Predictors Of Surgical Complications Research Articles

The role of subcutaneous fat and BMI in predicting surgical outcomes and patient reported outcomes in robotic-assisted total hip arthroplasty

BackgroundThe purpose of this study was to assess if subcutaneous fat (SCF) or BMI is a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA). MethodsPatients who underwent robotic-assisted primary THAs at one institution between 2018 and 2020 were included in this retrospective cohort study. Prior to surgery, computed tomography (CT) was used to measure SCF in the posterolateral quadrant of the hip. SCF was measured 3 centimeters (cm) proximal to the greater trochanter (PGT) and 3 cm inferior to the distal tip of the greater trochanter (DGT).Measurements were normalized to the size of the patient's bony anatomy by dividing the subcutaneous fat area measurement by the transverse diameter of the femur 10 cm inferior to the tip of the greater trochanter. Patients were divided into quintiles determined by SCF distribution around the mean (groups 1-5) and BMI (BMI<25, BMI 25-29.9, BMI 30-34.9, BMI 35-39.9, and >40). Ninety day outcomes and PROMIS (Patient Reported Outcome Measures Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database preoperatively, at 14-112 days post-operative and at the latest follow up. ResultsThere were 175 patients identified with a mean age of 63.83 years (range 27-89) and a mean BMI of 30.73kg/m2 (range 18.2-48.4). Interclass correlation coefficient was greater than 0.9 in all PGT, DGT, and GT measurements. Analysis of Variance (ANOVA) found there was a significantly shorter time from incision to closure in quintiles 1 and 3 when compared to the SCF quintile 5 (p<0.05) and that there was a significantly shorter time from incision to closure in BMI categories 1, 2, and 3 when compared to BMI category 5 (BMI > 40). There were no differences between SCF and BMI as predictive of length of stay, transfusion status, infection, or PROMIS scores. ConclusionIt can be concluded that hip SCF on axial CT images can reliably measure SCF and is predictive of time from incision to closure, but it does not show a significant difference in predicting the length of stay, infection, or PROMIS scores when compared to BMI.

Evaluation of pre-operative high dose corticosteroids in elective colorectal surgery and effects on gut barrier function: A phase 2 clinical trial

BackgroundPerioperative inflammation is a predictor of surgical complications and cancer prognosis in surgical oncology. Multimodal protocols are ongoing in order to find ways to control inflammation. A preoperative flash high-dose of corticosteroids has been suggested as a way to control perioperative inflammation, but its safety in colorectal surgery needs to be established prior to a phase 3 trial. The physiologic effects of such a dose should also be explored. MethodsProspective bicentric phase 2 single-arm study with a biological ancillary study. Patients were administered 20 mg/kg of methyl-prednisone before colorectal surgery. Primary outcome was major post-operative complications defined as a grade >II according to the Dindo-Clavien classification. Ancillary outcome was plasma endotoxin concentration and activity. ResultsSixty-seven patients were included. Twelve (17.9 % [90 %CI:10.9 %-29.6 %]) patients developed major post-operative complications. No homeostatic disturbances troubles were observed. Severe postoperative hyperglycemia concerned 3 (4 %) patients which were all non-diabetic. The concentrations of endotoxin (mass) and its activity lowered between the pre-operative time point and the day after surgery. ConclusionPre-operative single flash of high dose methylprednisolone (20 mg/kg) before elective colorectal surgery seemed safe. Our results suggest that corticosteroids could promote gut barrier integrity, reducing endotoxemia in patients with colorectal surgery. Further studies (in particular a large randomized controlled trial) are needed to confirm our findings and explore a potential benefit of corticosteroid in this population. ClinicalTrials.gov03437746

Role of phase angle as a predictor for surgical complications in critically ill patient

Role of phase angle as a predictor for surgical complications in critically ill patient

Predictors of surgical complications in boys with hypospadias: data from an international registry

BackgroundComplications are frequently reported after hypospadias repair and there is a need to understand the factors that influence their occurrence.MethodsData from boys with hypospadias born between 2000 and 2020 were...

