxemia during the first hour in the postanesthesia care unit nor with an increase in pulmonary complications. Nevertheless, our findings cannot definitively exclude the deleterious effects of vaping and e-cigarette use on the lungs, and anesthesiologists should consider potential perioperative complications.

Inguinal hernia repair in newborns: A systematic literature review

Background: Inguinal hernia (IH) is a prevalent condition in children necessitating surgical repair. However, determining the optimal timing (early or delayed) of inguinal herniotomy in neonates and preterm infants remains debatable. While open herniotomy traditionally serves as the standard inguinal hernia repair (IHR) procedure, laparoscopic repair has gained traction in recent decades. Our study aims to scrutinize both the optimal timing and approach to inguinal hernia repair in neonates and preterm infants. Methods: We conducted a literature review on surgical repair of IH in neonates and preterm infants published between 1999 and 2024. Results: Twenty studies met the inclusion criteria for this review. All studies were retrospective, predominantly originating from Europe and the United States. Thirteen out of the 20 studies focused solely on preterm infants. Patient sample sizes ranged from 30 to 8037, totaling 14533 patients. Most studies indicate that delaying inguinal hernia repair in newborns and preterm infants does not increase the risk of incarceration or recurrence. Moreover, postponing repair until after discharge from the NICU correlates with a shorter postoperative hospital stay and notably diminishes the risk of long-term postoperative ventilator dependence, thereby mitigating potential perioperative complications. Hence, this approach seems safe for certain patients whose families can reliably access appropriate surgical care. Conclusion: Significant disparities exist in the timing of inguinal hernia repair for newborns and preterm infants across various pediatric surgery centers. Current evidence suggests delayed inguinal hernia repair may be a viable option for selected patients. Regarding the optimal approach in this population, laparoscopy appears safe and effective.

Development and validation of a 30-day point-scoring risk calculator for small bowel obstruction surgery.

Small bowel obstruction (SBO) is one of the most frequent causes of general emergency surgery. The 30-day mortality rate post-surgery ranges widely from 2 to 30%, contingent upon the patient population, which renders risk assessment tools helpful. this study aimed to develop a 30-day point-scoring risk calculator designed for patients undergoing SBO surgery. Patients who underwent SBO surgery were identified in the ACS-NSQIP database from 2005 to 2021. Patients were randomly sampled into an experimental (2/3) and a validation (1/3) group. A weighted point scoring system was developed for the risk of 30-day mortality, utilizing multivariable regression on preoperative risk variables based on Sullivan's method. The risk scores underwent both internal and external validation. Furthermore, the efficacy of the risk score was evaluated in 30-day major surgical complications. A total of 93,517 patients were identified, with 63,521 and 29,996 assigned to the experimental and validation groups, respectively. The risk calculator is structured to assign points based on age (> 85years, 4 points; 75-85years, 3 points; 65-75years, 2 points; 55-65years, 1 point), disseminated cancer (2 points), American Society of Anesthesiology (ASA) score of 4 or 5 (1 point), preoperative sepsis (1 point), hypoalbuminemia (1 point), and fully dependent functional status (1 point). The risk calculator showed strong discrimination (c-statistic = 0.825, 95% CI 0.818-0.831) and good calibration (Brier score = 0.043) in the experimental group. The point scoring system was successfully translated from individual preoperative variables (c-statistic = 0.840, 95% CI 0.834-0.847) and was externally validated in ACS-NSQIP (c-statistic = 0.827, 95% = CI 0.834-0.847, Brier score = 0.043). The SBO risk score can effectively discriminate major surgical complications including major adverse cardiovascular events (c-statistic = 0.734), cardiac complications (c-statistic = 0.732), stroke (c-statistic = 0.725), pulmonary complications (c-statistic = 0.727), renal complications (c-statistic = 0.692), bleeding (c-statistic 0.674), sepsis (c-statistic = 0.670), with high predictive accuracy (all Brier scores < 0.1). This study developed and validated a concise yet robust 10-point risk scoring system for patients undergoing SBO surgery. It can be informative to determine treatment plans and to prepare for potential perioperative complications in patients undergoing SBO surgery.

