Predictors Of Major Postoperative Complications Research Articles

Predictors of major postoperative complications in cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy.

Cytoreductive Surgery (CRS) ± Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is associated with a high incidence of postoperative morbidity. Our aim was to identify independent, potentially actionable perioperative predictors of major complications. We reviewed patients who underwent CRS ± HIPEC from June 2020 to January 2022 at a high-volume center. Postoperative complications were categorized using the Comprehensive Complication Index, with the upper quartile defining major complications. Multivariate logistic analysis identified predictive and protective factors. Of 168 patients, 119 (70.8%) underwent HIPEC. Mean Comprehensive Complication Index was 12.6 (12.7) and upper quartile cut-off was 22.6. Medical complications were more frequent but less severe than surgical (63% vs 18%). Forty-six patients (27.4%) comprised the "major complications" group (mean CCI 30.1 vs 6.3). Multivariate logistic regression showed that heart disease (RR 1.9; 95% CI: 1.1 to 3.3), number of anastomoses (RR 2.4; 95% CI:1.3 to 4.6) and first 24-h fluid balance (RR 1.1; 95% CI: 1.1 to 1.2), were independently associated as risk factors for major complications, while opioid-free anesthesia (RR 0.6; 95% CI: 0.3 to 0.9) and high preoperative hemoglobin (RR 0.9; CI 95%: 0.9 to 0.9) were independent-protective factors. Preoperative heart diseases, number of anastomoses and first 24h-fluid balance are independent risk factors for major postoperative complications, while high preoperative hemoglobin and opioid-free anesthesia are protective. Correction of anemia prior to surgery, avoiding positive fluid balance and incorporation of opioid-free anesthesia strategy are potential actionable measures to reduce postoperative morbidity.

Surgical Apgar Score and Controlling Nutritional Status Score can be predictors of major postoperative complications after spine surgery

Assessing intraoperative hemodynamics with Surgical Apgar Score (SAS) and preoperative nutritional status with the Controlling Nutritional Status (CONUT) score are said to be useful to predict postoperative complications in many surgical services, but little is reported in the field of spinal surgery. The purpose of this study was to assess the utility of SAS and the CONUT score for predicting the risk of major postoperative complications after spinal surgery. We included 659 people who undergone spinal surgery in our institute in eight consecutive years. The occurrence of postoperative major complications was investigated. Background clinical information, surgical information including the SAS and the CONUT score, and the length of postoperative hospital stay were collected. The risk factors of postoperative complications were assessed statistically. Complications occurred in 117 cases (17.8%). The multivariate analysis showed that history of diabetes mellitus (odds ratio [OR] 1.81: P = 0.035), coronary disease (OR 3.33; P = 0.009), American Society of Anesthesiologists Physical Status (OR 1.71; P = 0.025), use of instruments (OR 2.07; P = 0.026), operation time (OR 1.30; P < 0.001), SAS (OR 0.59; P < 0.001), and CONUT (OR 1.34; P < 0.001) were independent risk factors of major complications after spinal surgery. Assessing the intraoperative hemodynamics with SAS and preoperative nutritional status with the CONUT score was useful in predicting major postoperative complications after spinal surgery. People who are detected as high risked people should be managed carefully after spinal surgery.

Can perioperative pCO2 gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis

The difference between venous and arterial carbon dioxide pressure (pCO2 gap), has been used as a diagnostic and prognostic tool. We aimed to assess whether perioperative pCO2 gaps can predict postoperative complications. This was a secondary analysis of a multicenter RCT comparing goal-directed therapy (GDT) to standard care in which 464 patients undergoing high-risk elective abdominal surgery were included. Arterial and central venous blood samples were simultaneously obtained at four time points: after induction, at the end of surgery, at PACU/ICU admission, and PACU/ICU discharge. Complications within the first 30 days after surgery were recorded. Similar pCO2 gaps were found in patients with and without complications, except for the pCO2 gap at the end of surgery, which was higher in patients with complications (6.0 mmHg [5.0–8.0] vs. 6.0 mmHg [4.1–7.5], p = 0.005). The area under receiver operating characteristics curves for predicting complications from pCO2 gaps at all time points were between 0.5 and 0.6. A weak correlation between ScvO2 and pCO2 gaps was found for all timepoints (ρ was between − 0.40 and − 0.29 for all timepoints, p < 0.001). The pCO2 gap did not differ between GDT and standard care at any of the selected time points. In our study, pCO2 gap was a poor predictor of major postoperative complications at all selected time points. Our research does not support the use of pCO2 gap as a prognostic tool after high-risk abdominal surgery. pCO2 gaps were comparable between GDT and standard care. Clinical trial registration Netherlands Trial Registry NTR3380.