MP07-02 PREDICTING RISK FOR PATIENTS UNDERGOING SACROCOLPOPEXY FROM FRAILTY INDEXES

You have accessJournal of UrologyCME1 Apr 2023MP07-02 PREDICTING RISK FOR PATIENTS UNDERGOING SACROCOLPOPEXY FROM FRAILTY INDEXES Rishabh Simhal, Kerith Wang, Maria D'Amico, Courtney Capella, Radhika Ragam, Joon Yau Leong, Yash Shah, Whitney Smith, Patrick Shenot, and Alana Murphy Rishabh SimhalRishabh Simhal More articles by this author , Kerith WangKerith Wang More articles by this author , Maria D'AmicoMaria D'Amico More articles by this author , Courtney CapellaCourtney Capella More articles by this author , Radhika RagamRadhika Ragam More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Yash ShahYash Shah More articles by this author , Whitney SmithWhitney Smith More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , and Alana MurphyAlana Murphy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacrocolpopexy (SCP) is a definitive treatment option for pelvic organ prolapse (POP). Because there are less invasive, albeit less definitive treatment options, a frailty index that best predicts outcomes and mortality for patients desiring SCP is useful to aid in decision making. METHODS: Open and minimally invasive SCPs performed from 2006 to 2020 were identified inthe National Surgical Quality Improvement Program (NSQIP) database. Frailty was determined by the NSQIP modified frailty index (mFI-5), a validated 5-item score including points for diabetes, impaired functional status, COPD, CHF, and hypertension, and by the revised surgical Risk Analysis Index (RAI-rev), a validated score accounting for patient comorbidities, age, and functional status. As previously published, patients with mFI-5 scores of 2 or more and RAI-rev scores of 26 or more were considered “frail.” Univariate logistic regression and t-test analyses were performed for mFI-5 and RAI-rev as predictors of surgical complications, 30-day readmissions, 30-day mortality, and hospital length of stay (LOS). RESULTS: 9,082 SCPs were identified in the database. In total, 5.2% of patients experienced minor complications (superficial SSIs, pneumonia, UTIs, bleeding requiring transfusion, or AKIs), and 1.4% of patients experienced major complications (sepsis, DVT, stroke, reintubation, renal failure, myocardial infarction, pulmonary embolism, septic shock, wound dehiscence, deep wound infections, or cardiac arrest). The 30-day readmission and mortality rates were 2.7% and 0.02%, respectively. On univariate logistic regression, a frail mFI-5 score was not predictive of minor complications, major complications, 30-day readmissions or mortality. However, a frail compared to a non-frail mFI-5 was associated with a higher LOS (1.6 vs 1.4, p=.008). A frail compared to a non-frail RAI-rev was predictive of major complications [OR 2.52; 95% CI 1.34-4.72; p=0.004], 30-day readmissions [OR 2.62, 95% CI 1.61-4.26; p=.0001], 30-day mortality [OR 26.8; 95% CI 1.67-428.88; p=0.02], and LOS (1.8 vs 1.4 days, p=.0008). CONCLUSIONS: The RAI-rev is a better predictor than the mFI-5 for major complications, readmission rate, mortality, and hospital LOS and may help in the decision making and risk counseling for patients POP considering an SCP. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e84 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Kerith Wang More articles by this author Maria D'Amico More articles by this author Courtney Capella More articles by this author Radhika Ragam More articles by this author Joon Yau Leong More articles by this author Yash Shah More articles by this author Whitney Smith More articles by this author Patrick Shenot More articles by this author Alana Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of age with perioperative morbidity among patients undergoing surgical management of minor burns.

Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n= 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p= 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p= 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.

Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: An Analysis of 214,504 Patients Using the TOPS Database.

Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures. The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined. A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use. There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement. Risk, III.

