Predictor Of Postoperative Complications Research Articles

Is Sarcopenic Obesity an Indicator of Poor Prognosis in Gastric Cancer Surgery? A Cohort Study in a Western Population

BackgroundThe prognostic value of sarcopenic obesity in gastric cancer surgery remains debated. We aimed to evaluate the impact on outcomes of body composition and sarcopenic obesity after gastrectomy for gastric cancer. MethodsA retrospective review of prospectively maintained database of patients undergoing gastrectomy for gastric cancer from 2010 to 2017 was performed. Skeletal muscle mass and visceral adipose tissue were evaluated by preoperative computed tomography to define sarcopenia and obesity. Patients were classified in body composition groups according to the presence or absence of sarcopenia and obesity. Prognostic factors for survival were assessed by multivariate Cox analysis. ResultsOf the 198 patients undergoing gastrectomy for gastric cancer, 90 (45.4%) patients were sarcopenic, 130 (67.7%) obese, and in the subclassification for body composition categories: 33 (17%) nonsarcopenic nonobesity, 75 (38%) non sarcopenic obesity, 35 (17%) sarcopenic nonobesity, and 55 (28%) sarcopenic obesity. No category of body composition was a predictor of postoperative complications and worse overall and disease-free survival outcomes. Multivariable analysis identified ASA III classification, preoperative weight loss > 10%, postoperative surgical re-intervention, and advanced tumor stage as independent prognostic factors for overall survival, and patients aged 75 years or older, preoperative weight loss > 10%, elevated netrophil-lymphocyte ratio, and advanced tumor stage as independent prognostic factors for disease-free survival. ConclusionsSarcopenia, obesity, and sarcopenic obesity were not associated with worse outcomes after gastric cancer surgery.

Predictors of Postoperative Complications in Patients Undergoing Below Knee Amputation

To identify risk factors for development of wound complications in patients undergoing a below knee amputation (BKA). Retrospective chart review was performed of patients who underwent BKA between January 1, 2014, and December 31, 2016. Data on patient demographics, preoperative comorbidities, limb salvage attempts (LSA) before amputation, and outcomes after BKA were collected for each limb analyzed. LSAs were defined as endovascular revascularization, open surgical revascularization, wound debridement requiring intravenous sedation or general anesthesia, and amputation at or below the level of transmetatarsal amputation. Postoperative wound complications were defined as residual limb wound infection or nonhealing wound. Primary outcome was the need for procedural reintervention on the ipsilateral limb within 12 months of the initial amputation (washout, debridement, or revision to higher level). There were 155 BKAs identified in 129 patients. Mean age at amputation was 63.7 ± 11.7 years. Of BKAs, 72.3% were performed on male patients. Mean follow-up was 836 days after index amputation. Patients with a history of deep venous thrombosis (DVT) in either lower extremity before amputation had a higher risk of developing post-BKA wound complications (26.7% vs 12.7%; P = .034). Of patients who did not have a preoperative popliteal pulse, 60.0% developed wound complications within 12 months, compared to 24.2% of those with a popliteal pulse (P = .004). Additionally, of patients without a popliteal pulse, 31.3% eventually needed revision to above the knee amputation, compared to 9.7% of those with a popliteal pulse (P = .013). If a patient experienced a complication after any LSA (postoperative DVT, Clostridium difficile, community-acquired infection, need for postoperative transfusion, acute cardiopulmonary event, or need for unplanned surgical reintervention within 24 hours), their risk for developing wound complications after BKA more than doubled (45.6% vs 22.0%; P = .003). Patients admitted more than 17 cumulative days after LSAs were more likely to experience a BKA complication (38.1% vs 22.0%; P = .030). Patients who underwent two or more prior revascularizations experienced a higher rate of BKA complications (36.7% vs 21.0%; P = .032). Risk factors for wound complications after BKA include prior DVT, absence of a popliteal pulse, complications with prior LSA, longer total admissions for LSA, and multiple revascularizations before amputation. Absence of a popliteal pulse increases the risk of eventual need for above the knee amputation by over three-fold. This research suggests that a complete pulse examination and greater scrutiny regarding the usefulness of multiple LSAs may decrease rates of wound complications after BKA.

