Predictor Of Postoperative Outcome Research Articles

The prognostic role of aspartate transaminase to platelet ratio index on outcomes after nonemergent major hepatectomy

IntroductionNoninvasive screening methods to identify patients preoperatively with abnormal liver texture remain limited. Aspartate transaminase to platelet ratio index has been validated to predict fibrosis in patients with hepatitis C; however, its use as a predictor of postoperative outcomes in patients without viral hepatitis remains unknown. MethodsWe queried the American College of Surgeons National Surgical Quality Improvement Program dataset to identify patients who underwent a major hepatectomy between 2014 and 2021. We excluded patients who underwent emergent operations, patients with viral hepatitis, and patients with ascites. Aspartate transaminase to platelet ratio index was calculated using the following equation: (aspartate transaminase/40)/(platelet count) × 100. An aspartate transaminase to platelet ratio index ≥0.7 was used to identify patients with significant fibrosis. Univariable analysis was performed to identify factors associated with aspartate transaminase to platelet ratio index ≥0.7, perioperative transfusion, serious morbidity, overall morbidity, and 30-day mortality. Multivariable logistic regression analysis was performed to identify adjusted predictors of these outcomes. ResultsOf the 8,933 patients who met inclusion criteria, 1,170 (13.1%) patients had an aspartate transaminase to platelet ratio index ≥0.7. A perioperative blood transfusion was administered to 2,497 (28.0%). The number of patients who experienced overall morbidity, serious morbidity, and mortality were 3,195 (35.8%), 2,665 (29.8%), and 238 (2.7%), respectively. Aspartate transaminase to platelet ratio index ≥0.7 was an independent predictor of transfusion (odds ratio: 1.51 [1.32–1.72], P < .001), overall morbidity (1.16 [1.01–1.33], P = .032), and mortality (1.56 [1.12–2.13], P = .006). Transfusion was an independent predictor of overall morbidity (2.50 [2.26–2.76], P < .001), serious morbidity (2.51 [2.26–2.79], P < .001), and mortality (3.28 [2.49–4.33], P < .001). ConclusionAn aspartate transaminase to platelet ratio index ≥0.7 is associated with perioperative transfusion, overall morbidity, and 30-day mortality. The aspartate transaminase to platelet ratio index may serve as a noninvasive tool to risk stratify patients before elective major hepatectomy.

Usefulness of Preoperative Prognostic Nutritional Index in Secondary Spontaneous Pneumothorax

BackgroundThe prognostic nutritional index has been identified as a predictor of postoperative outcomes in various fields. We investigated the usefulness of the prognostic nutritional index as a risk factor for postoperative complications in secondary spontaneous pneumothorax. MethodsIn this retrospective study, patients who underwent surgery for secondary spontaneous pneumothorax were reviewed. The associations among the prognostic nutritional index, body mass index, and performance status were examined, and risk factors for postoperative complications were investigated in a multivariate analysis. In the subgroup analysis, on the basis of the receiver operating characteristics, we divided patients into high– and low–prognostic nutritional index groups and investigated the utility of the prognostic nutritional index for postoperative complications. ResultsOf 91 patients who underwent surgery for secondary spontaneous pneumothorax, 34 patients with postoperative complications were included. The prognostic nutritional index was significantly positively and negatively correlated with body mass index (P < .001) and performance status (P < .001), respectively. Multivariate analysis revealed that a decreased prognostic nutritional index was an independent risk factor for postoperative complications (P = .0048). In the subgroup analysis, the postoperative outcomes, including the duration of chest tube placement (P = .042), hospital stay (P = .0014), complications (P = .0089), and mortality (P = .044), were significantly worse in the low– than in the high–prognostic nutritional index group. ConclusionsThe prognostic nutritional index may be useful for evaluating the severity of secondary spontaneous pneumothorax in preoperative patients and may be a risk for postoperative complications.

