Predictor Of Postoperative Complications Research Articles

Prospective analysis of preoperative C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of postoperative complications in bile duct injury repair.

The role of inflammation in the bile duct injury has been suggested. Regarding, this study aims to determine the relationship between preoperative White Blood Cell count (WBC), C-reactive protein (CRP), and neutrophil-lymphocyte ratio (pNLR) with post-operative short- and long-term outcomes in patients undergoing a hepaticojejunostomy (HJ) for a bile duct injury (BDI) repair. This prospective longitudinal study (R-2022-3001-127) enrolled fifty patients. pNLR, WBC, and CRP were determined from preoperative laboratory analysis. Morbidity/Mortality, Accordion and National Surgical Quality Improvement Program (NSQIP), primary HJ patency and actual primary patency rate were registered. Perioperative morbidity and mortality were 34% and 2%. Primary patency was 92%. Median CRP and pNLR were statistically significantly higher in patients with Accordion > 3, NSQIP any complication, and biliary complications. CRP cut-off was consistent (6.3-6.6mg/dl) with area under curve (AUC) 0.8, in all post-operative complications. pNLR had a good AUC (0.7; 2.7-3.1 cut-off value) in any complication and biliary complications. Preoperative inflammatory biomarkers of patients who underwent a HJ for BDI repairs were associated with post-operative complications.

Machine learning perioperative applications in visceral surgery: a narrative review.

Artificial intelligence in surgery has seen an expansive rise in research and clinical implementation in recent years, with many of the models being driven by machine learning. In the preoperative setting, machine learning models have been utilized to guide indications for surgery, appropriate timing of operations, calculation of risks and prognostication, along with improving estimations of time and resources required for surgeries. Intraoperative applications that have been demonstrated are visual annotations of the surgical field, automated classification of surgical phases and prediction of intraoperative patient decompensation. Postoperative applications have been studied the most, with most efforts put towards prediction of postoperative complications, recurrence patterns of malignancy, enhanced surgical education and assessment of surgical skill. Challenges to implementation of these models in clinical practice include the need for more quantity and quality of standardized data to improve model performance, sufficient resources and infrastructure to train and use machine learning, along with addressing ethical and patient acceptance considerations.

Charlson Comorbidity Index can be a Predictor of Post-Operative Complications and Hospital Stay by Using Clavien-Dindo Classification of Patients Undergoing Per-Cutaneous Nephrolithotomy

Charlson Comorbidity Index can be a Predictor of Post-Operative Complications and Hospital Stay by Using Clavien-Dindo Classification of Patients Undergoing Per-Cutaneous Nephrolithotomy

Prediction of Postoperative Complications after Major Lung Resection: A Literature Review

Prediction of Postoperative Complications after Major Lung Resection: A Literature Review

Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery.

Narrative review. To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery. Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery. Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications. Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery. Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.

Anxiety and depression as risk factors for postoperative complications and pain in lumbar spine surgery: A national database study.

Objective: To investigate the potential association between anxiety and depression and surgical outcomes in patients undergoing LSS. By analyzing data from the Nationwide Inpatient Sample (NIS) database, we aim to identify whether anxiety and depression serve as predictors for postoperative complications and pain-related symptoms. Methods: A retrospective analysis was conducted via the NIS database. Those undergoing LSS from 2010 to 2019 were divided into four groups: those with a diagnosis of anxiety, depression, both depression and anxiety, and neither depression nor anxiety. The chi-squared test, rank sum test, the Student-Newman-Keuls, least significant difference, and Bonferroni tests were used to identify differences between these groups. Logistic regression analysis was utilized to determine if anxiety and depression were predictors for postoperative complications and pain-related symptoms. Results: From 2010 to 2019, 832,099 patients undergoing LSS were identified. Patients with either anxiety or depression were associated with heavier economic burdens ($85,375, $76,840, $88,542 in the anxiety, depression, and comorbid group, respectively, p < 0.001) and prolonged hospital stay (p < 0.001). They were identified to experience higher risks of various complications especially thrombophilia (OR = 1.82, and 1.55 in the anxiety and the depression group, respectively, p < 0.01). Multiple pain-related symptoms, but face reduced risks of inpatient mortality (OR = 0.71, 0.75, and 0.63 in the anxiety, depression, and comorbid group, respectively, p < 0.01). Conclusions: The overall morbidities of depression and anxiety were relatively high. Psychiatric comorbidities were closely correlated with the negative outcomes after LSS. The psychological health of patients receiving LSS requires necessary attention to ensure pain control and prevent complications postoperatively.