The relationship between perioperative central venous oxygen saturation and postoperative complications in highly invasive gastroenterological surgery.

Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after these surgeries is high, which affects the postoperative course and mortality. In patients who undergo these types of surgeries, continuous monitoring of the perioperative central venous oxygen saturation (ScvO2) is possible via a central venous catheter. We aimed to investigate the relationship between continuously monitored perioperative ScvO2 values and postoperative complications. The medical records of 115 patients who underwent highly invasive gastroenterological surgeries and ScvO2 monitoring from April 2012 to March 2014 were analyzed. Sixty patients met the inclusion criteria, and their ScvO2 levels were continuously monitored perioperatively. The relationship between ScvO2 levels and major postoperative complications, defined as Clavien-Dindo grade ≥ III, was examined using uni- and multivariate analysis. Thirty patients developed major postoperative complications. The adequate cut-off value derived from receiver operating curves of the postoperative average ScvO2 levels for predicting major complications was 75%. Multivariate analysis revealed that low average postoperative ScvO2 levels (p = 0.016) and blood loss ≥ 1000 mL (p = 0.039) were significant predictors of major postoperative complications. Low perioperative ScvO2 values were associated with an increased risk of major postoperative complications. Continuous ScvO2 monitoring will help prevent postoperative complications.

Prognostic role of body composition in peritoneal carcinomatosis patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy

BackgroundBioelectric impedance analysis (BIA)-measured body composition and nutritional status have been used as prognostic indicators in various cancer cohorts. This study investigated whether BIA could provide information on prognosis in peritoneal carcinomatosis patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsWe retrospectively analyzed the data of 99 patients with preoperative BIA data among those who underwent CRS and HIPEC. The association between BIA-derived parameters and intraoperative peritoneal cancer index (PCI) score was assessed. Predictive analysis for the occurrence of postoperative morbidities including major complications (Clavien–Dindo classification 3–4) and re-admission within 30 days after surgery as well as 1 year mortality was also performed.ResultsBIA-derived mineral (r = 0.224, p = 0.027), fat (r = − 0.202, p = 0.048), and total body water (TBW)/fat-free mass (FFM) (r = − 0.280, p = 0.005) showed significant associations with intraoperative PCI score. Lower TBW/FFM was an independent predictor of major postoperative complications (OR 0.047, 95% CI 0.003–0.749, p = 0.031) and re-admission (OR 0.094, 95% CI 0.014–0.657, p = 0.017) within 30 days after surgery. Higher fat mass was also independently associated with a higher risk of major postoperative complications (OR 1.120, 95% CI 1.006–1.248, p = 0.039) and re-admission (OR 1.123, 95% CI 1.024–1.230, p = 0.013). Intraoperative PCI score > 20 (OR 4.489, 95% CI 1.191–16.917, p = 0.027) and re-admission within 30 days after surgery (OR 5.269, 95% CI 1.288–21.547, p = 0.021) independently predicted postoperative 1-year mortality.ConclusionsWe demonstrate that preoperative BIA-derived TBW/FFM and fat mass were significantly correlated with metastatic extent, assessed by PCI score, in patients with peritoneal carcinomatosis. In addition, BIA-derived TBW/FFM and fat mass showed independent predictability for postoperative 30-day major complications and re-admission in patients undergoing CRS and HIPEC. Our findings suggest that assessment of BIA may improve discrete risk stratification in patients who are planned to receive CRS and HIPEC.