Low skeletal muscle mass as predictor of postoperative complications and decreased overall survival in locally advanced head and neck squamous cell carcinoma: the role of ultrasound of rectus femoris muscle.

Skeletal muscle mass (SMM) depletion and sarcopenia as predictors of postoperative complications and poorer overall survival (OS) have been validated in many surgical fields through cross-sectional imaging (CT, MRI), with potential limitations. We evaluated it in a stage III-IV head and neck squamous cell carcinoma (HNSCC) surgical cohort through ultrasound (US) of rectus femoris muscle (RF), a quick, cheap, repeatable alternative. Patients submitted to surgical treatment with curative purpose were recruited and prospectively evaluated through clinical, biometric, biochemical, surgical, pathological and functional prognosticators and with preoperative US of RF with regards to 30-day complications and OS. Forty-seven patients completed the study. RF cross-sectional area (RF-CSA) was used to identify patients with low SMM (CSA ≤ 0.97cm2: 18/47, 38.3%). RF-CSA was lower in complicated cases (0.95 ± 0.48 vs 1.41 ± 0.49cm2; p = 0.003), remaining the only independent predictor of postoperative complications at multivariate analysis, with a model including ASA score and modified Frailty index (OR 9.84; p = 0.004). SMM depletion significantly impaired OS (13.6 ± 2.9 vs 26.3 ± 2.1months; p = 0.017), being its only independent prognosticator at multivariate Cox regression analysis (OR 4.42; p = 0.033). RF-CSA, evaluated with US, seems a reliable method for identification of patients with low SMM in a stage III-IV HNSCC cohort, defining a subset at high-risk of 30-day complications and poorer OS.

Renal resistive index as a predictor of postoperative complications in liver resection surgery. Observational study.

Mortality after liver surgery reduced during the last three decades to less than 2%, but post-operative morbidity occurs in 20-50% of cases. Patients are often considered eligible for post-operative intensive-care unit (ICU) admission. Predicting which patients that are at higher risk could lead to a more precise perioperative management. We investigated whether renal resistive index (RRI), alone or along with other items, can predict post-operative complication after hepatic resection. All consecutive patients undergoing hepatectomy for primary or metastatic neoplasm at our Institution between February 2015 and March 2017 were enrolled. They received RRI measurement before entering in operative room and after awakening from general anesthesia. 183 Patients were enrolled. High surgical invasiveness, surgery time > 360min, pre-operative RRI and postoperative serum lactate clearance < - 6%, showed to be associated with postoperative complications. Pre-operative RRI, complex liver resection, long-lasting surgery and poor lactate clearance (cLac) close to awakening from general anesthesia, all together may permit to classify the risk of post-operative adverse outcome after hepatic resection surgery.

Erratum: Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction.

Background Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). Methods A retrospective case–control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. Results Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p Conclusion Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.

Predictors of post-operative complications after surgical resection of hepatocellular carcinoma and their prognostic effects on outcome and survival: A propensity-score matched and structural equation modelling study