412. COMPARISON BETWEEN PREOPERATIVE MALNUTRITION, AND SARCOPENIA AND POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS

Abstract Background Typical indicators of malnutrition in cancer patients include BMI, CONUT, PNI, and prealbumin, while SMI and PMI are often used as indicators of skeletal muscle mass loss (sarcopenia). Although these indicators have been reported to be associated with surgical outcomes, their combination may be useful in determining the effectiveness of perioperative management because these are closely related during the perioperative period. Methods A total of 132 esophageal cancer patients who underwent esophagectomy between January 2021 and May 2023 were included in this study. Preoperative BMI, CONUT, PNI, prealbumin, SMI (measured by BIA), and PMI (measured by CT imaging) were extracted from clinical record. We also selected BMI and SMI as a new indicator for combined malnutrition and loss of skeletal muscle. Then, we investigated the association between these indicator and postoperative complications (pneumonia, suture failure, total CD Grade ≥II, total CD ≥IIIa), and length of hospital stay. Results The mean age of patients was 67.3 years, 107 were male and 25 were female. Preoperative chemotherapy was administered to 58 patients. Although associations with each single index were found for postoperative pneumonia and low BMI, low SMI, and low PMI, there was no significant association with anastomotic leakage or overall complications. On the other hand, low BMI+SMI was strongly correlated with postoperative pneumonia, overall Grade≥II, and Grade≥IIIa complications. In postoperative hospital stay, low BMI, low PNI, and low SMI as single indicators showed a significant increase in hospital stay, while low BMI+SMI showed further statistically significant increase. Conclusion In patients who underwent esophagectomy, single index for malnutrition and low skeletal muscle mass may be predictors of postoperative complications respectively. However, because perioperative management is inseparable from nutritional therapy and exercise therapy, composite index of BMI and SMI may be better predictor of therapeutic efficacy of perioperative nutrition and exercise therapy.

Major coronary artery calcifications as predictors of postoperative complications in Ivor Lewis esophagectomies: a five-year retrospective analysis.

This study aimed to determine the relationship between preoperative arterial calcifications and postoperative outcomes after Ivor Lewis esophagectomies. This was a single-center retrospective review of Ivor Lewis esophagectomies from 2013 to 2018. Preoperative CT imaging was reviewed, and arterial calcifications were graded (absent, minor, or major) in various locations. The primary outcome included major complications (defined by the Clavien-Dindo classification III-V) and the secondary outcomes were 90-day reoperations, readmissions, and mortality. Significant associations (p < 0.05) between calcifications and outcomes on univariable analysis were evaluated using a multivariable logistic regression model (odds ratios, OR; 95% confidence intervals, CI). One hundred patients underwent esophagectomies from 2013 to 2018 (79% male, 90% White, median age 68years), and 85% were classified as ASA III. Ninety-four patients had accessible preoperative imaging. Arterial calcifications in specific areas were observed: 82 in coronary arteries (major in 33 patients), 54 in the aortic valve, 78 in supra-aortic arteries, 79 in the thoracic aorta, 82 in the abdominal aorta, and 71 in common iliac. Furthermore, 60 patients exhibited celiac axis calcifications, with 40 patients classified as major. Twenty-five patients experienced major complications. Anastomotic leak occurred in two patients, and graft necrosis occurred in one patient. Ninety-day readmission was 10%, reoperation was 12%, and mortality was 4%. On univariable analysis, major coronary artery calcifications were significantly associated with major complications (OR 4.04; 95% CI 1.34-12.16; p = 0.02) and 90-day readmissions (OR 8.20; 95% CI 1.01-68.47; p = 0.04). However, no significant associations were identified between 90-day reoperations or mortality and arterial calcifications. This study demonstrated that preoperative coronary calcifications increase the risk of postoperative complications, as this may be a surrogate of overall health. Nonetheless, the correlation between splanchnic calcifications and postoperative outcomes needs further exploration.