American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator as a Predictor of Postoperative Outcomes After Adult Spinal Deformity Surgery: A Retrospective Cohort Analysis.

In recent years, there has been an outpouring of scoring systems that were built to predict outcomes after various surgical procedures; however, research validating these studies in spinal surgery is quite limited. In this study, we evaluated the predictability of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP SRC) for various postoperative outcomes after spinal deformity surgery. A retrospective chart review was conducted to identify patients who underwent spinal deformity surgery at our hospital between January 1, 2014, and December 31, 2022. Demographic and clinical data necessary to use the ACS NSQIP SRC and postoperative outcomes were collected for these patients. Predictability was analyzed using the area under the curve (AUC) of receiver operating characteristic curves and Brier scores. Among the 159 study patients, the mean age was 64.5 ± 9.5 years, mean body mass index was 31.9 ± 6.6, and 95 (59.7%) patients were women. The outcome most accurately predicted by the ACS NSQIP SRC was postoperative pneumonia (observed = 5.0% vs predicted = 3.2%, AUC = 0.75, Brier score = 0.05), but its predictability still fell below the acceptable threshold. Other outcomes that were underpredicted by the ACS NSQIP SRC were readmission within 30 days (observed = 13.8% vs predicted = 9.0%, AUC = 0.63, Brier score = 0.12), rate of discharge to nursing home or rehabilitation facilities (observed = 56.0% vs predicted = 46.6%, AUC = 0.59, Brier = 0.26), reoperation (observed 11.9% vs predicted 5.4%, AUC = 0.60, Brier = 0.11), surgical site infection (observed 9.4% vs predicted 3.5%, AUC = 0.61, Brier = 0.05), and any complication (observed 33.3% vs 19%, AUC = 0.65, Brier = 0.23). Predicted and observed length of stay were not significantly associated (β = 0.132, P = .47). The ACS NSQIP SRC is a poor predictor of outcomes after spinal deformity surgery.

The Effect of Osteoporosis on Complications and Reoperation Rates After Surgical Management of Adult Thoracolumbar Spinal Deformity: A Systematic Review and Meta Analysis.

Systematic Review. While substantial research has explored the impact of osteoporosis on patients undergoing adult spinal deformity (ASD) correction, the literature remains inconclusive. As such, the purpose of this study is to synthesize and analyze existing studies pertaining to osteoporosis as a predictor of postoperative outcomes in ASD surgery. We performed a systematic review and meta-analysis to determine the effect that a diagnosis of osteoporosis, based on ICD-10 coding, dual-energy X-ray absorptiometry (DEXA) or computed tomography, has on the incidence of adverse outcomes following surgical correction of ASD. Statistical analysis was performed using Comprehensive Meta-Analysis (Version 2) using a random effects model to account for heterogeneity between studies. After application of inclusion and exclusion criteria, 36 and 28 articles were included in the systematic review and meta-analysis, respectively. The meta-analysis identified greater rates of screw loosening amongst osteoporotic patients (70.5% vs 31.9%, P = .009), and decreased bone mineral density in patients who developed proximal junctional kyphosis (PJK) (.69 vs .79g/cm2, P = .001). The systematic review demonstrated significantly increased risk of any complication, reoperation, and proximal junctional failure (PJF) associated with reduced bone density. No statistical difference was observed between groups regarding fusion rates, readmission rates, and patient-reported and/or functional outcome scores. This study demonstrates a higher incidence of screw loosening, PJK, and revision surgery amongst osteoporotic ASD patients. Future investigations should explore outcomes at various follow-up intervals in order to better characterize how risk changes with time and to tailor preoperative planning based on patient-specific characteristics.