S1179 Sarcopenia as a Predictor for Major Postoperative Complications in Patients With IBD: A Systematic Review and Meta-Analysis

S1179 Sarcopenia as a Predictor for Major Postoperative Complications in Patients With IBD: A Systematic Review and Meta-Analysis

Is preoperative sarcopenia associated with postoperative complications after pelvic exenteration surgery?

PurposePelvic exenteration (PE) involves radical surgical resection of pelvic organs and is associated with considerable morbidity. Sarcopenia is recognised as a predictor of poor surgical outcomes. This study aimed to determine if preoperative sarcopenia is associated with postoperative complications after PE surgery.MethodsThis retrospective study included patients who underwent PE with an available preoperative CT scan between May 2008 and November 2022 at the Royal Adelaide Hospital and St. Andrews Hospital in South Australia. Total Psoas Area Index (TPAI) was estimated by measuring the cross-sectional area of the psoas muscles at the level of the third lumbar vertebra on abdominal CT, normalised for patient height. Sarcopenia was diagnosed based on gender-specific TPAI cut-off values. Logistic regression analyses were performed to identify risk factors for major postoperative complications with a Clavien-Dindo (CD) grade ≥ 3.ResultsIn total, 128 patients who underwent PE were included, 90 of whom formed the non-sarcopenic group (NSG) and 38 the sarcopenic group (SG). Major postoperative complications (CD grade ≥ 3) occurred in 26 (20.3%) patients. There was no detectable association with sarcopenia and an increased risk of major postoperative complications. Preoperative hypoalbuminemia (P = 0.01) and a prolonged operative time (P = 0.002) were significantly associated with a major postoperative complication on multivariate analysis.ConclusionSarcopenia is not a predictor of major postoperative complications in patients undergoing PE surgery. Further efforts aimed specifically at optimising preoperative nutrition may be warranted.

Risk stratification in subpectoral to prepectoral pocket conversion to reduce post-reconstruction animation deformity

BackgroundAnimation deformity is a morbid complication that impacts women undergoing subpectoral implant-based breast reconstruction. Transferring implants from the subpectoral to prepectoral space, pocket conversion, can be performed to minimize this issue. While prior literature has evaluated outcomes associated with this procedure, we investigated the risk factors most commonly associated with post-conversion complications. MethodsWe performed a retrospective cohort investigation of women undergoing prepectoral pocket conversion. Pre-conversion clinical characteristics and surgical complications (major and minor) were collected. Predictors for postoperative complications were identified using univariate and multivariate logistic regression models. Odds ratios (OR) and adjusted odds ratios (aOR) are presented with 95% confidence intervals, and p-values were assessed at α = 0.05. ResultsA total of 34 patients (63 breasts) were included. Pocket conversion relieved animation deformity in all breasts. The overall rates of major and minor complications were 14.3% (n = 9/63) and 34.9% (n = 22/63), respectively, by mean follow-up of 11.1 months. After adjusting for confounders, pre-conversion implant rupture (OR= 6.00, CI= 0.99–34.58; aOR= 12.8, CI= 1.15–170.32) and duration of implant placement (OR=1.35, CI= 1.07–1.78; aOR= 1.1, CI= 1.00–1.21) were found to be significant predictors of major postoperative complications. ConclusionWith a fairly inclusive patient population, this series provides data for improved risk stratification of patients considering conversion to relieve animation deformity. Interestingly, traditional risk factors (namely, body mass index and smoking status) were not significant predictors for postoperative complications, suggesting that conversion may be safe in high-risk patients. Such data support more informed preoperative counseling and wider application of this procedure.

Poster 179: Fracture Morphology, Surgical Technique, and Obesity as Predictors of Major Postoperative Complications in Midshaft Clavicle Fractures