The high-risk pediatric patient for ambulatory surgery.

The aim of this article is to briefly review the pediatric ambulatory surgery landscape, identify two of the most common comorbidities affecting this population, examine the influence of pediatric obesity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA) on perioperative care, and provide information that can be used when formulating site specific criteria for ambulatory surgical centers. Most pediatric surgeries performed are now ambulatory, a majority of which take place outside of academic centers. Children with comorbidities such as obesity and SDB/OSA are undergoing surgical or diagnostic procedures which were previously deemed unacceptable for ambulatory surgery. The increase in pediatric ambulatory surgery coupled with a recent shortage of pediatric anesthesiologists means many children will receive anesthesia care from general clinicians who care for children intermittently and may be unfamiliar with the perioperative risks these comorbidities can present. Our pediatric ambulatory surgical population is anticipated to demonstrate increasing rates of obesity and SDB/OSA. Bringing attention to potential perioperative complications associated with these comorbidities provides a stronger foundation upon which to formulate criteria for individual ambulatory centers. It allows for targeted anesthetic management, influences provider assignments and/or staffing ratios, and informs scheduling times. For anesthesiologists who do not practice pediatric anesthesia daily, knowing what to anticipate plays a significant role in the ability to eliminate surprises and care for these patients safely.

Outcomes following elective cerclage versus ultrasound surveillance in women with one prior preterm event

ObjectivePreterm birth, defined as delivery before 37 weeks’ gestation, is a major obstetric challenge and is associated with serious long-term complications in those infants that survive. Preventative management includes cervical cerclage, either as an elective procedure or performed following transvaginal ultrasound surveillance and shortening of the cervix (≤25 mm). Significant questions remain regarding the optimal management, target population and technique. Therefore, this study aimed to assess differences in risk factors and pregnancy outcomes for women who received an elective cerclage versus ultrasound surveillance, following one prior premature event (spontaneous preterm birth/second trimester loss). Study designWomen were retrospectively identified from St Thomas’s Hospital Preterm Birth Clinical Network Database. Women who had one prior premature event (between 14+0 and 36+6 weeks’ gestation) were included and they were separated into those that an elective cerclage and those who underwent ultrasound surveillance to assess differences in demographics, pregnancy risk factors and preterm birth outcomes. We excluded women who received other preventative therapies. We also separately analysed those women who required an ultrasound-indicated cerclage, comparing the differences between women that delivered preterm and term. ResultsWe collected data from 1077 women who had a prior preterm event. 66 women received an elective cerclage. 11.4% of women who had ultrasound surveillance received an ultrasound indicated cerclage. Women with a prior history of mid-trimester loss, instead of preterm birth, were more likely to receive an elective cerclage. The mean gestational age of delivery was similar between those women who received an elective cerclage and those who had ultrasound surveillance with and without an ultrasound-indicated cerclage (38+1 vs 37+1), however, preterm birth rates <37 weeks’ were twice as high in this ultrasound group (OR 2.3 [1.1–4.5], p = 0.02). In those women that do require an ultrasound-indicated cerclage, 50.4% deliver preterm. ConclusionsIn conclusion, this study shows that in women with one prior preterm event, both history-indicated cerclage and ultrasound surveillance are appropriate management options. The majority of women undergoing ultrasound surveillance did not require a cerclage and so avoided the potential perioperative complications of cerclage insertion. However, those that did require an ultrasound-indicated cerclage were at high risk of preterm birth so should be followed up closely to enable adequate preterm birth preparation. Further prospective studies comparing history indicated cerclage and US surveillance in women with one prior preterm event are necessary.