IntroductionAlthough hepatectomy is the mainstay of curative therapy for hepatocellular carcinoma (HCC), post-operative complications remain high. Presently there is conflicting data on the impact of morbidity on oncologic outcomes. We sought to identify predictors for the occurrence of post-hepatectomy complications, as well as to analyse the impact on overall survival (OS) and recurrence-free survival (RFS). Materials and methodsWe performed a retrospective review of 888 patients who underwent resection for HCC from 2001 to 2016 in our institution. ResultsA total of 237 patients (26.7%) developed 254 complications of Clavien-Dindo Grade ≥2. Hepatitis B (p = 0.0397), elevated ASA score (p = 0.0002), higher platelet counts (p = 0.0277), raised pre-operative APRI scores (p = 0.0105) and bloodloss (p < 0.0001) were independently associated with the development of complications. After propensity-score matching, 458 patients were compared in a 1:1 ratio (229 with complications versus 229 without). Patients with complications had significantly longer median length of stay (9 days [IQR 7-15] versus 6 days [IQR 5-8], p < 0.0001), higher 90-day mortality rates as well as inferior OS (p = 0.0139), but there was no difference in RFS (p = 0.4577). Age (p = 0.0006), elevated Child Pugh points (p < 0.0001), microvascular invasion (p = 0.0002), multifocal tumours (p = 0.0002), R1 resection (p = 0.0443) and development of complications (p = 0.0091) were independent predictors of inferior OS. ConclusionPost-operative morbidity affected both short-term and OS outcomes after hepatectomy for HCC. Hepatitis B, higher ASA scores, elevated preoperative APRI and increased blood loss were found to predict a higher likelihood of developing complications. This may potentially be mitigated by careful patient selection and adopting strict measures to minimise intraoperative bleeding.

Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients.

Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy. We retrospectively reviewed consecutive patients aged ≥ 65years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group. Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS. GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.

Presepsin as a Predictor for Postoperative Complications Following Pancreatic Resection

Presepsin as a Predictor for Postoperative Complications Following Pancreatic Resection

The burden of chronic obstructive pulmonary disease in open heart surgery-a retrospective cohort analysis of postoperative complications: STROBE compliant.

Chronic obstructive pulmonary disease (COPD) has a major impact on mortality and morbidity in patients undergoing cardiac surgery. Mortality risk increases by 50% in patients who were re-intubated or required prolonged mechanical ventilation after the operation. The aim of this study was to assess the impact of COPD on the prediction of postoperative complications and outcome including intensive care unit (ICU) and hospital stay, postoperative morbidity and mortality in patients undergoing all types of cardiac surgery.We performed a retrospective cohort analysis of prospectively collected data from a tertiary cardiac surgery department of a university hospital between 2014 and 2016. We divided patients undergoing cardiac surgery into 2 sub-groups – the first – with a clinical diagnosis of COPD (n = 198) and the second comprised all other non-COPD patients (n = 2980).Among patients with COPD a longer intubation time (P = .039), longer ICU stay (P < .001) and longer hospitalization time (P = .006) was noted as compared with non-COPD patients. Patients with COPD required reintubation more often than non-COPD patients, reintubation occurring twice, 19 (9.60%) versus 144 (4.83%) P = .002, reintubation occurring 3 or more times, 7 (3.54%) versus 34 (1.14%) P = .006. Mortality within 30 days after surgery was higher in patients with pulmonary problems before surgery (P = .003). Multivariable logistic regression analysis corrected for interfering variables showed an increased risk of postoperative bronchoconstriction (odds ratio [OR] = 4.40, P = .002), respiratory failure (OR = 1.67, P = .018), atrial fibrillation (OR = 1.45, P = .023), and use of hemofiltration (OR = 1.60, P = .029) for patients with COPD.Patients with COPD undergoing all types of cardiac surgery are at increased risk of respiratory complications and mortality. The occurrence of COPD was associated with longer ICU and hospital stay. In COPD patients, undergoing cardiac surgery, treatment strategies aimed at preventing reintubation and early weaning mechanical ventilation must be employed to reduce postoperative complications.

Factors related to short-term outcomes and delayed systemic treatment following primary tumor resection for asymptomatic stage IV colorectal cancer

The effectiveness of primary tumor resection (PTR) for asymptomatic stage IV colorectal cancer patients to continue prolonged and safe systemic chemotherapy has recently been re-evaluated. However, postoperative complications lead to a prolonged hospital stay and delay systemic treatment, which could result in a poor oncologic outcome. The objective of this study was to identify the risk factors for morbidity and delay of systemic chemotherapy in such patients. Between April 2016 and March 2018, 115 consecutive colorectal cancer patients with distant metastasis who had no clinical symptoms and underwent PTR in all participating hospitals were retrospectively reviewed. The patients were divided into two groups according to the presence (CD ≥ 2, n = 23) or absence (CD < 2, n = 92) of postoperative complications. The proportion of combined resection of adjacent organs was significantly higher in the postoperative complication group (p= 0.014). Complications were significantly correlated with longer hospital stay (p < 0.001) and delay of first postoperative treatment (p = 0.005). Univariate and multivariate analyses showed that combined resection (odds ratio 4.593, p= 0.010) was the independent predictor for postoperative complications. Median survival time was 8.5months. Postoperative complications were not associated with overall survival, but four patients (3.5%) could not receive systemic chemotherapy because of prolonged postoperative complications. Although PTR for asymptomatic stage IV CRC patients showed an acceptable prognosis, appropriate patient selection is needed to obtain its true benefit.