Transurethral Resection of Bladder Tumor Outcomes Are Predicted by a 5-Item Frailty Index

ObjectiveTo evaluate the mFI-5 as a predictor of post-operative outcomes following transurethral resection of bladder tumor (TURBT). MethodsThe National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. mFI-5 scores were calculated by assigning a point to COPD, CHF, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged length of stay (PLOS), unplanned readmission (UR), and discharge to continued care (DCC). Multivariate regression assessed the predictive value of mFI-5 scores on outcomes. Results40,278 TURBT cases were identified (mFI-5 = 0: 12,400, mFI-5 = 1: 17,328, mFI-5 = 2: 9,225, mFI-5 ≥ 3: 1,416). Patients with higher mFI-5 scores were more likely to be older, male, White, and have larger tumors, all p < 0.05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all p < 0.001. On multivariate analysis, mFI-5 ≥ 3 classification was a predictor of CD I/II (OR = 1.280), CD IV (OR = 2.539), mortality (OR = 2.202), HCRU (OR = 2.094), PLOS (OR = 2.136), DCC (OR = 3.401), and UR (OR = 1.705), all p < 0.05. A mFI-5 ≥ 3 demonstrated a sensitivity ranging from 6.0 – 13.5% and a specificity ranging from 96.6 – 97.0% for all outcomes. ConclusionsThe mFI-5 is an easily ascertainable pre-operative risk assessment tool that is a predictor of adverse clinical and HCRU outcomes following TURBT.

The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

The role of geriatric nutritional risk index as a predictor for postoperative outcomes in gastrointestinal emergencies.

The geriatric nutritional risk index (GNRI) is a simple nutritional and inflammatory marker for older adults. The aim of the present study was to investigate the usefulness of the GNRI in older adults who underwent emergency gastrointestinal surgery. This study included 206 older adults who had undergone emergency gastrointestinal surgery. We retrospectively investigated the relationship between the GNRI and postoperative complications. Univariate and multivariate analyses were performed to evaluate risk factors for postoperative complications. We then evaluated the association between GNRI and clinical variables among older adults undergoing emergency gastrointestinal surgery. Postoperatively, all complications occurred in 89 (43%) older adults, infectious in 53 (26%), and non-infectious in 36 (17%). In the multivariate analysis, age (p=0.016), GNRI (p=0.012), operative severity (p=0.003), and operation time (p=0.003) were independent risk factors for all postoperative complications. While the GNRI (p=0.049) was an independent risk factor for infectious complications, age (p=0.035) and bleeding volume (p=0.035) were independent risk factors for postoperative non-infectious complications. In the low GNRI group, age (p=0.029), serum C-reactive protein levels (p<0.001), and proportion of sarcopenia (p<0.001) were significantly higher, and the length of hospital stay (p<0.001) was significantly longer than that in the high GNRI group. In Spearman's rank correlation coefficient, the skeletal mass index and the GNRI had a positive correlation (r=0.415 and p<0.001). The GNRI may be a predictor of postoperative infectious complications in older adults after emergency gastrointestinal surgery, suggesting the usefulness of the GNRI as a nutritional marker and sarcopenia-related parameter. No. 22-16.

Decision-making for Postoperative Care in Geriatric Patients Undergoing Minor Surgeries using Mini Mental State Examination, Barthel Index of Activities of Daily Living and CSHA-Clinical Frailty Scale

Purpose: The prediction of postoperative outcome following major surgeries in elderly patients requires a decision-making process, which was suggested to be constructed on data pertaining to the cognitive function, functional status and frailty. We aimed to evaluate their predictive value for minor surgeries.&#x0D; Material and Methods: Patients, ≥65 years of age with ASA 1-3, scheduled for elective minor surgeries between January-June 2019 were enrolled. MMSE, Barthel Index (BI) of ADL and CSHA-CFS were used to evaluate the cognitive function, functional status and frailty on admission, respectively. The MMSE cut-off point was 24 and the frailty cut-off point was 4. The relationships of these parameters with postoperative status either as outpatient or inpatient, PACU stay, LOS in hospital and readmission within 30 days were evaluated. &#x0D; Results: Ninety-nine patients were included. The MMSE scores, BIs and CSHA-CFS scores were similar in all groups. The number of inpatients were higher among patients either with MMSE 2 (n=20 (83.3%)) (p=0.023). The patients with ASA&gt;2 had higher probability of length of stay &gt;1 day (p=0.036) and for PACU stay (p=0.042) irrespective of frailty score. There was no correlation with readmission within 30 days.&#x0D; Conclusion: ASA&gt;2 was correlated with inpatient status when associated with MMSE1 day in the elderly after minor surgeries. CSHA-CFS ≥4 was also correlated with inpatient status independently.

