Prediction Of Postoperative Morbidity Research Articles

Penetrating Abdominal Trauma Index in Prediction of Postoperative Morbidity and Mortality

Abstract Background: Penetrating abdominal trauma is a major health problem worldwide, and in Iraq, it constitutes a main job in the trauma field for general surgeons working across the country. Factors affecting the postoperative complication are well established. Moore found in 1981 that penetrating abdominal trauma score is considered an independent factor for postoperative mortality. Objective: The study aimed to evaluate patient outcomes in Al-Yarmuk Teaching Hospital regarding postoperative morbidity and mortality using the penetrating abdominal trauma index (PATI) score. Patients and Methods: A cross-sectional study was done for 1 year from April 2022 to April 2023 at Al-Yarmouk Teaching Hospital; 96 patients were admitted to the theater for explorative laparotomy after having the appropriate initial management at the emergency department were included in the study; and intraoperative findings were obtained and tabulated. Basic statistical analysis to compare means and Chi-square test for P value of complicated, noncomplicated, and mortality cases were used. Results: Patients who died scored a PATI mean of 27.16, while those who were complicated in general were 23.52, and the uncomplicated cases had a mean PATI of 10.48. Conclusion: Increasing the PATI score will increase the postoperative complications that can lead to death. This makes the PATI score >25 a risk factor for morbidity and mortality in penetrating abdominal trauma.

The effect of postoperative hepatic fibrosis factors on morbidity in mitral valve replacement surgery: A single center ten years' experience.

Previous studies have shown that hepatic fibrosis indices and rates can be used to predict cardiovascular mortality and morbidity. Our aim with this study was to investigate the effect of aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fibrosis-4 (FIB-4) index calculated with ALT, AST, and platelet biomarkers, which are simple, fast, and relatively inexpensive and were used in previous studies to predict cardiovascular disease prognosis, on the prediction of postoperative morbidity and early mortality after mitral valve replacement (MVR) surgery. By scanning the hospital electronic health record system, 116 patients who underwent isolated MVR or MVR + tricuspid valve intervention were identified from 178 patients who underwent MVR with the standard sternotomy procedure between 2011 and 2021. The study was completed with 81 of these patients. Patients were divided into AST/ALT <2 (Group 1) and >2 (Group 2). In addition, the same patients were divided into FIB-4 index <3.25 (Group 3) and >3.25 (Group 4), and a total of four groups were formed. The mean age of Group 2 was significantly higher than Group 1 (P = 0.049). In addition, the mean age of Group 4 was significantly higher than Group 3 (P = 0.003). Postoperative complications did not differ between Groups 1 and 2 (P > 0.05). While noninvasive mechanincal ventilation (NIMV) requirements did not differ between Groups 3 and 4 (P > 0.05), MV duration and intensive care unit stay were significantly longer in Group 4 (P < 0.05). The AST/ALT ratio, which has been shown to be a predictor of cardiovascular mortality in various studies, was not useful in predicting mortality and morbidity in our study. However, a high FIB-4 index, another hepatic fibrosis index, was found to be associated with increased perioperative bleeding, duration of mechanical ventilation, and cardiac intensive care unit stay, which are important criteria in the prediction of morbidity in cardiovascular surgery.

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

BackgroundInflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied.AimThe aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery.MethodsThis is a retrospective study which catalogs 218 patients undergoing elective, potentially curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics.ResultsElevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6, and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC = 0.871), and values above 17.5 mg/L predicted severe complications (AUC = 0.934).ConclusionsElevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

Evaluation of the role of pre-operative albumin and its post-operative drop in the prediction of outcomes of emergency laparotomy