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). A retrospective case-control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11, p < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%, p < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (p < 0.01), venous thromboembolism (p < 0.01), prolonged ventilation (p < 0.01), delirium (p < 0.01), fistula (p < 0.05), wound disruption (p < 0.05), and longer intensive care unit stays (p < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (p < 0.001) and flap-specific complications (p < 0.01). Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.

Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Background: Sarcopenia is common in oncology patients and has been found to be associated with poorer outcomes after surgery. Pelvic exenteration is a major surgery associated with high rates of morbidity. The aim of this study was to determine if preoperative sarcopenia is associated with postoperative complications and outcomes after pelvic exenteration surgery. Methods: A retrospective study was conducted including 64 oncology patients who had undergone pelvic exenteration surgery between August 2015 and January 2018 and had available preoperative lumbar CT images. Skeletal muscle index (SMI) was calculated by analysing CT images using body composition software. Sarcopenia was determined by using previously published SMI sex-specific cut-offs. Preoperative nutritional status, nutritional indicators and other clinical factors were also collected. Results: There was no association between preoperative sarcopenia and outcomes after pelvic exenteration surgery, however, increased weight (p=0.027) and BMI (p=0.025) were associated with a greater number of total complications. Increasing age was also significant (p=0.001) in explaining the greater number of complications. Greater complexity of surgery itself was associated with greater postoperative complications (p=0.014) and increased length of hospital stay (p=0.001). Conclusion: Preoperative sarcopenia, using dichotomous cut-off points, is not sensitive enough to predict postoperative complications and outcomes in oncology patients undergoing pelvic exenteration surgery; however, other preoperative factors such as weight, BMI and age, and the complexity of surgery, do affect outcomes. Assessment tools that incorporate several clinical and physical factors, such as frailty assessments, should be used in future studies to identify risk factors in such major surgeries.

Hypotension during hip fracture surgery and postoperative morbidity

BackgroundHip fracture is a growing healthcare challenge, with 6–8% 30-day mortality and 20–30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity.ObjectiveWe evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity.MethodsA retrospective analysis was carried out on n = 52 patients undergoing hip fracture surgery between January and June 2017. Measurements of patients’ intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia, logged electronically through an anaesthesia information management system, were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP < 75 mmHg, MAP < 55 mmHg, SAP ≤ 80% admission baseline or SAP ≤ 80% pre-induction baseline). Univariate and bivariate descriptive statistics were generated for all relevant variables. With multivariable regression models containing known predictors, cumulative duration of hypotension was correlated with postoperative comorbidities as quantified by the Clavien-Dindo and Comprehensive Complication Indices.ResultsMean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia. Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP < 80% pre-induction value adjusted to gender, age and the Charlson Comorbidity Index was associated with progression to a higher Clavien-Dindo classification (odds ratio 1.020 per additional minute; 95% CI 1.008–1.035; P = 0.003).ConclusionsIn this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.

The relationship between perioperative markers of the systemic inflammatory response and postoperative complications in patients undergoing curative resection of colon cancer.