Indicators for cochlear implantation in children with auditory neuropathy spectrum disorder: A systematic review.

ANSD refers to a group of auditory diseases demonstrating intact outer hair cells and desynchronized neural firings of the auditory nerve. A cochlear implant is a promising intervention strategy for severe to profound sensorineural hearing loss (SNHL). However, due to its variable outcomes in children with ANSD, a consensus has yet to be reached on its performance. This study aimed to review the literature to determine the efficacy of cochlear implants in children with ANSD and to determine prognostic indicators. The study identifies the pre-operative and post-operative predictors of success for CI in children with ANSD. The review was carried out using PRISMA guidelines. This resulted in 9630 topic-related articles. Among these, 17 articles met the inclusion and exclusion criteria that were included for the study. The quality and potential risks associated with each article were evaluated using the quality impact assessment protocol (QUIPS) tool. A review of 17 articles was conducted to highlight these predictors. Most selected studies included case reports, case series, cohorts, and comparisons between children with ANSD and SNHL. Assessment of study quality reported an overall low risk of bias. The overall result showed cochlear implant would be an effective option for children with ANSD. However, there are specific prognostic indicators about which clinician needs to be aware before recommending CI for children with ANSD. Our review study identified a set of pre-operative and post-operative indicators that predicted speech and auditory performance and gave some insight into the lesion site in ANSD individuals. This review concludes CI is an effective option for children with ANSD. However, before recommending CI, a detailed assessment is required from different perspectives, which could serve as predictors of postoperative outcomes. This review highlights the need to include more precise tools, such as genetic testing to describe the lesion site to choose the most appropriate management strategy for children with ANSD. Knowledge about the prognostic indicators and the effective assessment protocols would help clinicians for the better candidacy selection.

Outcome monitoring and risk stratification after cardiac procedure in neonates, infants, children and young adults born with congenital heart disease: protocol for a multicentre prospective cohort study (Children OMACp)

IntroductionCongenital heart disease (CHD) represents the most common birth defect, affecting from 0.4% to 1.2% of children born in developed countries. The survival of these patients has increased significantly, but...

Is the measurement of sarcopenia associated with oncological disease in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Peritoneal malignancies are challenging cancers to manage. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC), may offer a cure, it is a radical procedure associated with significant morbidity. Pre-emptive identification of deconditioned patients for optimization may mitigate surgical risk. However, the difficulty lies in identifying a cost-effective predictive tool. Recently, there has been interest in sarcopenia, which may occur due to malignancy. The purpose of this study was to assess the utility of sarcopenia at predicting post-operative outcomes. A quaternary-centre retrospective study of CRS and HIPEC patients (2017-2020), were conducted to determine the association between pre-operative sarcopenia on oncological (peritoneal carcinomatosis index (PCI)) and surgical outcomes (complications). Sarcopenia from lumbar CT-images were measured using Slice-o-matic™. Statistical differences were analysed using Mann-Whitney U and Chi-squared test. Cohort analysis (n = 94) found 40% had sarcopenia, majority were female (53.2%), and average age of 55 years. The major pathologies was colorectal cancer (n = 39, 41.5%), appendix adenocarcinoma (n = 21, 22.3%), and pseudomyxoma peritonei (PMP) (n = 19, 20.2%). Sarcopenia was associated with decreased weight, 72.7 versus 82.2 kg (P = 0.014) and shorter survival, 1.4 versus 2.1 years (95% CI, 1.09-3.05, P = 0.032). Median PCI (excluding PMP) was 11 (6-18) and median PCI (only PMP) was 25 (11-32). Post-operatively, sarcopenia patients experienced more complications (72.5% vs. 64.8%, P = 0.001). Pre-emptive identification of sarcopenia may be a useful prognostic indicator and predictor of post-operative outcomes in CRS and HIPEC. For oncological patients, sarcopenia may be an indicator of patients requiring targeted pre-operative rehabilitation, or advanced disease requiring further treatment.