The Clinicopathological Characteristics and Surgical Treatment of Gastrointestinal Neuroendocrine Neoplasm-A 10-Year Single-Center Experience.

Background: Gastrointestinal neuroendocrine neoplasms (GI-NENs) represent a diverse group of tumors, with surgical resection being the gold standard for treatment. Materials and Methods: A retrospective analysis was conducted on 63 patients (32 women, 31 men) who underwent surgery for GI-NENs at the Department of Digestive Tract Surgery from January 2013 to June 2023. Tumors were classified by stage (localized, regionally advanced, metastatic). Results: Clinical symptoms were reported by 42 (66.7%) patients, with abdominal pain being the most common symptom, affecting 28 (44.4%) patients. The majority of tumors (44, 69.8%) originated in the midgut. The most frequently performed surgery was right hemicolectomy, carried out on 33 (52.4%) patients. Radical tumor resection was performed in 35 (55.6%) patients. Postoperative complications occurred in 12 (19%) patients, with male gender identified as an independent predictive factor for complications (p = 0.04). Non-functioning tumors were more common (33, 52.4%), and most tumors were classified as grade 1 histopathologically (49, 77.8%). Distant metastases were present in 29 (46%) patients. The overall two-year survival rate was 94.9%, with a five-year survival rate also estimated at 94.9%. Conclusions: GI-NENs are often diagnosed at advanced stages, frequently with distant or lymph node metastases, and predominantly arise in the midgut. Despite low postoperative morbidity and mortality, male gender may be a predictor of postoperative complications. Overall, the prognosis for GI-NENs is favorable, reflected in high overall survival rates.

Association between recovery from desaturation after stair climbing and postoperative complications in lung resection.

The stair-climbing test (SCT) is used as a surrogate for cardiopulmonary exercise testing, which measures maximal oxygen uptake, and considered a useful method for assessing exercise capacity in thoracic surgery. This study aims to investigate whether the recovery time of percutaneous oxygen saturation (SpO2) after stair climbing is a predictor of postoperative complications after lobectomy. We retrospectively identified 54 patients who performed SCT and underwent lobectomy between January 2015 and February 2023 at Shizuoka Cancer Center. The SpO2 recovery time was defined as the time required to recover from the minimum to resting value after stair climbing. The association between SpO2 recovery time and early postoperative pulmonary complications within 30days after surgery was analyzed. Eleven patients (20.4%) had postoperative pulmonary complications (≥ Clavien-Dindo Classification Grade 2). The cutoff value of SpO2 recovery time obtained from the receiver operating characteristic curve analysis was 90s [sensitivity, 81.8%; specificity, 72.1%; AUC, 0.77 (95% confidence interval, 0.64-0.90)]. The occurrence of postoperative pulmonary complications was 42.9% in the delayed recovery time (DRT; SpO2 recovery time ≥ 90s) group and 6.1% in the non-DRT (SpO2 recovery time < 90s) group (p = 0.002). DRT was a predictor of postoperative pulmonary complications (odds ratio, 11.60; 95% CI 2.19-61.80). DRT of SpO2 after stair climbing is a predictor of postoperative pulmonary complications following lobectomy in borderline patients who require exercise capacity assessment. SpO2 monitoring after stair climbing may be useful as one of the preoperative assessments in patients undergoing lobectomy.

PP01.131 The Lee Revised Cardiac Risk Index as a Predictor of Postoperative Complications and Survival after Robotic-Assisted Pulmonary Lobectomy

PP01.131 The Lee Revised Cardiac Risk Index as a Predictor of Postoperative Complications and Survival after Robotic-Assisted Pulmonary Lobectomy

Vasoactive Inotrope Score as a Predictor of Postoperative Complications in Cancer Surgery Patients-A Prospective Observational Study.