Background: Laparotomies are commonly performed surgeries in an emergency setting. The complications associated with these are a result of the activation of the surgical stress response, the magnitude and duration of which are proportional to the surgical injury. Albumin is an important negative phase reactant. This study was an attempt to evaluate the effectiveness of measurement of pre-operative albumin and the post-operative drop in albumin levels in the prediction of post-operative morbidity and mortality following laparotomy.Methods: Albumin levels of 50 patients undergoing emergency exploratory laparotomy in Victoria Hospital were measured pre and post operatively. The percentage drop in albumin levels was noted. The outcomes were noted and classified according to Clavein Dindo Classification. Unpaired t-test and ANOVA test was used for statistical analysis. A p value of &lt;0.05 was considered statistically significant.Results: 62% of the patients had hypoalbuminemia preoperatively. 58% of patients had post-operative complications. The mean preoperative albumin levels for patients without complications was 3.83 while that for patients with complications was 2.78 (p&lt;0.05). The mean percentage drop in albumin values was 9.66% for patients without complications while it ranged from 14.79 (Clavein Dindo 1) - 24.27 (Clavein Dindo 5) for patients with complications (p=0.047). A negative correlation was noted between the preoperative albumin values and the duration of hospital stay while the drop in albumin levels showed a positive correlation with the duration of hospital stay.Conclusions: Measurement of albumin levels pre-operatively and in the immediate post-operative period following laparotomy can prove as a useful tool and an early indicator of morbidity and mortality following laparotomy.

Oxygen Uptake Efficiency Slope and Prediction of Post-operative Morbidity and Mortality in Patients with Lung Cancer.

Peak oxygen consumption is a very valuable cardiopulmonary functional parameter in pre-operative evaluation of patients with lung cancer. However, it has several critical limitations for operability decision due to failure in achieving maximal level of exercise test for cases. The aim of this study was to reveal the importance of more accurate cardiopulmonary parameters that can be calculated from data of submaximal level test, such as oxygen uptake efficiency slope (OUES) and to determine whether it could be used in the operability decision phase for borderline cases by means of morbidity and mortality. One hundred and twenty-five patients who were scheduled to undergo lung surgery due to lung cancer were included in the study. Peak oxygen uptake (pVO2), heart rate at the anaerobic threshold, and oxygen consumption volume at anaerobic threshold values were obtained after performing the cardiopulmonary exercise test. The OUES value was calculated from the ratio of the peak VO2 value and logarithmic equivalent of the ventilatory volume (VE). The following equation was used for determining OUES: VO2/log10 VE. The peak VO2 mean value was 21.37 ± 4.20mL/min/kg in patients. However, OUES mean value was 12.44 ± 2.11. When the metabolic parameters of the patients were compared, a significant correlation was determined between the peak VO2 value and peak VE, OUES, and survival (p < 0.01). This study demonstrated that OUES is significantly correlated with peak VO2 and it does not require the performance of maximal exercise and can be used together with peak VO2 in this patient population when there is difficulty in making decision for surgery in patients with lung cancer.

Objective Model Using Only Gender, Age and Medication List Predicts In-hospital Morbidity After Elective Surgery

Abstract Background Most current surgical risk models contain many variables: some of which may be esoteric, require a physician's assessment or must be obtained intraoperatively. Early preoperative risk stratification is essential to identify high risk, elective surgical patients for medical optimization and care coordination across the perioperative period. We sought to create a simple, patient-driven scoring system using: gender, age and list of medications to predict in-hospital postoperative morbidity. We hypothesized that certain medications would elevate risk, as indices of underlying conditions. Methods Two Logistic regression models were created based on patient's gender, age, and medications: GAMMA (Gender, age and type of medications to predict in-hospital morbidity) and GAMMA-N (Gender, age and number of medications to predict in-hospital morbidity). A logistic regression models predicting in-hospital morbidity based on ASA score alone was also created (ASA-M). The predictive performance of these models was tested in a large surgical patient database. Results Our GAMMA model predicts postoperative morbidity after perioperative care with high accuracy (c-statistic 0.819, Brier score 0.034). This result is similar to a model using only the ASA score (c-statistic 0.827, Brier score 0.033) and better than our GAMMA-N model (c-statistic 0.795, Brier score 0.050). Conclusions The combination of a patient's gender, age, and medication list provided reliable prediction of postoperative morbidity. Our model has the added benefit of increased objectivity, can be conducted preoperatively, and is amenable to patient-use as it requires only limited medical knowledge.

Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery.

ABSTRACTWe sought to determine the short- and long-term prognoses among ‘marginal-risk’ non-small cell lung cancer patients who have a predicted postoperative- (ppo) forced expiratory volume in the first second (FEV1) of 30–60% and/or a ppo-diffusing capacity of the lung for carbon monoxide (DLCO) of 30–60%. The present study included 73 ‘marginal-risk’ and 318 ‘normal-risk’ patients who underwent anatomical resection for clinical stage I lung cancer between 2008 and 2012. The rates of postoperative morbidity, prolonged hospital stay, and overall survival were assessed. Postoperative morbidity occurred in 35 (48%) ‘marginal-risk’ patients and 66 (21%) ‘normal-risk’ patients, and 17 (23%) ‘marginal-risk’ patients and 20 (6%) ‘normal-risk’ patients required a prolonged hospital stay. The three- and five-year survival rates were 79% and 64% in the ‘marginal-risk’ patients and 93% and 87% in the ‘normal-risk’ patients, respectively. A ‘marginal-risk’ status was a significant factor in the prediction of postoperative morbidity (odds ratio [OR] 2.97, p < 0.001), the rate of prolonged hospital stay (OR 3.83, p < 0.001), and overall survival (hazard ratio 2.07, p = 0.028). In conclusion, ‘Marginal-risk’ patients, who are assessed based on ppo-values, comprise a subgroup of patients with poorer short- and long-term postoperative outcomes.

Frailty score: Prediction of postoperative morbidity and mortality in surgical oncology?

e21526Background: Frailty Scores have developed as important prognostic tools to risk stratify especially for older adults and have recently been applied to the surgical field. In this systematic r...

Use of cardiopulmonary exercise testing (CPET) to identify patients at high risk for adverse outcome after pancreaticoduodenectomy.

e15072 Background: Pancreaticoduodenectomy is the standard of care for tumours confined to the head of pancreas and can be undertaken with low operative mortality. However, the procedure has a high morbidity, particularly in older patient populations with pre-existing co-morbidities. Many of the currently available methods for assessment of pre-operative risk rely on either scoring systems or indirect measures of cardiopulmonary function. In contrast, pre-operative cardiopulmonary exercise testing (CPET) provides a direct functional assessment of integrated cardiac and respiratory performance. This study evaluates the role of pre-operative cardiopulmonary exercise testing (CPET) for prediction of post-operative morbidity and outcome after pancreaticoduodenectomy. Methods: In a prospective cohort undergoing pancreaticoduodenectomy, those aged over 65 years (or younger with co-morbidity) were categorized as high-risk and underwent preoperative assessment by CPET according to pre-defined protocol. Data were collected on functional status, postoperative complications and survival. The predictive potential of CPET-derived markers was assessed. Results: 143 patients underwent preoperative assessment of whom 50 were deemed low-risk for surgery per protocol. Of 93 high-risk patients 64 proceeded to surgery after preoperative CPET. CPET-derived ventilatory equivalent of carbon dioxide (VE/VCO2) at anaerobic threshold (AT) was a predictive marker of postoperative mortality with an AUC of 0.85 (95% CI 0.63 to 1.07, p = 0.020); a threshold of 41 was 75% sensitive and 94.6% specific (PPV 50%, NPV 98.1%). Above this threshold, raised VE/VCO2 was a predictor of poor long-term survival (HR 1.90, 95%CI: 1.02 to 3.57, p = 0.045). Conclusions: CPET is a useful adjunctive test for predicting post-operative outcome in patients being assessed for pancreaticoduodenectomy. CPET-derived VE/VCO2 above a threshold of 41 predicts early post-operative death and poor long-term survival. CPET should be considered in the pre-operative work-up prior to pancreaticoduodenectomy.

