Preoperative Morbidity Research Articles

Cricopharyngeal Myotomy in National Surgical Quality Improvement Program (NSQIP): Complications for Otolaryngologists Versus Non-otolaryngologists.

Objective: Comparing outcomes after cricopharyngeal myotomy (CM) performed by otolaryngologists (OTO) and non-otolaryngologists (NO).Methods: A retrospective analysis of the 2014-19 ACS-NSQIP database (American College of Surgeons National Surgical Quality Improvement Program) of patients who underwent open CM (CPT code 43030) as their primary procedure. Analyzed variables include medical comorbidities, operative time, the total length of stay, readmission, reoperation, concurrent procedures, postoperative complications, and postoperative diagnoses. 183 patients were included, 97 (53%) females and 86 (47%) males. 120 had surgery by OTO and 63 by NO. Results: There were no differences in preoperative morbidity. OTO had more outpatient surgeries compared to NO (p<.001). OTO had a longer mean operating time (p=.008). OTO had a higher proportion of concurrent laryngeal procedures and other unspecified procedures compared to NO, while NO had a higher proportion of concurrent esophageal procedures (p=.028). The total length of stay was not significantly different between the two groups. 5.8% OTO and 7.9% NO patients were readmitted for a related reason (p=.586). Complications were similar between the two groups (p>.05). NO had more postop diagnoses of acquired diverticula and achalasia of the stomach cardia, while OTO had more diagnoses of dysphagia and muscular dystrophy (p<.001). Conclusion: There were differences in the surgical setting, length of procedure, concurrent procedures, and postop diagnoses between NO and OTO surgeons but similar complication rates.

Comparing Characteristics and Postoperative Outcomes of Hysterectomy for Endometriosis Versus Other Benign Indications: A NSQIP Study

<h3>Study Objective</h3> Endometriosis is known to cause mild to significant intra-abdominal adhesions, theoretically making surgical procedures more challenging. However, little comparative surgical outcomes data is available. <h3>Design</h3> The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was searched from 2018 to 2019 for all total hysterectomies. Hysterectomies for malignant conditions, emergent cases, and cases with pre-operative morbidity were excluded. Univariate comparisons were made between patients with hysterectomies for endometriosis vs other benign indications (abnormal bleeding, leiomyoma, prolapse, and pelvic pain). Unadjusted and adjusted logistic regression models were used to investigate the association between primary outcomes and hysterectomy indication, with covariates in the adjusted model including age, race, ethnicity and surgical route. <h3>Setting</h3> Within 30 days post operative. <h3>Patients or Participants</h3> Patients undergoing hysterectomy 18-55 years old. <h3>Interventions</h3> Hysterectomy. <h3>Measurements and Main Results</h3> A total of 29,742 women underwent hysterectomies, of which 3,596 (12.1%) were performed for endometriosis. Patients undergoing hysterectomy for endometriosis were statistically likely to be younger, predominately white, and had lower BMI. They were also more likely to have had prior abdominal surgery, prior pelvic surgery, undergo a laparoscopic approach, and undergo lysis of adhesions (all p<0.001). Overall length of stay (1.1 vs 1.2 days, p<0.001) and operative time (130.8 vs 136.8 minutes, p<0.001) were lower in patients undergoing hysterectomy for endometriosis. Examining primary outcomes, patients with endometriosis were more likely to experience major morbidity (AOR 1.25, p=0.033), with no difference in minor morbidity (p=0.87). There were two mortalities. Endometriosis patients were more likely to develop deep surgical site infection (SSI) (OR 1.42, p=0.004), and less likely to receive blood transfusion (OR 0.58, p<0.001). There was no significant difference in occurrence of superficial SSI, sepsis, venous thromboembolism, readmission or re-operation between groups. <h3>Conclusion</h3> Patients undergoing hysterectomy for endometriosis were more likely to experience major morbidity and deep surgical site infection compared to patients with other benign indications.