Objectives:Optimal management of midshaft clavicle fractures remains controversial. This study assessed demographic factors, injury patterns, and surgical technique as potential predictors of complications following open reduction internal fixation (ORIF) of midshaft clavicle fractures. We hypothesize that smoking, diabetes, obesity, and fracture pattern would be risks factors for surgical complications.Methods:Consecutive patients who presented to a single tertiary institution who underwent ORIF of midshaft clavicle fractures were identified retrospectively from 2007-2019. Patients who were lost to follow-up or had a follow-up period of 12 weeks or less, were excluded from analyses. Of the 354 eligible patients, 223 (63%) completed at least 12 weeks of follow-up.Demographics, injury data, surgery characteristics, and postoperative complications were recorded. Postoperative complications were obtained via chart review and separated into major (reoperation) and minor (no reoperation) complications based on reoperation status. Chi-squared statistics, Fisher’s Exact test, and multivariate logistic regression were utilized with significance level set to p<0.05.Results:223 patients (average 39.3 + 15.2 yo) were identified with average follow-up of 9.2 months Table 1. Overall complication incidence was 21.5% (95% [CI], 16.3% to 27.5%), minor complication incidence was 15.2% (95% [CI], 10.8% to 20.6%), major complication incidence was 6.3% (95% [CI], 3.5% to 10.3%), and incidence of non-union was 1.8% (95% [CI], 0.5% to 4.5%). Major complications requiring reoperation revealed 4 cases of non-union (28.6%), 4 instances of symptomatic hardware (28.6%), 3 incidents of deep infections (21.4%), 1 instance of acromioclavicular joint dislocation (7.1%), and 1 incident of broken hardware (7.1%).Smoking status, obesity, and fracture morphology were significant prognostic factors for overall complication risk while diabetes was not. Results from a multivariate analysis demonstrated a 2.4- and 3.2-times greater risk of overall post-operative complications among smokers and obese patients, respectively (p=0.013 and p=0.004, respectively). After adjusting for BMI and smoking status, the risk of post-operative complications among patients with a transverse fracture was 2.26 times greater compared to a patient with an oblique fracture (p = 0.035).Regarding major complications, obese patients were 3.5-times more likely to require reoperative intervention. Moreover, after adjusting for obesity status, transverse and z-type fractures had an 8.9- and 22.7-times greater risk for reoperation, relative to patients with oblique fractures respectively (p=0.04 and p=0.006, respectively. Finally, there were no reported major complications among patients with dual plating, and nonunion occurred exclusively among patients with transverse fractures. Conclusions:Fracture pattern, obesity, and smoking status were significant predictors of postoperative complications. However, only fracture morphology, BMI, and surgical technique were significant predictors of reoperative risk. Transverse and z-type fractures may require increased vigilance, especially among obese patients, with potential consideration for dual plating in these circumstances.Table 1.Baseline Characteristics

A scoring system to predict the risk of major complications after laparoscopic liver resection in elderly patients with hepatocellular carcinoma.

The safety of laparoscopic liver resection (LLR) in elderly patients is a matter of concern because the reduced physiologic reserve increases the risk of postoperative complications. However, there are few score systems for predicting complications after LLR in elderly patients. The aim of this study is to propose a new simplified scoring system based on the Geriatric Nutritional Risk Index (GNRI) to predict major complications after LLR in elderly patients with hepatocellular carcinoma (HCC). We retrospectively reviewed 257 consecutive patients aged ≥ 65years who underwent LLR for HCC between 2004 and 2019. The GNRI formula was 1.489 × serum albumin (g/L) + 41.7 × present weight/ideal weight (kg). A scoring system to predict the risk of major complications was developed by assigning points to each risk factor equal to its regression coefficient determined in the multivariable analysis. Major complications were defined as complications of Clavien-Dindo grade III or higher. Of the 257 patients, 219 patients were finally included in this study. Major complications occurred after LLR in 24 patients (10.9%). Multivariable analysis showed that the GNRI (hazard ratio [HR] 3.396, 95% confidence interval [CI] 1.242-9.288, P = 0.017), Child-Turcotte-Pugh score (HR 2.191, 95% CI 1.400-8.999, P = 0.036), major liver resection (HR 2.683, 95% CI 1.082-7.328, P = 0.050), and intraoperative transfusion (HR 1.802, 95% CI 1.428-7.591, P = 0.022) were independent predictors of major postoperative complications. These variables were assigned points based on their HRs, and the resulting 10-point model showed good discrimination (area under the curve 0.756, 95% CI 0.649-0.836, P = 0.001). The scoring system outperformed the GNRI for predicting major complications after LLR in elderly patients with HCC.