The Influence of Specific Factors on Postoperative Morbidity in Young Adults with Bronchiectasis

Surgical treatment of bronchiectasis is associated with acceptable mortality and morbidity rates. To date, few reports on the prediction of postoperative morbidity using some preoperative measures have been presented. We present our results regarding the influence of some specific factors on postoperative morbidity on young adult patients who were treated surgically for bronchiectasis. Between January 2000 and July 2007, 122 patients were operated upon. Female gender, increased number of resected segments, presence of haemoptysis and bilateral disease, compromised pulmonary function test (FEV1/VC<60%) and absence of preoperative fiberoptic bronchoscopy (FOB) were examined as the potential risk factors for postoperative complications such as persistent air leak (PAL), atelectasis, residual air space (RAS), bronchopleural fistula (BPF) and empyaema. There was no operative mortality. Morbidity was observed in a total of 16 patients with an overall morbidity rate of 13.1%. Complete resection was achieved in 88 patients (72.1%). The number of resected segments was not found to be significantly associated with increased morbidity. Presence of preoperative haemoptysis did not correlate with postoperative complications significantly. Absence of preoperative FOB was not found to be associated with post-operative complications (p<0.05). Compromised PFT was significantly associated with RAS (p=0.028), however it was not associated with increased risk of PAL, atelectasis or empyaema significantly. Multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after resection. Associated non-severe haemoptysis and absence of preoperative bronchoscopy are not associated with significant increased risk of postoperative morbidity.

A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system

BackgroundThis pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery.MethodsUni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity.ResultsIndividual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs ≥75%), ΔHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (ΔHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688).ConclusionsThree newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.

Prediction of Postoperative Morbidity Using the POSSUM Scoring System in Emergency Abdominal Surgery in the Elderly

Prediction of Postoperative Morbidity Using the POSSUM Scoring System in Emergency Abdominal Surgery in the Elderly

Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

Objective: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. Design: Prospective, descriptive study. Setting: An orthopaedic hip fracture unit in a university hospital. Patients: Four hundred and twenty-six consecutive hip fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. Main outcome measure: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to18 (fully mobile). The three assessments were correlated to short-term outcome parameters. Results: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P < 0.001 for all). The cumulated ambulation score was superior in its association with all postoperative outcome parameters to both the New Mobility Score and the mental score. A cumulated ambulation score of ±10 correlated with a 99% survival at one month and 93% discharge to own home. Conclusion: The cumulated ambulation score is a potentially valuable score for early prediction of short-term postoperative outcome after hip fracture surgery.

E-PASS (The Estimation of Physiologic Ability and Surgical Stress) Scoring System Helps the Prediction of Postoperative Morbidity and Mortality in Thoracic Surgery

Objective: When a new scoring system, ‘E-PASS’, standing for the Estimation of Physiologic Ability and Surgical Stress that predicts the postoperative surgical risk by quantification of the patient’s reserve and surgical stress applied to a population of general thoracic surgery patients, it should be investigated if this system could help us or not. Methods: The comprehensive risk score (CRS) of the E-PASS and the clinical course were evaluated retrospectively in 282 consecutive patients with primary lung cancer (group A), and in 458 patients who underwent elective thoracic operations (group B). Results: The morbidity and mortality rates in both group A and group B increased as the CRS increased. The CRS correlated significantly with the morbidity score, length of stay and cost of hospitalization. Conclusions: E-PASS scoring system may be useful in surgical decision-making and evaluating quality of care in patients who are tolerable for lung resection.