Uloga medicinske sestre u artroplastici kuka i koljena u jednodnevnoj kirurgiji

Background. Arthroplasty is a surgical procedure that has been shown extremely effective in reducing pain, improving joint function and overall quality of life. As a result, arthroplasty is steadily increasing as a procedure, especially in the hip and knee, thereby placing a financial burden on the healthcare system. It is believed that performing hip and knee replacements in day surgery should decrease public health costs. Aim. The aim of the research is to determine the current knowledge and doubts arising from the literature published so far regarding the performance of hip and knee arthroplasty in day surgery, perioperative nursing care, as well as detecting possible potential perioperative complications. Methods. The research of literature was conducted through the electronic databases, Medline via Pub Med (PMC), from March 3, 1992, till December 30, 2021. Key words used in the literature search are arthroplasty, replacement, hip, knee, adverse effects, ambulatory surgical procedures, nursing. Total of 22 papers was analyzed. Results. A clinical algorithm is suggested to accelerate recovery as a possible solution to complications of arthroplasty in outpatient procedures. These algorithms reduce the cost of treatment and the risk of complications. In addition to the aforementioned benefits, perioperative outcomes and patient satisfaction are also improved, enabling recovery in the comfort of one's own home, which is especially important for the successful rehabilitation of elderly patients. Nurses should develop empathy for patients, respecting their individuality and right to participate in treatment. Patients expect professionalism and trust from nurses and have specific expectations of nursing care. Conclusion. Minimally invasive arthroplasty results in less trauma, less blood loss, less postoperative pain, painful surgical reactions, and improved hip mobility. The development of surgery and anesthesia in ambulatory surgery requires nurses to play a particularly important role in postoperative recovery

Preoperative Stress Testing before Non-Cardiac Surgery.

The current guidelines from various medical societies provide a good summary of data regarding various preoperative exercise tests in patients prior to non-cardiac surgical interventions. However, there is no consensus among experts on the appropriateness of these methods for identifying risk groups for potential perioperative complications. A large volume of published studies describes the role of preoperative exercise stress testing impact in improving the prediction of potential cardiovascular (CV) risk in patients after non-cardiac surgery. Numerous stress tests are available in clinical practice, and the methods used and the best choice depends on the purpose of the study and the availability of equipment in the hospital. Traditionally, the value of exercise electrocardiography (ECG), or ECG stress test, has been based on the belief that it is beneficial for perioperative cardiac risk prediction. However, in the past two decades, the key role of this method has lost its importance due to the growing trend toward the use of imaging techniques. Moreover, in light of current trends, the six-minute walk test (6MWT) is a helpful tool in preoperative assessment and plays an important role in postoperative rehabilitation. Interestingly, the recent finding showed how 6MWT affects the risk of postoperative complications. Cardiopulmonary testing, as a dynamic clinical tool, determines the cardiorespiratory status of a patient. Various clinical indications for cardiopulmonary exercise testing include evaluation of therapy, stratification of risk factors, diagnosis of disease, and control of physical activity. Stress testing is one of the most practical ways of predicting perioperative risk and managing patients. This test is based on ischemia provoked by pharmacological agents or exercise. There is no established evidence of a significant advantage of pharmacological stress over exercise stress imaging in subjects who are capable enough to be physically active. All of these studies examined a stress test for induced myocardial ischemia. Currently, there are no data on the use of ischaemic stress tests, especially diastolic stress tests, in the assessment of perioperative risk before non-cardiac surgical interventions. We consider it promising and essential to continue research in this direction in patients with coronary heart disease and other categories of cardiac patients, in particular, comorbid and low-symptomatic individuals, before elective high-risk surgical interventions.

Radiologically Identified Morphologic Changes of Maxillary and Mandibular Bones among Diagnosed Cases of Skeletal Fluorosis in Ethiopia

In 1937, the chronic toxic effect of fluoride on skeletal fluorosis was demonstrated for the first time in history in the Indian state of Madras. Exposure to fluoride concentrations greater than eight ppm in water is reported to cause skeletal fluorosis. Skeletal fluorosis is a chronic metabolic bone disease resulting from prolonged ingestion of large amounts of fluoride. Bone knee syndrome, osteosclerosis, pathological fractures, calcification of ligaments, joint stiffness, immobility, muscle atrophy, and severe forms of neurological deficits are some of the consequences of skeletal fluorosis. Skeletal fluorosis, as such, is a highly morbid disease. Yet, the condition is overlooked, and, most importantly, little is known about its effects on the facial skeleton. This unique, investigative, crosssectional study was initiated to evaluate the morphologic changes in the jawbone caused by skeletal fluorosis in adults diagnosed with skeletal fluorosis. A two-dimensional radiograph was used to evaluate the possible skeletal fluorosis-related morphological changes in the maxillary and mandibular bones. A total of 9 patients diagnosed with skeletal fluorosis underwent panoramic radiography of the maxillary bones and mandibular. Several skeletal fluorosis-related morphological changes were detected in the jaw bones of 6 study participants, including exostosis, osteosclerosis, thickened cortical bone, narrowed bone marrow, and periosteal plaques. According to studies, these morphological changes pose a serious threat to the healing process of the bone. Therefore, surgeons practicing in the Oro-craniofacial region must be alert to potential perioperative and postoperative complications when treating patients diagnosed with skeletal fluorosis.