CO207 Post-Operative ICU Admission and SOFA Score Assessment after Elective Surgery: A Comparative Case Study of Laparoscopic and Robot-Assisted Low Anterior Resection

A use of Intensive Care Unit (ICU) and Sequential Organ Failure Assessment (SOFA) score, a scoring system to assess the level of organ dysfunction/failure, after surgery can be a predictor of post-operative outcomes. We conducted a study comparing the differences of ICU admissions, cost of ICU patients and SOFA scores by surgical modality to investigate the impact of surgical modality on surgical outcomes.

Clinical characteristics and surgical outcomes in children with mild malformation of cortical development and oligodendroglial hyperplasia in epilepsy.

Mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) is a new and rare histopathological entity of cortical developmental malformations. The clinical characteristics of MOGHE remain challenging. Children with histologically confirmed MOGHE were retrospectively studied. The clinical findings, electroclinical and imaging features, and postoperative outcomes were analyzed, and previously published studies were reviewed up to June 2022. Thirty-seven children were included in our cohort. Clinical characteristics included early onset in infancy (94.6% before 3 years), multiple seizure types, and moderate or severe delay. Epileptic spasm is the most common seizure type and initial manifestation. The lesions were mainly multilobar (59.5% multiple lobes and 8.1% hemispheres), and predominance in the frontal lobe was observed. The interictal EEG pattern was circumscribed or widespread. The prominent MRI characteristics were cortical thickening, cortical/subcortical hyperintense T2/FLAIR signal, and blurring at the GM and WM transition. Among the 21 children followed up for more than 1 year after surgery, 76.2% were seizure-free. Preoperative interictal circumscribed discharges and larger resections were significantly associated with a good postoperative outcome. The clinical features of 113 patients in the reviewed studies were similar to those we reported, but the lesions were mainly unilobar (73.5%) and Engel I was achieved in only 54.2% after surgery. Distinct clinical characteristics in MOGHE, especially age at onset, epileptic spasm, and age-related MRI characteristics, can help in early diagnosis. Preoperative interictal discharge and surgical strategy may be predictors of postoperative outcomes.

O036 Postoperative complications are predicted by surgery duration in the unilateral deep inferior epigastric perforator (DIEP) flap reconstruction: a retrospective cohort study

Abstract Introduction Currently, one published study documented operative time (OT) as a predictor for postoperative outcomes in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstructions. No literature has investigated this in unilateral DIEP flaps. We aimed to determine the relationship between unilateral OT, postoperative complications and length-of-stay (LOS). Methods Electronic hospital data of adult women that underwent elective immediate or delayed unilateral DIEP reconstruction at a tertiary centre in London, between 2021 to 2022, was retrospectively analysed. Patients were divided into four groups depending on OT quartiles to define a critical cut-off period. Data on extensive potential confounders was recorded and used in univariable and multivariable regression models. Further statistical analyses were performed where appropriate. Results The final cohort contained 66 patients. Through quartiles, the risk-adjusted cut-off OT was defined as 515 minutes. After risk-adjustment, operations &amp;gt;515 minutes had a significantly higher overall complication rate than ≤515 minutes (HR: 2.16, p=0.032, 95% CI: 1.067, 4.38). No significant difference in mean ranks of LOS (p=0.16) was noted above the cut-off period. In patients that developed at least one complication type, no significant difference was observed in the unadjusted return-to-theatre rate between the two groups (HR: 0.86, p=0.82, 95% CI: 0.23, 3.24). Conclusion We confirmed OT was an independent predictor for postoperative complications in the DIEP flap and demonstrated this in unilateral reconstructions. Larger multicentre prospective studies are required to ascertain the significance of the OT effects, and to deduce the minimum OT threshold below which detriment to patient outcomes arises.