75 Background: Surgical resection remains the mainstay of treatment for patients with potentially curable colorectal cancer (CRC). However, it can be associated with the development of postoperative complications (POC), which are associated with an increased cancer recurrence risk. Neutrophils are important in innate immunity, especially in the immediate postoperative period as part of the systemic inflammatory response (SIR). We aimed to assess the use of perioperative SIR markers as predictors of POC. Methods: Patients undergoing elective curative CRC surgery at one institution between March 2008 and June 2015 were identified from a prospective database. Demographics and clinicopathological data were extracted from medical records. Logistic regression was used to assess the relationship between perioperative blood counts, clinicopathological variables and POCs. Results: Of 443 cases, most were aged 65 years or older (n = 314, 71%), male (n = 245, 55%), smokers (n = 229, 52%), overweight or obese (n = 263, 59%) and had ASA score of 2 or less (n = 267, 60%). The majority underwent open resection (n = 288, 65%). Preoperative factors associated with the development of POC were: ASA grade &gt; 2 (OR 1.48, 95% CI 0.99-2.18, p = 0.05), smoking history (OR 1.99, 95% CI 1.35 – 2.93, p &lt; 0.001), neutrophil count &gt; 7.5x109/L (OR 3.40, 95% CI 1.82-6.36, p &lt; 0.001) and CRP &gt; 10mg/L (OR 1.70, 95%CI 1.12-2.59, p = 0.013). Postoperative factors associated with the development of POC were open surgery (OR 0.47, 95%CI 0.31-0.72, p &lt; 0.001), neutrophil count &gt; 7.5x109/L (OR 2.67, 95%CI 1.75-4.07, p &lt; 0.001) and CRP &gt; 150mg/L (OR 3.97, 95%CI 2.61-6.02, p &lt; 0.001) on postoperative day 3 (POD3). On multivariate analysis, a preoperative neutrophil count &gt; 7.5x109/L (OR 3.65, 95%CI 1.68-7.90, p &lt; 0.001), a neutrophil count &gt; 7.5 x109/L on POD3 (OR 1.69, 95%CI 1.05-2.72, p = 0.029) and CRP &gt; 150mg/L on POD3 (OR 3.66, 95%CI 2.29-5.87, p &lt; 0.001) were related to POC, independent of smoking, ASA and operative approach. Conclusions: Neutrophil count complements the prognostic value of pre and post-operative CRP to predict POC. Further validation work is required.

Preoperative muscle strength as a predictor of complications after esophagectomy.

454 Background: Sarcopenia has been associated with post-operative complications and length of stay (LOS) in patients undergoing esophagectomy. A variety of methods exist to measure muscle mass and strength, with few comparisons between methods. We compared hand-grip strength (HGS), muscle mass and intramuscular adipose tissue as predictors of post-operative outcomes. Methods: Patients with esophageal cancer undergoing esophagectomy were identified between January 2015 – June 2019 at Levine Cancer Institute. Skeletal muscle index (SMI) and skeletal muscle density (SMD), a measure of intramuscular adipose tissue, were derived from CT. HGS was measured using a dynamometer. Uni- and multivariable GLM analyses were performed. Results: 115 patients (100 male, 15 female) underwent esophagectomy with an average age of 64.3 +/- 9.8. The analysis was stratified by sex due to significant differences in HGS, SMI, and SMD. Among men, univariable analysis revealed a significant association between pre-operative HGS &lt;25 kg and increased risk of post-operative pneumonia ( p=0.02), ventilation &gt;48hrs ( p=0.02), LOS ( p=0.002), discharge to home ( p=0.001), and one-year mortality ( p=0.005). All associations except discharge home remained significant in multivariable analyses (Table). Among women, no factors analyzed were significantly associated with postoperative outcomes. Conclusions: HGS is a more powerful predictor of postoperative complications and LOS than either muscle mass or intramuscular adipose tissue among men undergoing esophagectomy. HGS is cost-effective and easily incorporated into routine clinical care, allowing for preoperative intervention to optimize patients for esophagectomy. To better understand the implications in women, additional research with a larger cohort is needed. [Table: see text]

Robotic intraperitoneal onlay versus totally extraperitoneal (TEP) retromuscular mesh ventral hernia repair: A propensity score matching analysis of short-term outcomes