Predictors of surgical complications in surger y of disseminated skull base tumors

Post-surgical complications are rather important, and, perhaps, more significant factors determining the efficiency of the provided treatment together with the natural oncological disease course, accompanying pathology, and peculiarities of the adjuvant therapy. The decrease in the frequency and severity of these complications, revealing of modifiable and non-modifiable risk factors, their prevention and reduction are definitely of scientific and practical interest. The aim of the work is the search for predictors of post-surgical complications in the patients with disseminated malignant skull base tumors. The retro-prospective single-center cohort study based on the analysis of the results of surgical treatment of 161 patients with such neoplasms was carried out. The study covered the patients at the age of 19–84 years, with the average age of 55 years (statistical deviation: +\- 1.2). There were 78 women and 83 men. Accordingly, the sex distribution was 1:1.064. The pre-surgical radical radiotherapy was made for 43 patients (26.71 %); 21 patients (13.04 %) underwent one or several cycles of multiagent chemotherapy. Morphologically, there were 16 different types of tumors, among which the epithelial tumors 40.37 % (n=65) prevailed: epidermoid cancer — 16.15 % (n=26), sinonasal cancer — 8.07 % (n=13), and acinic cell carcinoma 5.59 % (n=9). Sarcomas were diagnosed in 12 patients (7.45 %). The study results demonstrate the lack of particular statistically substantiated symptoms or clinical factors — predictors, individually and independently affecting the unfavorable results of the surgical treatment of the patients with disseminated malignant skull base tumors. On the contrary, the syndromological combination of local, general and organizational problems definitely influences the surgery result significantly, while not all mathematically predicted combinations can be formalized into some clinical equivalent.

Associação de exames hematológicos e bioquímicos e complicações pós-cirurgia cardiovascular

Cardiac surgery has postoperative complications of varying severities. Knowing the predictors of such complications can minimize risks and increase patient survival. However, studies address postoperative complications without any standardization of predictors of such complications. The objective of this study was to evaluate the association of hematological and biochemical parameters in the pre- and postoperative period with general clinical complications and those according to organ affected in the postoperative period of cardiac surgery. This is a cross-sectional, retrospective, analytical and documentary study. Inclusion criteria: Elective myocardial revascularization surgeries and/or valve replacements with a cardiopulmonary bypass from January to December 2017, in patients older than 18 years old, survivors until hospital discharge. Incomplete medical records were excluded. Ethical research precepts were followed. 194 patients were included. Preoperative leukocyte alterations increased the chance of postoperative complications by 8.24 times (p=0.039); high mean INR values in the first postoperative period were associated with complications (p=0.036); changes in creatinine (p=0.020) and INR (p=0.002) in the first and second postoperative period were associated with complications, in addition to changes in hemoglobin associated with cardiac complications on the third postoperative day (p≤0.001). There was an association between: leukocyte alteration prior to surgery and total postoperative complications; postoperative hematological and biochemical changes and complications in general and by affected organ. These results can support the development of risk indicators. This also indicates the need to improve monitoring of leukocyte levels, INR, hemoglobin, and creatinine, perceived as predictors of surgical complications.

Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease.

Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory diseases that affect the gastrointestinal tract, including Crohn's disease (CD) and ulcerative colitis. Surgery is a treatment option, and more than half of the patients with CD will undergo surgical interventions over the course of the disease. Postoperative complications are common in IBD patients, the most frequent being intra-abdominal sepsis, infection of the surgical site, and adynamic ileum, and nutritional status is a factor that can influence postoperative outcome. Recent studies have shown that malnutrition, obesity, sarcopenia, and myosteatosis are predictors of surgical complications. However, most were retrospective studies with small patient samples and heterogeneity of clinical and nutritional assessment methods, which limit the extrapolation of data. Therefore, knowing the pathophysiological mechanisms of IBD and identifying the best parameters for assessing nutritional status are essential for prompt implementation of adequate nutritional interventions.

Predictors of surgical complications in patients with sinonasal malignancy.