Esophageal Motility Disorders and Diverticula: Physiologic Implication and Surgical Considerations

Zenker’s diverticula are the most common diverticula of the esophagus and attributed to a hypertensive non-compliant cricopharyngeus muscle with reduced sphincter opening. Cricopharygeus myotomy is the treatment with variable management of the diverticulum. Mid-esophageal diverticula are classically attributed to traction, though many are associated with dysmotility similar to epiphrenic/distal esophageal diverticula. Myotomy is again key for symptomatic presentations. Resection of the diverticula and a partial fundoplication are other components in the surgical management. Although treatment of diverticula has evolved over the decades, it remains a rare condition often associated with significant pre-operative symptomatology and post-operative morbidity.

Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.ObjectiveTo...

Surgical complications in COVID-19 patients in the setting of moderate to severe disease.

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.

Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.MethodsBetween January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records.ResultsPatients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV1) and percentage of predicted forced expiratory volume in 1 s (FEV1%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV1%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008).ConclusionsWe believe this treatment combination is optimal for patients with lung cancer and COPD.

Does starting a beta-blocker in the preoperative period decrease perioperative mortality and morbidity?

Does starting a beta-blocker in the preoperative period decrease perioperative mortality and morbidity?

Strictureplasties performed by laparoscopic approach for complicated Crohn's disease. A prospective, observational, cohort study

BackgroundLaparoscopy is considered the best surgical approach for Crohn's Disease (CD), and strictureplasty a reliable alternative to intestinal resection. Nevertheless, their association has never been evaluated. AimTo investigate feasibility and safety of conventional (SP) and non-conventional (NCSP) strictureplasties, using laparoscopy, for complicated CD. MethodsStarting January 2008, a prospective cohort study was performed, in consecutive, unselected patients, undergoing primary surgery for CD (Group-A). The residential database (CD-CARD) was used for the retrospective extraction of control patients (Group-B). Univariate and multi-variate analysis of pre-operative characteristics, intra-operative findings, morbidity, and intra-abdominal septic complications (IASCs) was performed. ResultsBetween January 2008 and December 2019, 331 patients received 162 SPs, 138 NCSPs, and 373 resections (Group-A). From the CD-CARD, 227 control patients received 159 SPs, 117 NCSPs, and 271 resections (Group-B) (ns). Preoperatively, Group-A presented batter nutritional status and received more biological therapies, Group-B more steroids. Group-A presented less abdominal abscesses, planned ostomies, minor complications, shorter operating time and hospitalization than Group-B, but similar major complications, IASCs and anastomotic leaks. IASCs were related to older age, elevated inflammatory indices, and preoperative treatment with high-risk drugs. ConclusionsSP and NCSP are feasible by laparoscopy, with low morbidity rate, confirming the advantages of both minimally invasive and conservative surgery.

Glenn surgery: a safe procedure in the path of univentricular correction.

This study describes 35 years of experience in a tertiary care level hospital that treats cardiac patients with univentricular heart physiology who underwent Glenn surgery. The study consisted of a retrospective analysis of patients who underwent Glenn surgery, including variables related to pre-operative, intra-operative, and post-operative morbidity and mortality. From 1980 to 2015, 204 Glenn surgeries were performed. The most common heart disease was tricuspid atresia IB (19.2%). In 48.1% of the cases, the procedure was performed with antegrade flow. A bilateral Glenn procedure was performed in 12.5% of the cases and 10.3% were carried out without using a cardiopulmonary bypass pump. Reported complications included infections, bleeding, arrhythmias, chylothorax, neurological alterations, and pleural effusion. The mortality rate was 2.9%. Glenn surgery is a palliative surgery with good results. It significantly improves patient quality of life over a long period until a total cavopulmonary shunt is performed. The complications observed are few, and the mortality rate is low. Therefore, it is a safe surgery that should be used for univentricular congenital heart disease.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography

ObjectiveLung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. MethodsWe conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. ResultsNinety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. ConclusionLung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Impact of Neutrophil Lymphocyte Ratio (NLR) Platelet Lymphocyte Ratio(PLR), Albumin Globulin Ratio (AGR) and Aspartatetranaminase Platelet Ratio Index (APRI) on Predicting Outcomes after Liver Resection