Colorectal surgery in patients over 80 years: Analysis of perioperative complications, length of stay and 1-year mortality

Objectives: Aging results in older patients with important comorbidities presenting to major surgeries, such as colorectal procedures. Potential perioperative complications should be considered when evaluating these patients preoperatively. Our goal was to study the perioperative complications, length of stay and 1 year mortality of patients over 80 years-old in comparison to patients aged 70-79.

Modern aspects of cesarean section

The increase in the frequency of cesarean section (CS) remains one of the actual problems of modern obstetrics and causes the concern to the world community. Today, it is believed that the abdominal delivery is a safer and more non-traumatic method of delivery for the benefit of the fetus than vaginal delivery. The relative number of cases of abdominal delivery, according to the WHO, should not exceed 10 % of the total number of births, which minimizes the occurrence of complications and prevents the development of bleeding and purulent-inflammatory diseases in the postpartum period. But the latest data demonstrate that this percentage is 18.6 % worldwide, that is one in five births ends in CS. The frequency of CS has been growing rapidly in recent years in most countries of the world, and in this context Ukraine is no exception (14.2 % in 2006, to 25.08 % in 2020). This increases the risk of maternal and perinatal morbidity and mortality. In the presented material for the distance learning about the operative delivery, doctors will find up-to-date information on indications, contraindications, methods of CS, as well as recommendations on counseling of pregnant women before surgery and preventive measures to minimize complications during obstetric surgery. According to the modern approach, the indications for the CS are divided into planned and urgent ones, which are clearly defined in this article. Considerable attention is paid to counseling of the patients before this operation and the obligatory acquaintance of the pregnant woman with the method of performing CS, anesthesia and potential perioperative complications and signing her the informed consent on the possible expansion of surgery. According to the standpoint of evidence-based medicine, the most optimal method of CS is presented, which significantly reduces the likelihood of hemorrhagic, purulent-inflammatory complications during surgery and in the postoperative period. The issues related to modern methods of anesthesia of CS with the use of multimodal analgesia, early mobilization of women in labor and prevention of thromboembolic complications, rehabilitation measures are also identified.

Obstructive apnea syndrome as a risk factor for the development of postoperative complications in obese patients

Introduction. Early detection of patients with obstructive sleep apnea syndrome (OSAS) using preoperative screening is necessary to reduce risks in the perioperative period.The objective was to assess the effect of OSAS on the perioperative management of patients.Methods and materials. 54 patients with a BMI of more than 30 kg/m2 were examined, for whom a bariatric operation was performed as planned. Before the operation, all patients underwent respiratory polygraph with the calculation of the apnea/ hypopnea index (AHI), mean saturation (SpO2 m) during sleep and spirometry.Results. Patients were divided into 2 groups according to AHI: gr. 1 (n=33) with AHI&lt;15/hour, OSAS, gr. 2 (n=21) with a AHI ≥15/hour. In gr. 2 VC and FVC should be significantly lower than in gr. 1 (p&lt;0.01). A significant decrease in SpO2 m was noted (p&lt;0.001). On the first day after the operation, there was an increase in pCO2 of arterial blood in gr. 2, in comparison with gr. 1 (p&lt;0.05).Conclusions. OSAS can be considered as an independent adverse risk factor for potential perioperative complications. Early detection of OSAS will reduce the risks of postoperative complications.