In this study, we evaluated Vasoactive Inotrope score (VIS) for prognosis in onco-surgery patients and determine whether there is correlation between VIS and grade of complication (according to Modified Clavien-Dindo Classification). This prospective observational study was conducted at Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India. The setting conducted at a tertiary care referral centre. The participants aged 18-65years, undergoing major abdominopelvic and thoracic onco-surgeries, requiring vasopressor and ionotropic support in an intensive care unit from May 2022 to February 2023, were recruited into the study. Thus, 257 patients were enrolled. Patients were given noradrenaline, adrenaline, vasopressin, dopamine, and dobutamine. Patients, on other vasopressor infusions, who lost to follow-up and are not willing to participate in the study were excluded. The following are the main outcome(s) and measure(s): Initial Vasoactive Inotrope score (VIS0), maximum Vasoactive Inotrope score (VISmax), and grade of complication. VISmax has significant positive correlation (r = 0.147; p = 0.01) with grade of complication. Both VIS0 and VISmax have a significant positive correlation with length of ICU stay (r = 0.164, p = 0.001; r = 0.242, p = 0.001). Also there is a significant Odds Ratio (OR = 1.068; 95% CI = 1.004-1.136; p = 0.036) of patient having ≥ Grade 3 complication if VISmax increases by a unit. A cutoff of VISmax > 5.1 had a sensitivity of 82.1% and specificity of 33.5% (p = 0.014) to predict ≥ Grade 3 complications. VISmax may be helpful in predicting higher grade of complication and length of ICU stay in onco-surgery patients. This study is the very first one to evaluate VIS in cancer patients; further studies would help in strengthening the findings. Trial Registration: CTRI/2022/09/045237; www.ctri.nic.in.

Osteosarcopenia: the coexistence of sarcopenia and osteopenia is predictive of prognosis and postoperative complications after curative resection for colorectal cancer.

To establish if osteosarcopenia is related to postoperative complications, prognosis, and recurrence of colorectal cancer (CRC) after curative surgery. The clinical data of 594 patients who underwent curative resection for CRC between January, 2013 and December, 2018 were analyzed retrospectively to examine the relationship between clinicopathological data and osteosarcopenia. The following definitions were used: sarcopenia, low skeletal muscle mass index; osteopenia, low bone mineral density on computed tomography at the level of the 11th thoracic vertebra; and osteosarcopenia, sarcopenia with osteopenia. Osteosarcopenia was identified in 98 patients (16.5%) and found to be a significant risk factor for postoperative complications (odds ratio 2.53; p = 0.011). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates of the patients with osteosarcopenia were significantly lower than those of the patients without osteosarcopenia (OS: 72.5% and 93.9%, respectively, p < 0.0001; RFS: 70.8% and 92.4%, respectively, p < 0.0001). Multivariate analysis identified osteosarcopenia as an independent prognostic factor associated with OS (hazard ratio 3.31; p < 0.0001) and RFS (hazard ratio 3.67; p < 0.0001). Osteosarcopenia may serve as a predictor of postoperative complications and prognosis after curative surgery for CRC.

Allostatic load as a predictor of postoperative complications in patients with breast cancer

Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. Females ages 18+ with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort’s median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. Among 4459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01–1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01–1.26). Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.

Evaluation of The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Risk Calculator as A Predictor of Postoperative Complications After Coronary Artery Surgery

Evaluation of The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Risk Calculator as A Predictor of Postoperative Complications After Coronary Artery Surgery

Factors associated with postoperative efficacy evaluation in patients with morbid obesity