Introduction: The presence of various biomarkers like NLR, PLR, AGR and APRI has been associated with increased morbidity and mortality in several malignancies. Methods: Retrospective analysis of a prospectively maintained database of 309 patients undergoing liver resection for benign and malignant indications during January 2013 to December 2016 was performed. The association of preoperative NLR, PLR, AGR. APRI with clinicopathological characteristics and prognosis were assessed. Receiver operating characteristic (ROC) curve with Youden index was used to establish the cut-off value of NLR (3.6 for preoperative value and 8.6 for post-operative value) in predicting morbidity and mortality. Results: Median age was 52.57±13.99 years (Range; 7-84 years). The high-NLR, PLR group had a significantly higher morbidity (40.2 % vs 28.4% P=< 0.044) High NLR was also associated with decrease disease-free survival (37.7 % vs 52.7 %, P = 0.04) and overall survival (59 % vs 80.1 %, P < 0.001) than the low-NLR group. AGR did not affect peri-operative as well as long term outcomes. High APRI group was associated with increased post-operative mortality (p=0.052) without influencing overall outcomes. Conclusion: Preoperative NLR had a statistically significant association with preoperative morbidity and mortality and also OS and DFS at 3 years and may be considered as a low cost, reliable marker for predicting postoperative morbidity and oncological outcomes.

Predictive factors of post-laparoscopic appendectomy peritoneal collection in children and adolescents with complicated appendicitis.

Introduction:Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis.Patients and Methods:Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients' demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis.Results:Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10–13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75–88) versus 56 (50–66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis.Conclusion:Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.

Upper mini-sternotomy versus right mini-thoracotomy approach in mitral valve surgery

Background: Full median sternotomy has been a standard surgical approach for heart surgery for more than 50 years. Several advantages increasing the use of less invasive approaches to the mitral valve surgery including, cosmetic, blood product use, respiratory, and pain advantages over conventional surgery. Parasternal incision, right mini-thoracotomy and partial sternotomy are described approaches for less invasive cardiac surgery. Objective: Comparing the less invasive approaches via upper partial sternotomy vs right mini-thoracotomy in mitral valve surgery. Methods: Sixty patients, underwent mitral valve surgery in NHI, were enrolled in this study and divided into two equal groups, and randomly assigned into two equal groups: group upper mini-sternotomy (UMS group, n = 30) or group RMT group (n = 30).The preoperative characteristics, operative variables, mortality, and morbidity were analyzed prospectively. Results: No difference were found between the two groups as regards the mortality. However, in Group UMS, blood loss was significantly higher, also cross clamp time and total bypass time were significantly longer. RMT group showed less time on mechanical ventilation, ICU stay and total hospital stay. In Group UMS, two patients (7%) developed deep sternal wound infection, and one patient (3%) suffered unstable sternum and one patient (3%) required permanent pacemaker. Conclusion: Both approaches upper partial sternotomy and right mini thoracotomy are considered a safe alternative for mitral valve replacement and can provide adequate exposure for mitral valve. In Upper partial sternotomy, conventional cardiopulmonary bypass, no specific instruments or endoscope were needed. In right mini thoracotomy, a longer learning curve and special instruments were required, however, it carried better outcome considering patient satisfaction for pain and cosmetic outcome the hospital stay and short return to activity.

Sex differences in disease presentation, surgical and oncological outcome of liver resection for primary and metastatic liver tumors-A retrospective multicenter study.

BackgroundSex differences are becoming of rising interest in many fields of medicine. It remains unknown whether sex has a role in postoperative and long-term outcome after hepatic resection (HR). The aim of this study was to investigate sex differences in disease presentation, surgical and oncological outcome after curative HR.MethodsRetrospective analysis of 1010 patients who underwent HR between 2005 and 2018 at two tertiary hospitals in Austria. Demographics and survival data were obtained from a prospectively maintained database. Univariate analysis was used to identify sex differences for the entire cohort and for sub-cohorts. Disease-free- and overall survival was assessed by the Kaplan-Meier estimate and results were compared by log-rank tests.Results436 females and 574 males were analyzed. Women were younger (p<0.001), had less liver cirrhosis (p<0.001), cardiac comorbidities (p<0.001), diabetes (28 (p<0.001) and obesity (p<0.001). Type of HR and surgical management did not vary by sex. Ninety-day morbidity (p = 0.179) and -mortality (p = 0.888) were comparable. In patients with malignant disease, no differences in disease-free- and overall survival was observed, neither for the entire cohort nor for the subgroups according to tumor entity or type of resection. Only in HCC patients, females showed an inferior OS (p = 0.029).ConclusionThis study delivers new insights on the impact of sex differences in liver surgery. Despite the fact that male patients have a higher incidence of preoperative morbidities, we did not observe specific disparities in terms of immediate postoperative as well as long term oncological outcome between sexes.