V06-07 BLADDER INJURY DURING PROSTATIC ADENOMA MORCELLATION FOLLOWING THULIUM LASER ENUCLEATION OF THE PROSTATE

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-07 BLADDER INJURY DURING PROSTATIC ADENOMA MORCELLATION FOLLOWING THULIUM LASER ENUCLEATION OF THE PROSTATE Serena Maruccia, Paolo Spiga, Maria Chiara Clementi, Giancarlo Galbiati, and Stefano Casellato Serena MarucciaSerena Maruccia More articles by this author , Paolo SpigaPaolo Spiga More articles by this author , Maria Chiara ClementiMaria Chiara Clementi More articles by this author , Giancarlo GalbiatiGiancarlo Galbiati More articles by this author , and Stefano CasellatoStefano Casellato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic enucleation of the prostate (EEP) is one of the most preferred minimally invasive surgical technique for benign prostatic hyperplasia (BPH) treatment. Capsular perforation, superficial bladder mucosal injury, ureteral orifice injury and morcellator malfunction are potential perioperative complications of EEP. Morcellation of prostatic adenoma is the most worrisom stage of the whole procedure and bladder injury may occur in 0.5% to 18.2% of cases. This Video shows the clinical management of bladder wall injury during morcellation. METHODS: The video, recorded in 2020, refers to a Thulium laser enucleation of the prostate (ThuLEP) performed in a patient suffering from lower urinary tract symptoms due to BPH. Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 800 µm Thulium laser fiber. Once the median and lateral lobes have been enucleated, the external sheath is removed and the nephroscope is inserted to facilitate morcellation. Under continuous inflow irrigation, the Cyber Blade TM morcellator (manufactured by Quanta System, Samarate, Italy) is introduced. A 3.5-MHz convex abdominal ultrasound transducer is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: Despite ultrasound is an effective tool that makes the procedure safer, a bladder injury occurred. We managed the accident by stopping the suction and removing the morcellator blade from the lesion's site. A low power coagulation was performed on the bed and on the margins of lesion with Thulium laser. A postoperative ultrasound revealed no evidence of the pelvic and perivesical fluid. A catheter has been left on site for 36 hours.Patient was discharged on the second postoperative day being clinically asymptomatic. CONCLUSIONS: Extra attention should be paid during morcellation. In order to avoid bladder injuries, optimal hemostasis and bladder distention should be achieved before morcellation. Morcellation should be performed at a safe distance from the bladder mucosa. Superficial injuries may be treated with laser and should be managed conservatively with an indwelling catheter. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e450-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serena Maruccia More articles by this author Paolo Spiga More articles by this author Maria Chiara Clementi More articles by this author Giancarlo Galbiati More articles by this author Stefano Casellato More articles by this author Expand All Advertisement Loading ...

Perioperative Management of a Giant Ovarian Tumour in an Adolescence with Severe Scoliosis and Unilateral Diaphragmatic Dysfunction: A Case Report

Though giant ovarian tumor are rare but due to the limitations in oncology surgery during the COVID-19 pandemic, many oncology patients are presented with a more severe stage and giant ovarian tumors may be more commonly seen during this period. The aim of this case report study was to describe the perioperative management of an adolescent patient with a giant ovarian tumor, severe scoliosis, and unilateral diaphragm dysfunction. An 18-years-old girl weighing 28 kgBW came with a giant abdominal mass that extended to her thoracic and back areas. The patient had a history of severe scoliosis since childhood. She had signs of respiratory distress and was not comfortable lying down. Preoperatively, the surgeon used ultrasonography to guide cyst puncture using a thoracic tube and 6,500 cc of mucinous fluid was drained. Inhalational induction with preservation of spontaneous breathing was performed. Two massive masses filled the entire abdominal area, adhering to the peritoneum while pushing and tenting the diaphragm cranially and laterally to the right and bilateral salpingo-oophorectomy was conducted. Serial radiological examinations showed unilateral diaphragmatic dysfunction and a progressing ventilator associated pneumonia. Improving post-operative outcome of patients with giant intraabdominal masses must include preoperative assessment of potential peri-operative respiratory complications, preparation of intraoperative hemodynamic, and ventilatory disturbances with gentle weaning and multidisciplinary approach during the post-operative care to assess readiness of ventilator weaning.