BackgroundShort-term outcomes of robotic intraperitoneal onlay mesh(rIPOM) versus robotic totally extraperitoneal retromuscular mesh(rTEP-RM) ventral hernia repair were compared. MethodsA retrospective review of prospectively collected data of patients was conducted. A one-to-one propensity score matching(PSM) analysis was performed to achieve two well-balanced groups in terms of preoperative variables. A univariate and multivariate analysis were conducted to determine factors influencing post-operative outcomes. ResultsOf 291 rIPOM and rTEP-RM procedures, 68 patients were assigned to each group after PSM. Operative times were longer for the rTEP-RM group. Adhesiolysis was more frequently required in rIPOM. The rTEP-RM allowed for a greater mesh-to-defect ratio. The rate of overall perioperative complications, Clavien-Dindo grades, and surgical site events were higher for the rIPOM group than the rTEP-RM group. The Comprehensive Complication Index® morbidity scores were lower in favor of rTEP-RM group. Adhesiolysis, rIPOM, and craniocaudal defect size were predictors for post-operative complications. ConclusionRobotic TEP-RM repair has better early postoperative outcomes for ventral hernias, suggesting that it may be preferable over robotic IPOM repair. Further studies with longer follow-up are needed.

Frailty As A Predictor Of Postoperative Outcomes Following Liver Resection

Presenter: Tyler McKechnie BSc | McMaster University Background: Frailty, defined as a state of decreased physiologic reserve, characterized by a loss of resiliency in the face of acute stress is a condition that is frequently encountered by liver surgeons. We sought to evaluate frailty as a predictor of postoperative complications following liver resection using the modified frailty index (mFI). Methods: This is a retrospective cohort study of consecutive adult patients undergoing liver resection between 2011 and 2018 at a single academic institution. An mFI consisting of 11 variables adapted for the National Surgical Quality Improvement Program database from the Canadian Study of Health and Aging Frailty Index was used. These variables have been previously validated and include patient comorbidities and functional abilities. Patients were stratified into two groups, high mFI (≥0.27) and low mFI ( < 0.27). Postoperative complications were graded using Clavien-Dindo. The effect of mFI on postoperative complications and 90-day mortality was evaluated using multiple logistic regression and expressed as odds ratio (OR) and 95% confidence interval (CI). Results: Among 409 liver resections, there were 58/409 (14%) patients with a high mFI (mFI ≥0.27). Low mFI patients were significantly younger (63 vs. 70 years, p<0.001) and more likely to meet >4 METS (90% vs. 60%, p<0.001). There were no differences between the high versus low mFI group in the type of liver resection performed, open (37% vs. 35%) or laparoscopic (57% vs. 55%), in the number of liver segments resected (3 vs. 4, p=0.417) or in the operative room time (257 vs. 293 min, p=0.097), respectively. Median length of hospital stay was significantly longer for the high mFI group (9.5 vs. 5 days, p<0.001). When compared to patients with low mFI, patients with a high mFI had a significantly higher proportion of postoperative complications (79% vs. 46%, p<0.001). This was true for minor complications (69% vs. 42%, p<0.001), major complications (50% vs. 13%, p<0.001) and 90-day postoperative mortality (12% vs. 3.4%, p=0.04). By multivariate analysis, longer operating time, per 30-minute increase (OR 1.15, 95%CI 1.03 to 1.27), higher number of liver segments resected (OR 1.43, 95%CI 1.12 to 1.82), and high mFI, per unit increase (OR 6.74, 95%CI 2.76 to 16.51) were independent predictors for the development of major complications and 90-day mortality. Conclusion: The mFI predicts postoperative outcomes following liver resection and can be used as a risk stratification tool for patients being considered for surgery.