Role of preoperative albumin in predicting risk of postoperative complications in patients undergoing post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND).

416 Background: Testicular cancer with retroperitoneal metastases is often treated with chemotherapy, with subsequent post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) performed for residual masses after chemotherapy. While the cure rate is high, the surgery is associated with significant morbidity. Unlike in other genitourinary cancers, perioperative nutritional optimization is typically not prioritized as most patients are young, otherwise healthy men. Albumin is a systemic marker of nutritional status and has been shown to predict adverse outcomes in other urological cancers. We sought to assess whether preoperative albumin level is associated with postoperative outcomes in patients undergoing PC-RPLND. Methods: A database of patients who received PC-RPLND at our institution between 2007 and 2019 was created. Pre-RPLND albumin was obtained and correlated with postoperative outcomes using univariate and multivariable regression models. The primary outcome was the presence of major (Clavien-Dindo grade ≥ III) complications within 90 days of surgery. Results: Of 76 patients who underwent PC-RPLND, 70 patients had preoperative albumin values available. The median age (IQR) of patients at the time of surgery was 26 years (22 - 32) and median (IQR) preoperative albumin level was 4.4 g/dL (4.1 - 4.6). Patients with major postoperative complications had lower median preoperative albumin than those without a complication (4.1 g/dL vs. 4.4 g/dL; p = 0.03). Greater albumin level (per g/dL) was associated with a lower risk of major postoperative complications on multivariable logistic regression (OR = 0.12; p = 0.03). Other preoperative serum markers such as hemoglobin and creatinine did not associate with postoperative complications. Conclusions: To our knowledge, this is the first study to demonstrate that preoperative albumin is an independent predictor of major postoperative complications in patients undergoing PC-RPLND. This finding demonstrates the importance of nutritional optimization even in young, otherwise healthy individuals prior to undergoing this morbid surgery. Additional studies are warranted to more reliably predict which patients may experience complications.

The role of postoperative neutrophil-to-lymphocyte ratio as a predictor of postoperative major complications following total gastrectomy for gastric cancer.

PurposeThis study was performed to investigate the role of the perioperative neutrophil-to-lymphocyte ratio (NLR) as an early predictor of major postoperative complications after total gastrectomy for gastric cancer.MethodsThis single-center, retrospective study reviewed consecutive patients with gastric cancer who underwent total gastrectomy at a single institution from March 2009 to March 2021. The postoperative complications were graded according to the Clavien-Dindo classification. We analyzed the patient demographics and surgical outcomes according to the grade of postoperative complications in the major complications group (≥grade III) and the no major complications group (<grade III and no complication). Laboratory tests were performed preoperatively and on postoperative days (POD) 2 and 5 to determine the NLR.ResultsOut of 212 patients (mean age, 64.1 years; 152 male [71.7%]), 63 (29.7%) underwent minimally invasive surgery. Twenty-five (11.8%) were in the major complications group and 187 (88.2%) were in the no major complications group. There was a significant difference in the NLR on POD 2 (16.54 vs. 8.83, P = 0.033) between the 2 groups. According to the receiver operating characteristic curve for the NLR on POD 2, the cutoff was calculated to be 9.6. In multivariate analysis, an NLR on POD 2 of ≥9.6 and an American Society of Anesthesiologists physical status classification of ≥III were statistically significant predictors of major postoperative complications.ConclusionDetermination of the NLR on POD 2 is a simple and useful method for the early prediction of major complications after total gastrectomy for gastric cancer.