Perioperative care of heart transplant recipients undergoing non-cardiac surgery.

The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.

Pediatric Living Donor Liver Transplantation for Congenital Absence of the Portal Vein With Pulmonary Hypertension: A Case Report

Few reports of liver transplantation exist in patients with congenital absence of the portal vein and pulmonary hypertension. Living donor liver transplantation is usually performed before exacerbation of pulmonary hypertension. A 7-year-old girl (height: 131.5 cm; weight: 27.4 kg) with congenital absence of the portal vein was diagnosed with pulmonary hypertension (mean pulmonary artery pressure 35 mm Hg), and liver transplantation was planned before exacerbation of pulmonary hypertension. We successfully managed her hemodynamic parameters using low-dose dopamine and noradrenaline under monitoring of arterial blood pressure, central venous pressure, cardiac output, and stroke volume variation. Anesthesia was maintained using air-oxygen-sevoflurane and remifentanil 0.1 to 0.6 μg∙kg-1∙min-1. It is necessary to understand the potential perioperative complications in such cases and to adopt a multidisciplinary team approach in terms of the timing of transplantation and readiness to deal with exacerbation of pulmonary hypertension.

No difference in complication rate after neoadjuvant chemotherapy versus upfront pancreatic surgery - a review of the Swedish National Pancreatic and Periampullary cancer Registry

Background: During the last decade, the practice of neoadjuvant chemotherapy in pancreatic cancer has become more frequent. Pathological response and over-all survival are promising, however the knowledge of potential perioperative chemotherapy related complications is deficient. The aim of this study was to compare the complication scenario of patients receiving neoadjuvant therapy in borderline resectable and locally advanced disease with those who had upfront pancreatic surgery. Methods: From the Swedish National Pancreatic and Periampullary cancer Registry, all patients who were resected for pancreatic ductal adenocarcinoma between 2010 and 2017 were identified. Data on basic patient characteristics, neoadjuvant therapy and post-operative complications were additionally obtained from the registry. Comparisons between groups were performed using non-parametric tests. Results: Within the total cohort of 12006 patients, 3772 underwent surgery and 1619 patients (51% men, median age 69 years) were resected for pancreatic ductal adenocarcinoma. Among these, 75 patients received neoadjuvant treatment followed by surgery. The patients who received chemotherapy were younger (median 64 years versus 69 years, p<0.001), otherwise no evident variation was found in baseline characteristics. When comparing major post-operative complications bile leakage was more common among the neoadjuvant patients (p=0.046), however this subgroup contained only 5 patients. No other significant difference was found between the two groups (see attached table). Conclusions: When analyzing a large national database scarcely no difference in post-operative complications was found between patients receiving neoadjuvant therapy due to borderline resectable or locally advanced pancreatic cancer and those who underwent upfront surgery for the disease. Complications UFS and NAT

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Acute and Subacute Complications of Brachytherapy for Prostate Cancer: A Single Institution Claims-Based Analysis