The global obesity problem is becoming increasingly serious, with eight of the top ten causes of death in Taiwan in 2020 being related to obesity. Morbid obesity poses a significant threat to one’s health and well-being. In recent years, bariatric surgery has emerged as a more effective treatment option for patients with morbid obesity. However, the procedure is not without risks. This study aims to examine the factors that impact the postoperative efficacy evaluation of patients with morbid obesity. This study uses a retrospective cross-sectional design, with medical records being collected retrospectively. The data was collected from patients who underwent bariatric surgery between July 1, 2017 and June 30, 2020 at a hospital in southern Taiwan. A total of 663 patients were included in the study and were observed for 1 year after the surgery. The independent variables included demographic variables, perceived symptoms variables, perceived lifestyle variables, and surgery-related variables, while the dependent variables included weight loss outcomes and complications. The prognostic factors affecting the postoperative efficacy evaluation of patients with pathological obesity were determined using multiple regression analysis and binary regression analysis. The study found that 65.6% of the participants were female, with an average age of 36.8 years. The results of the multiple regression and binary logistic regression showed that gender, age, BMI, diabetes, and smoking habit were the predictors of postoperative weight loss. Hypertension, diabetes, liver disease, kidney disease, smoking habit, drinking habit, and operation time were the predictors of postoperative complications. The study found that the presence of the aforementioned 12 significant factors can affect the success of weight loss after surgery and the incidence of postoperative complications. This information can serve as a reference for clinical care institutions and patients to improve the postoperative efficacy evaluation.

Abstract PO5-23-06: Predictive Factors for Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients

Abstract Background: BRCA1 and BRCA2 mutations significantly increase the risk of breast cancer, and prophylactic mastectomy reduces the risk by around 90% in these patients. Previous studies have explored predictors of mastectomy type in high-risk genetic mutation patients, but further characterization is needed. This study aims to identify factors associated with resection and reconstruction methods and predictors of postoperative complications in mutation-positive (M+) patients. Methods: A multicenter retrospective cohort study included patients with a genetic predisposition for breast cancer undergoing breast surgery, seen between January 2016 and October 2022. Patient demographics, comorbidities, oncologic history, operative details, and postoperative outcomes were collected. Descriptive statistics and multivariate logistic regression were performed. Results: Among the 176 patients analyzed, 75 (42.6%) had BRCA1, 71 (40.3%) had BRCA2, 11 (6.3%) had PALB2, and 8 (4.5%) had CHEK2 mutations. Mean age and body mass index (BMI) were 41.0±17 years and 24.9±6.9 kg/m2, respectively. Among patients with prior breast reconstruction (n=86, 48.9%), augmentation mammoplasty (n=31, 17.6%) was the most common procedure, followed by oncologic resection (n=21, 11.9%) and reduction mammoplasty (n=15, 8.5%). Nipple-sparing mastectomy (NSM) (n=107, 60.8%) was the most frequent surgical approach, followed by skin-sparing mastectomy (SSM) (n=43, 24.4%), simple mastectomy (n=14, 8.0%), lumpectomy (n=4, 2.3%), and radical mastectomy (n=4, 2.3%). Tissue expander (n=77, 43.8%) was the most common reconstruction method. By a median follow-up duration of 23.9 months, 66 (37.5%) of patients experienced postsurgical complications. Operative complications recorded within 30 days included seroma (n=9, 5.1%), hematoma (n=8, 4.5%), cellulitis (n=10, 5.7%), dehiscence (n=13, 7.4%), surgical site infection (n=11, 6.3%), and delayed wound healing (DWH) (n=24, 13.6%). Other long-term complications included mastectomy flap necrosis (n=22, 12.5%), total reconstructive failure (n=9, 5.1%), red breast syndrome (n=2, 1.1%), and capsular contracture (n=12, 6.8%). The choice of autologous breast reconstruction was correlated with younger age (OR 0.81, 95% CI: 0.69-0.95, p = 0.012) and Hispanic or Latino race (OR 0.01, 95% CI: 0.001-0.25, p=0.007). BMI was significantly correlated with incidence of hematoma (OR 1.17, 95% CI: 1.02-1.33, p=0.024), DWH (OR=1.1, 95% CI: 1.01-1.20, p=0.030), and dehiscence (OR 1.25, 95% CI: 1.09-1.43, p=0.001). Choice of autologous reconstruction was positively correlated with DWH (OR 8.86, 95% CI: 2.25-34.86, p=0.002) and dehiscence (OR 18.24, 95% CI: 2.58-129.158, p=0.004). Conclusion: In this macroscopic study, the most common breast reconstruction method for M+ patients was tissue expander-based. However, only autologous reconstruction was found to have positive correlates, specifically younger age and Hispanic or Latino origin. Younger patients may pursue this method given less concern for short term complications, which are historically increased in autologous reconstruction. Minority distrust of foreign medical material implantation may play a role in Hispanic or Latino choice. Additionally, autologous reconstruction and BMI were associated with certain postoperative complications, particularly dehiscence, DWH, and hematoma, results consistent with general breast cancer surgery cohorts. This study helps better characterize the M+ population and contributes insight into the resection and reconstructive choice in this patient population. Citation Format: Shrayus Sortur, Jaytin Gupta, Christian Lava, Lauren Berger, Varsha Harish, Zoya Khan, Daisy Spoer, Lindy Rosal, Ian Greenwalt, Lucy De La Cruz, David Song, Kenneth Fan. Predictive Factors for Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-23-06.