170 SKELETAL MUSCLE LOSS DURING NEOADJUVANT CHEMOTHERAPY IS A PREDICTOR OF MAJOR POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH ESOPHAGUS CANCER

Abstract It is known that various factors, including surgical stress, nutritional deficits and sarcopenia, affect the incidence of postoperative complications. The aim of this study is to identify the predictors of major complications (Clavien-Dindo ≥II) after esophageal resection following neoadjuvant chemotherapy (NAC). Methods Forty-nine patients with esophageal cancer undergoing NAC and surgery between January 2017 and December 2019 were identified from our surgery database and retrospectively analyzed. Onodera prognostic nutritional index (PNI) was used as the indicator of nutritional status. For the evaluation of skeletal muscle mass, computed tomography imaging of the total cross-sectional muscle tissue measured at the third lumbar level defined the skeletal muscle index (SMI). Images were collected before and after NAC. Univariate and multivariate logistic regression analyses were used to assess the association between various predictors and major postoperative complications. Results Of the Forty-nine patients, 20 patients (40.8%) had major complication after surgery. Of the 20 patients, 5 had pneumonia and 4 had anastomotic leakage. Nine patients (18.3%) complete planned dose of NAC. SMI reduction was observed in 42 patients (85.7%) during NAC. According to univariate analysis, SMI reduction during NAC, and PNI before chemotherapy were significantly associated with major postoperative complications (P = 0.032, P = 0.035, respectively). According to multivariate analysis, SMI reduction during NAC is an independent predictor for the incidence of major postoperative complications (P = 0.0034). Conclusion Skeletal muscle loss during neoadjuvant chemotherapy can be an useful predictor of major postoperative complications in patients with esophageal cancer.

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

ObjectiveIn recent years, transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with symptomatic aortic valve stenosis considered to be at increased or high surgical risk....

Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications

ObjectiveTo estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. Study designAn uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo ≥ 2) postoperative complications. ResultsOver the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (±1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54–8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03–12.64, p < 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45–21.61, p < 0.001) were found as independent risk factors for major postoperative complications. ConclusionsTotal hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events.

Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

PurposeTo examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA).MethodsFrailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA).ResultsOverall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS.ConclusionIn patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

Age and risk of major complications in patients undergoing radical cystectomy for muscle invasive bladder cancer.

IntroductionRadical cystectomy is the treatment of choice for patients with muscle invasive bladder cancer (MIBC), but it may be unsafe in older patients.AimIn this study, we investigated whether age and selected clinical characteristics were associated with outcomes of radical cystectomy.Material and methodsWe enrolled 434 patients with MIBC who underwent radical cystectomy between 2012 and 2016, and we classified them into three age groups: < 65, 66–74, and ≥ 75 years. Postoperative complications were classified on the Clavien-Dindo scale. Regression models were used to find predictors of major postoperative complications (Clavien-Dindo score of 3 or more), long hospital stay (> 7 days), blood loss, and operating time. The models included American Society of Anesthesiologists scores, age group, sex, body mass index, Tumor Nodes Metastasis scores, type of urine derivation (ileal conduit or orthotopic bladder vs. ureterocutaneostomy), and operation type (open vs. laparoscopic).ResultsIn the regression models, age was not a significant predictor of major complications, long hospital stay, or blood loss (p ≥ 0.206). Older age was associated with shorter surgery times (p = 0.002). Higher preoperative American Society of Anesthesiologists scores tended to be associated with a greater risk of major complications (odds ratio, 1.47; p = 0.092).ConclusionsOlder age was not associated with an increased risk of major complications in patients who undergo radical cystectomy because of MIBC. Therefore, older age alone should not be a contraindication to this operation.

Frailty as a Predictor of Postoperative Morbidity and Mortality Following Liver Resection.

Liver resection is commonly performed among patients at risk of being frail. Frailty can be used to assess perioperative risk. Thus, we evaluated frailty as a predictor of postoperative complications following liver resection using a validated modified frailty index (mFI). A retrospective cohort of consecutive patients undergoing liver resection (2011-2018) were stratified according to the mFI and classified as the following: high (≥.27) and low mFI (<.27). The effect of mFI on postoperative complications (Clavien-Dindo) was evaluated using multiple logistic regression, expressed as odds ratios (OR) and 95% CI. Of 409 patients, 58 (14%) had high mFI. There were no differences in type of liver resection (laparoscopic: 57% vs 55%, P = .766), number of segments resected (3 vs 4, P = .417), or operative time (257 vs 293 minutes, P = .097) between the high and low mFI groups, respectively. High mFI patients had a longer median length of hospital stay (9.5 vs 5 days, P < .001) and higher proportion of postoperative complications (79% vs 46%, P < .001), including minor complications (69% vs 42%, P < .001), major complications (50% vs 13%, P < .001), and 90-day postoperative mortality (12% vs 3.4%, P = .04). On multivariable analysis, longer operating time (OR 1.15, 95% CI, 1.03 to 1.27), higher number of segments resected (OR 1.43, 95% CI, 1.12 to 1.82), and high mFI (OR 6.74, 95% CI, 2.76 to 16.51) were independent predictors of major postoperative complications. mFI predicts postoperative outcomes following liver resection and can be used as a risk stratification tool for patients being considered for surgery.