PC29. Surgical, Functional, and Survival Outcomes of Lip Reconstruction after Cancer Resection: A 20-year Experience at MD Anderson Cancer Center

PURPOSE: Lip reconstruction outcomes after head and neck cancer resection have been limited to small series. Herein, we report a 20-year experience with lip reconstruction in this population and delineate the rates and predictors of postoperative outcomes. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent lip reconstruction following cancer resection from January 1994 to January 2015. Patient demographics, surgical characteristics, defect dimensions and flap type were correlated with surgical and functional outcomes using multivariable regression. RESULTS: We identified 244 patients with mean follow-up time of 28.7±37.6 months. Most defects involved the lower lip (44.0%, n=80), without oral commissure resection (67.6%). Lip advancement (21.0%), primary closure (16.2%), Webster-Bernard (11.4%), and folded-fasciocutaneous free flaps (11.4%) were the most common reconstruction techniques. A minority of patients developed surgical complications (25.2%), microstomia (16.7%), food intolerance (14.6%), oral incompetence (11.9%), speech difficulty (3.3%), lip tethering (2.4%), and dysphagia (1.9%). 5-year survival probability was 43.5%. Tobacco use (OR, 3.18; P=.007), diabetes mellitus (OR, 2.29; P=.035), and concurrent mandible reconstruction (OR, 2.31; P=.018) were associated with surgical complications. Recurrent disease (OR, 2.62; P=.043) and oral commissure resection (OR, 2.71; P<0.001) were associated with oral incompetence. Tobacco use (OR, 12.02; P=.023), concurrent upper and lower lip resection (OR, 4.70; P=.028), and larger upper lip resection size (OR, 13.8; P=.028) were associated with microstomia. CONCLUSION: Lip reconstruction after oncological resection may contribute to improved function with relatively low complication rates. Careful consideration of risk factors and preoperative planning is imperative for successful lip reconstruction outcomes.

Trends in mortality and postoperative complications among octogenarian patients undergoing carotid endarterectomy

BackgroundElderly patients represent a large portion of patients undergoing vascular surgery. This study aims to assess the contemporary frequency of octogenarians undergoing carotid endarterectomy (CEA) and to evaluate their postoperative complications and survival rates. MethodsThe Vascular Quality Initiative (VQI) dataset was queried for patients who underwent elective CEA between 2012 and 2021. Patients aged >90 years were excluded, as well as emergent and combined cases. The population was divided into two age groups: <80 years and ≥80 years. Frailty scores were generated using Vascular Quality Initiative variables grouped into 11 domains historically associated with frailty. Patients with scores within the first 25th percentile, between the 25th and 50th percentile, and above the 75th percentile were categorized into low, medium, and high frailty classes, respectively. Procedural indications were defined as hard (stenosis ≥80% or ipsilateral neurologic symptoms) or soft. Primary outcomes of interest were 2-year stroke-free and 2-year overall survival comparing (i) octogenarians with nonoctogenarians and (ii) octogenarians by frailty class. Standard statistical methods were used. ResultsOverall, 83,745 cases were included in this analysis. Between 2012 and 2021, a consistent proportion averaging 17% of CEA patients were octogenarians. Among this age group, the proportion of patients undergoing CEA for hard indications increased over time from 43.7% to 63.8% (P < .001). This increase was accompanied by a statistically significant increase in the combined 30-day perioperative stroke and mortality rate from 1.56% in 2012 to 2.96% in 2021 (P = .019). A Kaplan-Meier analysis showed a significantly lower 2-year stroke-free survival among octogenarians compared with the younger group (78.1% vs 87.6%; P < .001). Similarly, there was a significantly lower 2-year overall survival among octogenarians compared with the younger group (90.5% vs 95.1%; P < .001). Multivariate Cox proportional hazard analyses showed that high frailty class was associated with increased 2-year stroke risk (hazard ratio, 2.26; 95% confidence interval, 1.61-3.17; P < .001) and 2-year mortality (hazard ratio, 2.43; 95% confidence interval, 1.71-3.47; P < .001). Repeat Kaplan-Meier analysis stratifying octogenarians by frailty class revealed that octogenarians with low frailty can have stroke-free and overall survival rates comparable with nonoctogenarians (88.2% vs 87.6% [P = .158] and 96.0% vs 95.1% [P = .151], respectively). ConclusionsChronological age should not be regarded as a contraindication for CEA. Frailty score calculation is a better predictor for postoperative outcomes and is an appropriate tool to risk stratify octogenarians, aiding in the decision between best medical treatment or intervention. The risk benefit assessment for high frailty class octogenarians is paramount because the postoperative risks may outweigh the long-term survival benefits of the prophylactic CEA.