Sinonasal and skull base tumors are rare, making it difficult to identify trends in surgical outcome. This study examines complications in a large cohort of patients undergoing surgery for sinonasal malignancy. Following IRB approval, an institutional database was reviewed to identify patients who underwent surgery for sinonasal or skull base malignancies from 1973 to 2016 at our institution. Charlson comorbidity index score and Clavien-Dindo grade were calculated. The main study endpoint was subgroup analysis of Clavien-Dindo Grade 0, Grades 1-2, and Grades 3-5 complications. An ordinal logistic regression model was constructed to assess the association between comorbidities, demographics, tumor characteristics, and surgical complications. In total, 448 patients met inclusion criteria. Perioperative mortality rate at 30 days was 1.6% (n = 7). The rate of severe complications (Clavien-Dindo 3 or higher) was 13.6% (n = 61). Multivariate analysis using an ordinal logistic regression model showed no association between Charlson comorbidity index score and Clavien-Dindo grade of postoperative complication. Advanced T-stage was significantly associated with complications (p = 0.0014; odds ratio: 3.442 [95% confidence interval: 1.615, 7.338]). Surgery for sinonasal and skull base tumors is safe with a low mortality rate. Advanced T-stage is associated with postoperative complications. These findings have implications for preoperative risk stratification. Key Points Surgery for sinonasal malignancy is safe with a 30 mortality of 1.6% and rate of severe complications of 12.8%. There is no association between patient comorbidity and post operative complication. On multivariate analysis, only advanced T stage was associated with increased rate of surgical complication.

Uterine Weight as a Predictor of Surgical Complications [36B

INTRODUCTION: The objective of this study is to investigate the impact of uterine weight on peri-operative hysterectomy outcomes. Risk stratification based on uterine weight may help guide surgical planning and post-operative management. METHODS: Hysterectomy patients were identified from the NSQIP Database (2014 – 2017). Uterine weight was evaluated as a categorical variable: Group A (less than or equal to 250 g), Group B (greater than 250 g to less than or equal to 500 g), Group C (greater than 500 g). Univariable and multivariable statistics were performed. IRB approval was waived. RESULTS: 50,333 patients were included, 82.6% in Group A (n=41,581), 12.7% in Group B (n=6,369), and 4.7% in Group C (n=2,383). The majority of the patients were white (71.5%). Median age and BMI were 48 (IQR 42, 59) and 30.5 (IQR 25.7, 36.8). There was an association between race and the proportion of patients in Group C: white 3.3%, AA 11.6%, Asian 9.0%, Other 4.8% (P=.000). Uterine weight was moderately correlated (R2=0.038) with operative time. Group B had nearly 3 times the likelihood of blood transfusion (OR 2.82, 95% CI 2.34, 3.40). Likelihood increased to 4 times for Group C (OR 4.08, 95% CI 3.22, 5.18). Group C was associated with increased conversion from MIS to open (OR 4.93, 95% CI 1.91, 12.71). There was no association with LOS, infection, dehiscence, urinary injury, VTE, readmission/re-operation. CONCLUSION: Increased uterine weight is associated with transfusion and conversion to open approach. Uterine weight may assist with pre-operative risk stratification and serve as a predictor of complications.

Predictors of surgical complications and evaluation of outcomes after surgical correction of adult-acquired buried penis.

To determine predictors for surgical complications and assess patient satisfaction after surgical treatment of Adult-Acquired Buried Penis (AABP). A retrospective review was performed on all patients diagnosed with AABP who underwent surgical treatment at a single institution from January 2013-December 2017. Patient demographics and peri-operative data were extracted. Univariate and multivariate regression analyses were performed to identify predictors for surgical complications. Patients' post-operative satisfaction was likewise assessed for factors such as successful outcome, post-operative erection quality, and complications related to the surgery. Twenty-four patients of median age 61.5years (IQR 54-67) with median follow-up of 12 months (IQR 3.25-29) were included. Overall success was 87.5% (21/24). Complications occurred in 15 (62.5%) patients with 7 (29%) Clavien-Dindo category ≥ 3. Based on regression analyses, body mass index (BMI) ≥ 40 (HR 25; 95% CI 1.45-431.81) and tobacco smoking (HR 14.6; 95% CI 1.15-199.98) were identified as independent predictors of overall complications. Concomitant performance of abdominal panniculectomy was associated with Clavien-Dindo category ≥ 3 (HR 28; 95% CI 2.4-326.74) complications. Patient satisfaction was associated with surgical success (p < 0.0001), post-operative erection (p < 0.027), and absence of surgical morbidity that needed further surgical intervention (p = 0.032). Surgical management of AABP following an individualized algorithm results in a high success rate but also in relatively high procedure-related morbidity. Peri-operative BMI ≥ 40 and tobacco smoking have higher odds for overall complication occurrence, while concomitant abdominal panniculectomy results in more occurrence of Clavien-Dindo category ≥ 3 morbidities. Patient's eventual satisfaction correlates well with surgical success, post-procedural erection condition, and lack of Clavien-Dindo ≥ 3 morbidity.