While late toxicity associated with prostate brachytherapy is well-described, there are few data reporting short-term procedural complications. We sought to quantify the perioperative and postoperative complications of high dose rate (HDR) and low dose rate (LDR) brachytherapy among patients treated at a single institution. We hypothesized a low incidence of acute brachytherapy complications. Patients age >18 who had biopsy proven adenocarcinoma of the prostate and underwent treatment with HDR or LDR between 1998-2014 were identified from a prospective institutional database. We identified ICD-9, ICD-10, and CPT billing codes associated with potential perioperative complications or events, divided into six categories [lower urinary tract symptoms (LUTS), bladder injury, urinary retention, urethral stricture, rectal, and cardiopulmonary complications]. Claims data were queried for these codes, and presence of one or more of these billing codes within 4 months of treatment was inferred as a complication associated with brachytherapy. We used Fisher’s exact tests and Wilcoxon tests to determine the association between the complication groups and patient/treatment factors. For continuous measures of interest, we used classification and regression trees to find optimal cut points. There were 582 patients identified, including 97 treated with HDR using 192iridium (192Ir), and 485 treated with LDR using 125iodine (125I) or 103palladium (103Pd). Complications were identified in 105 (18%) of patients. Of those patients identified, 28 had 2 codes, 23 had 3-6 codes, and 1 had 15 codes (see table). On univariate analysis, a baseline diagnosis of heart disease was associated with cardiopulmonary complications (OR 4.97, 95% CI 1.48-16.67, p=0.03). Having an American Urologic Association (AUA) score of >7 was associated with LUTS (17% vs 6% complication rate, p = 0.0005). Prostate size was not associated with increased risk of urinary retention for either HDR (OR 1.05, 95% CI 0.97-1.12, p=0.13) or LDR (OR 1.04, 95% CI 1.00-1.09, p=0.06).Abstract SU_30_2291; TableSummary of ComplicationsComplicationsN%None47782.0LUTS498.4Bladder Injury234.0Urinary Retention223.8Urinary Stricture101.7Rectal30.5Cardiopulmonary111.9 Open table in a new tab Among well-selected patients, the overall incidence of procedural-related complications within 4 months of brachytherapy is less than 20%. Lower urinary tract symptoms represent the most common complication with an approximate 4% incidence of urinary retention. Serious cardiopulmonary events were very rare (< 2%) and associated with baseline cardiovascular risk factors. These data provide further evidence for the safety of brachytherapy among patients treated at a single institution with expertise in this treatment.

Radiofrequency ablation of small renal masses in comorbid patients.

IntroductionOver the recent years, the progress in imaging techniques has led to increased detection of small renal masses (SRMs), including in elderly and high-risk patients. Partial nephrectomy (nephron-sparing surgery – NSS), the current standard of care in T1a kidney tumours, has some limitations in patients who are poor candidates for surgery, as it is associated with potential perioperative complications and possible renal function loss. Radiofrequency ablation (RFA), a minimally invasive method that can be performed percutaneously, is an option in such cases.AimTo present our experience in treatment of SRMs using RFA in comorbid patients.Material and methodsIn the years 2006–2012, 103 percutaneous, ultrasound-guided RFA procedures were performed in the Oncology Centre in Bydgoszcz in patients with an ASA score ≥ 3. Abdominal computed tomography and tumour biopsy were performed before the procedure. The average follow-up time was 46 months.ResultsThe 1, 3 and 5-year overall survival rates were respectively 97%, 90% and 75%, while cancer-specific survival was 100%. No Clavien-Dindo grade ≥ 3 complications were observed.ConclusionsRadiofrequency ablation performed percutaneously is a minimally invasive treatment and may be applied in patients who are, due to comorbidities, poor candidates for surgery. In comorbid patients, where other causes of death play an important role, the application of a minimally invasive treatment method with satisfactory oncological effectiveness is justified.

Dermatologic surgery in children: an update on indication, anesthesia, analgesia and potential perioperative complications.

Children undergoing dermatosurgical procedures require, unlike adults, particular attention; the administration of various analgesics, anesthetics or sedatives requires a thorough knowledge of drug pharmacokinetics and pharmacodynamics. Furthermore, there are concerns that drugs used for sedation/general anesthesia may result in anesthetic/analgesic complications in children undergoing surgery, with a risk of impaired mental development. Based on our clinical experience and a literature review, we illustrate the most commonly used analgesic, anesthetic and sedative drugs in pediatric dermatosurgery, and identify risk factors and complications following dermatosurgical procedures. Topical anesthetics can be used in children for superficial dermatologic procedures or prior to infiltration anesthesia. Maximum recommended doses based on body weight should be calculated in order to avoid overdosage of local anesthetics. General anesthesia in dermatosurgery is considered safe and has a low rate of side effects. However, caution is advised in children under the age of one due to potential long-term neurological side-effects. NSAIDs and opioids play a significant role in analgesia for children. This article reviews currently available data on analgesia, anesthesia and complications that may arise in pediatric dermatosurgery. These data may be useful in optimizing the safety and quality of care and in improving parent counseling.