MP13-02 COMPARING MFI-5, ASA CLASS, AND MCCI AS PREDICTORS OF POSTOPERATIVE OUTCOMES FOLLOWING ENDOSCOPIC TREATMENT OF BPH

You have accessJournal of UrologyCME1 Apr 2023MP13-02 COMPARING MFI-5, ASA CLASS, AND MCCI AS PREDICTORS OF POSTOPERATIVE OUTCOMES FOLLOWING ENDOSCOPIC TREATMENT OF BPH Justin James, Grace Jun, Jacob Gaines, Zeph Okeke, Gregory Mullen, and Arun Rai Justin JamesJustin James More articles by this author , Grace JunGrace Jun More articles by this author , Jacob GainesJacob Gaines More articles by this author , Zeph OkekeZeph Okeke More articles by this author , Gregory MullenGregory Mullen More articles by this author , and Arun RaiArun Rai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While frailty has emerged as a predictor of morbidity following urological surgery, it remains difficult to measure. A new frailty index (modified Frailty Index-5(mFI-5)) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH); however, its discriminatory abilities for postoperative complications has not been investigated. Therefore, we compared mFI-5 to two most commonly used indexes, the American Society of Anesthesiologists physical classification (ASA) and modified Charlson Comorbidity Index (mCCI) using the National Surgical Quality Improvement Program (NSQIP) database. METHODS: We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using CPT and ICD codes. Patients were stratified by procedure type (transurethral resection of the prostate (TURP), laser vaporization (LVP) and enucleation (LEP) of the prostate). Risk indexes were calculated and compared as predictors of postoperative outcomes using C-statistics (AUC). RESULTS: 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%, but upon stratifying by procedure, the complication rates were 11.0%, 10.3%, and 7.6% for TURP, LVP, and LEP, respectively. In aggregate, ASA Class, mFI-5, and mCCI were fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). ASA Class and mCCI were poor models (AUC: 0.6-0.7) for 30-day readmission and surgical complications; however, mFI-5 failed to model either postoperative outcome. All indexes failed to model any other postoperative outcomes (any complication, medical complications, reoperation, disease severity, length of stay ≥2 days) (AUC<0.6). Upon stratifying by endoscopic procedure, all three indexes remained fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). Likewise, when stratifying by endoscopic procedure, all three indexes remained poor models for any readmissions and surgical complications (AUC>0.6). CONCLUSIONS: All three indexes are fair models of mortality for endoscopic treatment of BPH. However, these indexes were inadequate models for all other postoperative outcomes, despite previous studies demonstrating an association. Endoscopic treatment of BPH needs better risk indexes to predict post-operative complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e173 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin James More articles by this author Grace Jun More articles by this author Jacob Gaines More articles by this author Zeph Okeke More articles by this author Gregory Mullen More articles by this author Arun Rai More articles by this author Expand All Advertisement PDF downloadLoading ...