Impact of the COVID-19 pandemic on the outcome, morbidity, and mortality of acute care surgery patients: A retrospective cohort study

BackgroundCoronavirus disease (COVID-19) has impacted both emergency and elective surgical management owing to its highly infectious nature and the shortage of personal protective equipment. This study aimed to review the outcomes of emergency surgical conditions and trauma during the pandemic lockdown. Material and methodsWe retrospectively reviewed and collected data from patients who attended the Acute Care Surgery Service from 1st April to May 31st, 2020 during Thailand's COVID-19 pandemic lockdown. We separated staff and performed preoperative COVID-19 swab testing on all patients to assess the requirement for personal protective equipment. Compared with previous years of service, of 2018 and 2019. Preoperative COVID-19 testing was performed using multiplex and manual RT-PCR. Morbidity and mortality, consultation time, and waiting time to surgery were analyzed. ResultsA total of 61 patients were enrolled. The average age of patients was 53.8 years. The average consultation time, waiting time to surgery, and surgical duration were 10 min, 660 min, and 88.77 min, respectively. The average time taken to obtain the preoperative COVID-19 test result was 227.26 min. The morbidity and mortality rates were 9.84% and 1.64%, respectively. Compared with the same period in 2018 and 2019, consultation time was significantly faster (10 min; p = 0.033) and waiting time to surgery was significantly longer (660 min, respectively; p = 0.011). Morbidity and mortality between pandemic period and the previous year of service were not significantly different. No medical workers were infected with COVID-19. ConclusionsDuring the COVID-19 pandemic, optimal triage of emergency patients is key. Waiting for preoperative COVID-19 swab testing in emergency case is safe and results in good outcomes. Although the waiting time to surgery was significantly longer owing to the time required to receive preoperative COVID-19 swab results, morbidity and mortality rates were unaffected.

The Effect of Preoperative Anemia and Perioperative Transfusion on Surgical Outcomes After Gastrectomy for Gastric Cancer

BackgroundThe aim of this study is to examine the interaction between preoperative anemia and perioperative transfusions with postoperative morbidity and mortality among patients undergoing gastrectomy for cancer. Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2016. Restricted cubic splines modeled the nonlinear relationship between preoperative hematocrit (Hct) and 30-day overall morbidity, sepsis, and mortality. Preoperative Hct was categorized based on cut points for the three models. Multiple regression modeling examined the interactive effect of preoperative anemia and postoperative transfusion on surgical outcomes. ResultsAmong 9936 included patients, complication incidence was 38.9% (sepsis 12.7%; mortality 6.0%). Preoperative Hct cut points were identified at 29 and 42. Hct <29 was associated with higher risk of morbidity (OR 2.47, 95%CI 2.10-2.93). Postoperative transfusion was associated with lower risk of morbidity for Hct <29 (OR 0.56, 95%CI 0.43-0.73) but increased risk between 29 and 42 (OR 1.59, 95%CI 1.21-2.08). Similar relationships were found for sepsis and mortality. ConclusionsPreoperative Hct <29 is associated with an increased risk of surgical complications after gastrectomy for cancer and perioperative transfusions appear to be beneficial for Hct <29 only. There may be a role for better optimization of red cell mass among high-risk patients before gastrectomy for cancer.

Incidence and risk factors of preoperative deep venous thrombosis in closed tibial shaft fracture: a prospective cohort study.