Prediction of postoperative morbidity after lung resection using an artificial neural network ensemble

Objective: To propose an ensemble model of artificial neural networks (ANNs) to predict cardio-respiratory morbidity after pulmonary resection for non-small cell lung cancer (NSCLC). Methods: Prospective clinical study was based on 489 NSCLC operated cases. An artificial neural network ensemble was developed using a training set of 348 patients undergoing lung resection between 1994 and 1999. Predictive variables used were: sex of the patient, age, body mass index, ischemic heart disease, cardiac arrhythmia, diabetes mellitus, induction chemotherapy, extent of resection, chest wall resection, perioperative blood transfusion, tumour staging, forced expiratory volume in 1 s percent ( FEV 1%), and predicted postoperative FEV 1% ( ppoFEV 1%). The analysed outcome was the occurrence of postoperative cardio-respiratory complications prospectively recorded and codified. The artificial neural network ensemble consists of 100 backpropagation networks combined via a simple averaging method. The probabilities of complication calculated by ensemble model were obtained to the actual occurrence of complications in 141 cases operated on between January 2000 and December 2001 and a receiver operating characteristic (ROC) curve for this method was constructed. Results: The prevalence of cardio-respiratory morbidity was 0.25 in the training and 0.30 in the validation series. The accuracy for morbidity prediction (area under the ROC curve) was 0.98 by the ensemble model. Conclusion: In this series an artificial neural network ensemble offered a high performance to predict postoperative cardio-respiratory morbidity.

Performance of three preoperative risk indices; CABDEAL, EuroSCORE and Cleveland models in a prospective coronary bypass database.

The aim of the present study was to evaluate the performance of three different preoperative risk models in the prediction of postoperative morbidity and mortality in coronary artery bypass (CAB) surgery. Data on 1132 consecutive CAB patients were prospectively collected, including preoperative risk factors and postoperative morbidity and in-hospital mortality. The preoperative risk models CABDEAL, EuroSCORE and Cleveland model were used to predict morbidity and mortality. A C statistic (receiver operating characteristic (ROC) curve) was used to test the discrimination of these models. The area under the ROC curve for morbidity was 0.772 for the CABDEAL, 0.694 for the EuroSCORE and 0.686 for the Cleveland model. Major morbidity due to postoperative complications occurred in 268 patients (23.6%). The mortality rate was 3.4% (n=38 patients). The ROC curve areas for prediction of mortality were 0.711 for the CABDEAL, 0.826 for the EuroSCORE and 0.858 for the Cleveland model. The CABDEAL model was initially developed for the prediction of major morbidity. Thus, it is not surprising that this model evinced the highest predictive value for increased morbidity in this database. Both the Cleveland and the EuroSCORE models were better predictive of mortality. These results have implications for the selection of risk indices for different purposes. The simple additive CABDEAL model can be used as a hand-held model for preoperative estimation of patients' risk of postoperative morbidity, while the EuroSCORE and Cleveland models are to be preferred for the prediction of mortality in a large patient sample.

EVALUATION OF INDOCYANINE GREEN RETENTION AND AMINOPYRINE BREATH TESTS IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION

Impaired hepatic function is a major contributory factor to the high incidence of postoperative morbidity and mortality in patients with malignant biliary obstruction. Dynamic hepatic function tests such as indocyanine green (ICG) retention and aminopyrine breath tests were evaluated in such patients to define whether they were clinically useful for prediction of postoperative morbidity and mortality. Forty-four patients with malignant biliary obstruction undergoing surgery for relief of obstructive jaundice were recruited into the study. Indocyanine green retention and aminopyrine breath tests were carried out in all patients pre-operatively and repeated in 36 patients postoperatively. The ICG retention was abnormal in all patients before surgery and there was significant improvement 2 weeks after surgery (32.8 +/- 2.5% vs 18.3 +/- 2.8%, P = 0.001). The change in ICG retention levels correlated with the serum bilirubin levels but the pre-operative ICG retention value could not predict postoperative morbidity and mortality. The aminopyrine breath test was abnormal in all but one patient. It correlated with pre-operative prothrombin time of the patients before surgery but it did not improve significantly after surgery and was not predictive of postoperative outcome. It is concluded that both ICG retention and aminopyrine breath tests have limited clinical value in the pre-operative evaluation of patients with malignant biliary obstruction.

Prediction of postoperative morbidity and mortality by preoperative VO2 max in lung cancer patients (Meeting abstract).

Prediction of postoperative morbidity and mortality by preoperative VO2 max in lung cancer patients (Meeting abstract).