632 Waist/Hip Circumference and Ratio are Better Predictive Measures of Postoperative Outcomes in Patients Following Coronary Artery Bypass Graft Surgery Than Body Mass Index

It remains unclear whether obesity, measured by body mass index (BMI) is an independent risk factor of morbidity and mortality after coronary artery bypass grafting (CABG). We sought to determine whether body fat distribution, measured by waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) is a better predictor of postoperative complications after CABG than BMI. 2,062 patients who underwent isolated elective on-pump CABG with documented BMI were identified from the ANZSCTS database (2010-2019) at St Vincent’s Hospital, Melbourne. Our primary analysis assessed the relationship between BMI and postoperative complications using multivariable logistic regression. Secondary analysis included only those patients with recorded waist and hip circumferences (n=640). WHR, WC and HC were compared with incidence of postoperative complications in multivariate analyses. BMI was associated with an increased risk of new renal failure (OR 1.08, p<0.00). Increasing WHR significantly increased the risk of prolonged intubation in females (OR 1.12, p<0.01). In males, both WC and HC were significantly associated with increased risks of new renal failure (OR 1.06, p<0.00; OR 1.07, p<0.00) and ICU readmission (OR 1.05, p<0.01; OR 1.04, p<0.04). WC, HC and WHR may be useful screening tools in identifying patients at risk of postoperative complications. This study is one of the first to consider these alternative anthropometric measures to BMI in predicting postoperative outcomes following CABG.

Risk factors for postoperative complications after elective ileocolic resection for Crohn's disease: a retrospective study.

BackgroundThe incidence of postoperative complications (POC) in patients with Crohn’s disease (CD) who undergo intestinal resection is high. The literature provides conflicting data about the risk factors for POC, especially regarding preoperative immunosuppressive medications. The purpose of this study was to evaluate the impact of anti-tumor necrosis factor (TNF) agents on the postoperative course and identify other predictors for POC after ileocolic resection (ICR).MethodsThis was a single-center retrospective study that included 153 CD patients who underwent elective ICR in a Greek tertiary center between January 2010 and December 2018. Risk factors for overall POC and intra-abdominal septic complications (IASC) were assessed with univariate and multivariate analyses.ResultsOverall POC and IASC occurred in 35 (22.9%) and 19 (12.4%) patients, respectively. In multivariate analysis, anti-TNF agents (n=61), as either monotherapy or combination treatment, were not associated with an increased risk for overall POC (21.3% vs. 23.9%, P=0.71) or IASC (13.1% vs. 12.0%, P=0.83). Similarly, no combined immunosuppressive regimen significantly correlated with POC. Patients with perianal disease, disease duration >10 years, or previous intestinal resections had significantly higher rates of both overall POC and IASC. In multivariate analysis, previous resection was the only independent risk factor for overall POC (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.38-11.06; P=0.010) and IASC (OR 4.56, 95%CI 1.51-13.77; P=0.007).ConclusionsPreoperative administration of anti-TNF agents or other immunosuppressive regimens was not a risk factor for total POC or IASC. A history of previous resection independently correlated with both overall POC and IASC.

Morphometry of adipose tissue for prediction of the outcomes of total pancreatectomy with pancreatic islets autotransplantation in patients with chronic pancreatitis

To compare different clinical and morphometric features of patients undergoing TPAIT for prediction of postoperative outcomes. A retrospective review enrolled patients who underwent TPAIT for the period from January 2007 to October 2017. Morphometric parameters were analyzed using preoperative CT scans and patients were grouped to examine association of these characteristics with postoperative morbidity. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on pancreatic islet features, perioperative blood transfusion, ICU- and hospital-stay, complications, repeated admission within 90 days and islet function was assessed. A total of 34 patients were included in this study (12 males and 24 females). At the time of diagnosis, mean age of patients was 43.1 years. Mean body mass index (BMI) in sarcopenic patients was 24.9 kg/m2, mean BMI in those without sarcopenia - 24.8 kg/m2 (p=1.00). Various surgical complications were observed in 11 patients (32.3%). Patients with sarcopenia experienced more complications (83.3%) compared with patients without sarcopenia (50%). However, differences were not significant (p=0.31). Islet characteristics (islet numbers, purity), readmission, ICU- and hospital-stay, incidence of blood transfusion and islet function were also similar in both groups. Sarcopenia is not a predictor of postoperative complications and islet cell function in chronic pancreatitis patients following TPAIT.