Neutrophil to Lymphocyte Ratio as a Predictor of Postoperative Outcomes in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

(1) Introduction: Traumatic brain injury (TBI) is a leading cause of injury and mortality worldwide, carrying an estimated cost of $38 billion in the United States alone. Neutrophil to lymphocyte ratio (NLR) has been investigated as a standardized biomarker that can be used to predict outcomes of TBI. The aim of this review was to determine the prognostic utility of NLR among patients admitted for TBI. (2) Methods: A literature search was conducted in PubMed, Scopus, and Web of Science in November 2022 to retrieve articles regarding the use of neutrophil to lymphocyte ratio (NLR) as a prognostic measure in traumatic brain injury (TBI) patients. Inclusion criteria included studies reporting outcomes of TBI patients with associated NLR values. Exclusion criteria were studies reporting only non-primary data, those insufficiently disaggregated to extract NLR data, and non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess for the presence of bias in included studies. (3) Results: Following the final study selection 19 articles were included for quantitative and qualitative analysis. The average age was 46.25 years. Of the 7750 patients, 73% were male. Average GCS at presentation was 10.51. There was no significant difference in the NLR between surgical vs. non-surgical cohorts (SMD 2.41 95% CI -1.82 to 6.63, p = 0.264). There was no significant difference in the NLR between bleeding vs. non-bleeding cohorts (SMD 4.84 95% CI -0.26 to 9.93, p = 0.0627). There was a significant increase in the NLR between favorable vs. non-favorable cohorts (SMD 1.31 95% CI 0.33 to 2.29, p = 0.0090). (4) Conclusions: Our study found that NLR was only significantly predictive for adverse outcomes in TBI patients and not surgical treatment or intracranial hemorrhage, making it nonetheless an affordable alternative for physicians to assess patient prognosis.

The Geriatric 8 (G8) Score as a Predictor of Postoperative Outcomes in Elderly Patients Undergoing Surgical Interventions for Malignancies

The Geriatric 8 (G8) Score as a Predictor of Postoperative Outcomes in Elderly Patients Undergoing Surgical Interventions for Malignancies

The Neutrophil-to-Lymphocyte Ratio as a Predictor of Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Grafting.

The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a novel predictive marker of cardiovascular disease. However, its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is unclear. This study aimed to determine the association between the preoperative NLR and early mortality in patients undergoing CABG. Cardiac surgery was performed in 2,504 patients at Seoul St. Mary's Hospital from January 2010 to December 2021. This study retrospectively reviewed 920 patients who underwent isolated CABG, excluding those for whom the preoperative NLR was unavailable. The primary endpoints were the 30- and 90-day mortality after isolated CABG. Risk factor analysis was performed using logistic regression analysis. Based on the optimal cut-off value of preoperative NLR on the receiver operating characteristic curve, high and low NLR groups were compared. The 30- and 90-day mortality rates were 3.8% (n=35) and 7.0% (n=64), respectively. In the multivariable analysis, preoperative NLR was significantly associated with 30-day mortality (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.17-1.39; p<0.001) and 90-day mortality (OR, 1.17; 95% CI, 1.07-1.28; p<0.001). The optimal cut-off value of the preoperative NLR was 3.4. Compared to the low NLR group (<3.4), the high NLR group (≥3.4) showed higher 30- and 90-day mortality rates (1.4% vs. 12.1%, p<0.001; 2.8% vs. 21.3%, p<0.001, respectively). Preoperative NLR was strongly associated with early mortality after isolated CABG, especially in patients with a high preoperative NLR (≥3.4). Further studies with larger cohorts are necessary to validate these results.