Blood Lactate Level as Predictor of Early Outcome after Off-Pump Coronary Artery Bypass Grafting

Background: Identification of predictors of morbidity and mortality is an important issue for the management of cardiac surgical patients. Elevated lactate concentrations in the immediate postoperative period reflect unmet metabolic demand and may be associated with outcome.&#x0D; Methods: A prospective observational study was carried out in the department of cardiac surgery, at National Heart Foundation Hospital&amp; Research Institute(NHFH&amp;RI), Dhaka. commencing from July 2016 to March 2018. In all Adult patients irrespective of sex undergoing elective off-pump coronary artery bypass grafting (OPCABG). Purposive sampling was applied with patient with blood lactate level &lt; 3 mmol/L 6hours after shifting from OT to ICU in Group-A and blood lactate level ≥3mmol/l, 6hours after shifting to the ICU in Group-B.Postoperative early adverse outcomes were analyzed in both the patient groups.&#x0D; Results: Blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time, (OR 2.540, 95% CI 1.781-3.621, p= &lt;0.001).prolonged ICU stay, .(OR 1.767, 95% CI 1.348-2.315, p=&lt; 0.001) pulmonary complication (OR 1.503, 95% CI 1.104-2.046, p= 0.010).and renal dysfunction(OR 1.460, 95% CI 1.156-1.843, p= 0.001). following off-pump coronary artery bypass grafting. Other risk factors for adverse outcome including, low LVEF, diabetes mellitus, blood transfusion and inotropic support were also found to be predictors of major complications in our study.&#x0D; Conclusion: The findings of this study permits to conclude that blood lactate level 6hours after ICU transfer is associated with an increased risk of postoperative early adverse outcome after off-pump coronary artery bypass grafting. It is found that lactate is an independent predictor of major postoperative complications. So, achieving normal blood lactate level following OPCABG is essential for minimizing postoperative adverse outcome.&#x0D; Cardiovasc. j. 2020; 12(2): 120-125

Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer.

Purpose We aimed to evaluate the postoperative complications of laparoscopic colorectal cancer (CRC) surgery and the adverse events of postoperative chemotherapy in elderly patients compared to younger patients and to identify the factors influencing the termination of postoperative chemotherapy.Methods Between June 2015 and May 2018, 188 patients with CRC underwent laparoscopic surgery with curative intent. Patients aged ≥ 70 were defined as elderly. Postoperative complications and adverse events of chemotherapy were assessed by using the Clavien-Dindo classification and the Common Terminology Criteria for Adverse Events, respectively. The clinicopathological factors were analyzed retrospectively.Results Seventy-eight patients were considered elderly with a mean age of 77.5 ± 5.5 years. Overall postoperative complications occurred in 68 patients (36.2%). Age and primary tumor location were independent predictors of overall postoperative complications. Smoking history was the only independent predictor of major postoperative complications. Of 113 patients who were recommended postoperative chemotherapy, 90 patients (79.6%) received postoperative chemotherapy. Overall adverse events occurred in 40 patients (44.4%). The American Society of Anesthesiologists physical status classification and chemotherapy regimen were significantly associated with overall adverse events. The chemotherapy regimen was the only factor significantly associated with severe adverse events. Of 90 patients, postoperative chemotherapy could not be completed in 11 (12.2%). Age was the only factor significantly associated with stopping postoperative chemotherapy (P = 0.003).Conclusion This study shows that laparoscopic CRC surgery and postoperative chemotherapy were feasible in elderly patients. Further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding postoperative chemotherapy.