D13. Ratio of Resected Tissue Mass to Pre-operative Weight Loss as a Predictor for Post-operative Complications in Abdominal Contouring Procedures after Massive Weight Loss

D13. Ratio of Resected Tissue Mass to Pre-operative Weight Loss as a Predictor for Post-operative Complications in Abdominal Contouring Procedures after Massive Weight Loss

Postoperative Complications in Living Donors for Lung Transplantation.

Living donor lobar lung transplantation is a life-saving procedure for critically ill patients. This requires 2 healthy donors exposed to risks and without medical benefit. Therefore, the donor's safety and minimal postoperative complications are crucial. This study aimed to investigate the short-term outcomes and identify the risk factors affecting these outcomes. The data of 175 living donors enrolled between 1998 and 2022 were analyzed. Donors were divided into era 1 (1998-2009) and era 2 (2010-2022). The overall incidence of postoperative complications was 39%, of which 7% were major complications. Donors who underwent surgery on the right side had a higher incidence of delayed pulmonary fistulae (P = 0.01) and elevated liver enzyme levels (P = 0.028). Living donor surgery on the right side (P = 0.01), era 2 (P = 0.01), and the need for plasty (P = 0.04) were predictors of postoperative complications. Updated data on complications and their correlation with postoperative quality of life from this study could aid in the selection of potential donors and facilitate informed consent.

An esophagectomy surgical Apgar score-based nomogram-a risk-based postoperative triage system: a phase II randomised trial.

The esophagectomy surgical Apgar score (eSAS) has been found to be a predictor of postoperative complications in esophagectomy. In our previous study, we built a graphic nomogram based on eSAS and demonstrated that it can effectively predict the risk of major morbidity after esophagectomy. In this study, we aimed to assess the benefits of using an eSAS-based nomogram model as a postoperative risk-based triage system for patients undergoing esophagectomy. We enrolled 119 patients diagnosed with esophageal carcinoma and randomly assigned them to a nomogram group (NG) or control group (CG) from January 2019 to December 2020. Patients in the NG were assigned to a low-risk group and high-risk group based on the nomogram. Patients in the high-risk group were admitted to the intensive care unit (ICU) after esophagectomy. Risk estimation in the CG patients was based on the surgeon's clinical experience. Thirty-day major complications, postoperative hospital stay, hospital costs, and quality of life (QOL) during the follow-up were compared between the two groups. Baseline clinicopathological characteristics were comparable between the NG (n=58) and CG (n=61). All patients underwent esophagectomy. Postoperative complications were significantly higher in the CG (30, 49.2%) than in the NG (14, 24.1%) (P=0.008), with pneumonia being the most common (CG: 23, 37.7%; NG: 12, 20.7%; P=0.042). There was no significant difference in anastomotic leakage (NG: 1, 1.7%; CG: 6, 9.8%; P=0.12). Postoperative median hospital stay was shorter in the NG (14 days) than in the CG (16 days) (P=0.041). Hospital costs (NG: ¥60,045.1; CG: ¥63,961.5; P=0.21) and postoperative QOL did not differ significantly between groups. An eSAS-based nomogram as a triage system can reduce the overall occurrence of postoperative complications and shorten postoperative hospital stay without increasing hospital costs. Chinese Clinical Trial Registry ChiCTR1900021636.