To investigate the preoperative morbidity of deep venous thrombosis (DVT) and predictive risk factors associated with DVT after closed tibial shaft fracture. Ultrasonography and blood analyses were performed preoperatively in patients who sustained tibial shaft fracture between October 2014 and December 2018. Univariate analyses were used in the data of demographics, comorbidities, mechanism of injury, concomitant fractures and laboratory biomarkers. Multivariate logistic regression analyses were conducted to determine the independent risk factors associated with DVT. In total, 918 patients with an operatively treated tibial shaft fracture were included, among whom 122 patients had preoperative DVTs, indicating a crude morbidity of 13.3%. Ninety-two of 758 (12.1%) patients with isolated tibial shaft fracture developed DVT, while 30 of 160 (18.8%) patients with concurrent fracture presented with DVT. The average interval between fracture and initial diagnosis of DVT was 3.1days (median, 2days), ranging from 0 to 33days. Among DVT-positive patients, 16 (13.1%) patients presented with proximal DVT and 106 (86.9%) patients had distal DVT. Multivariate logistic regression analysis showed four independent risk factors were significantly correlated to the development of DVT, including increased age (OR=1.17, p=0.003), diabetes (OR=1.99, p=0.009), serum hydroxybutyrate dehydrogenase > 182 U/L (OR=1.83, p=0.008), and delay to DUS (in each day) (OR=1.13, p<0.001). In the present cohort study, the incidence of DVT was 12.1% in patients with isolated tibial shaft fracture. We suggest individualized risk stratification and early anticoagulation for patients with high risk factors including pre-existing diabetes, HBDH > 182 U/L, delay to DUS and older age. Level III, a prospective cohort study.

Preoperative Blood Transfusions and Morbidity in Neonates Undergoing Surgery.

Blood transfusions in the neonatal patient population are common, but there are no established guidelines regarding transfusion thresholds. Little is known about postoperative outcomes in neonates who receive preoperative blood transfusions (PBTs). Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Data Files from 2012 to 2015, we identified all neonates who underwent surgery. Mortality and composite morbidity (defined as any postoperative complication) in neonates who received a PBT within 48 hours of surgery were compared with that in neonates who did not receive a transfusion. A total of 12 184 neonates were identified, of whom 1209 (9.9%) received a PBT. Neonates who received a PBT had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with those who did not receive a transfusion (composite morbidity: 46.2% vs 16.2%; P < .01). On multivariable regression analysis, PBTs were independently associated with increased 30-day morbidity (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 1.63-2.22; P < .01) and mortality (OR = 1.98; 95% CI: 1.55-2.55; P < .01). In a propensity score-matched analysis, PBTs continued to be associated with increased 30-day morbidity (OR = 1.53; 95% CI: 1.29-1.81; P < .01) and mortality (OR = 1.58; 95% CI: 1.24-2.01; P = .01). In a propensity score-matched model, PBTs are independently associated with increased morbidity and mortality in neonates who undergo surgery. Prospective data are needed to better understand the potential effects of a red blood cell transfusion in this patient population.

Visceral obesity and muscle mass determined by CT scan and surgical outcome in patients with advanced ovarian cancer. A retrospective cohort study

ObjectiveVisceral obesity (VO) is a risk factor for developing postoperative complications in patients undergoing abdominal oncological surgery. However, in ovarian cancer patients this influence of body composition on postoperative morbidity is not well established. The aim of this study is to assess the association between body composition and complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. MethodsPatients with FIGO stage 3 or 4 ovarian cancer between 2006 and 2017 were included. Visceral fat area, total skeletal mass and total fat area were measured on a single slice on the level of L3-L4 of the preoperative CT-scan. VO was defined as visceral fat ≥100cm2. The perioperative data were extracted retrospectively. A multivariate logistic regression analysis was performed to test the predictive value of multiple variables such as body composition, albumin levels and preoperative morbidity. Results298 consecutive patients out of nine referring hospitals were included. VO patients were more likely to be hypertensive (38% vs 17% p < 0.001), and to have an ASA 3 score (21% vs 10% P = 0.012). Complications occurred more often in VO patients (43% vs 21% P < 0.001). Thrombotic events were found in 4.9% of VO patients versus 0.6% of the non-visceral obese patients (p = 0.019). VO(OR: 4.37, p < 0.001), hypertension (OR:1.9, p = 0.046) and duration of surgery (OR: 1.004, p = 0.017) were predictors of post-surgical complications. Muscle mass is not a predictor of complications. ConclusionVisceral obesity is associated with a higher occurrence of complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

Implications of preoperative albumin levels on 30-day postoperative complications in endometrial cancer patients undergoing hysterectomy

Objective: The aim of this study was to investigate the relationship between preoperative serum albumin levels and 30-day postoperative morbidity and mortality for women with endometrial cancer undergoing surgical treatment.