Place of orthopedic surgery in gout.

To evaluate the indications, surgical results, and complications related to tophaceous gout surgery in the orthopedics and traumatology clinic of our hospital. A retrospective analysis of all patients who underwent surgery for topical gout in our orthopedics and traumatology clinic between January 2008 and December 2017 was carried out. Their history, physical examination, and radiological and laboratory tests were examined. Surgical indications, surgical results, and complications were analyzed. Total 18 lesions in 15 patients with gout tophi were operated (60% males). The most common lesion was in the elbow (6; 33%). All patients underwent total excision, and the mean mass size was 4.0 cm. Only one patient had a delayed wound healing. All other patients had no complications. The results of surgical procedures which were performed to confirm the diagnosis, to reduce mechanical problems due to tophaceous and to alleviate pain were excellent, and complication risk was acceptable. Comorbidities and sepsis were the predictors of surgical complications.

Preoperative serum albumin level as a predictor of surgical complications after emergency abdominal surgery

Background: Hypoalbumenia has been shown to be associated with increased morbidity and mortality in acute surgical patients due to increased catabolism. This study intends to correlate between hypoalbumenia and postoperative complications in patients undergoing emergency abdominal surgery.Methods: A prospective study is done in a rural tertiary care centre in a total of 190 patients undergoing emergency abdominal surgery after obtaining ethical clearance. In this study preoperative serum albumin and postoperative complications including death up to postoperative day thirty were recorded and gathered using a checklist designed for the study and analysed. Serum albumin less than 3.5g/dl is considered as hypoalbumenia in this study. The correlation between preoperative serum albumin and postoperative morbidity and mortality is assessed.Results: In a total of 190 patients, 93 (48.9%) patients had morbidity and 27 (14.2%) patients had mortality. Preoperative serum albumin less than 3.5g/dl is found in 120 (63.1%) cases and 70 (36.9%) patients has same or more than 3.5g/dl. Patients with preoperative serum albumin less than 3.5g/dl has morbidity in 87 (45.8%) patients than that of normal preoperative serum albumin level which is 6 (3.1%) cases (p= &lt;0.0001, chi-square =72.31). The total mortality is 27 (14.2%) in which all mortality is found in low albumin group compared to no mortality in patients with normal serum albumin. As the albumin level decreases the risk of morbidity and mortality increases with majority of complication in this study occurring in patients with albumin group less than 2.5g/dl to 3g/dl.Conclusions: Preoperative serum albumin is a good predictor of surgical outcome after emergency abdominal surgery.

Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer.

ABSTRACTObjective:Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods:We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results:There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions:Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.

Use of the subcutaneous lumbar spine (SLS) index as a predictor for surgical complications in lumbar spine surgery

Background contextLumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes. PurposeThis study aims to further previous investigations in elucidating the predictive nature of body mass distribution with peri- and postoperative complications in lumbar surgery. Study Design/SettingThis is a retrospective study conducted at a single institution. Patient SampleTwo hundred eighty-five patients who underwent lumbar laminectomy, laminotomy, or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures between 2013 and 2016. Outcome MeasuresMagnetic resonance imaging (MRI) results and electronic medical records were reviewed for measurements and relevant complications. MethodsPreviously known risk factors were identified and MRI measurements of subcutaneous adipose depth (SAD) relative to spinous process height (SPH) were measured at the surgical site to generate the subcutaneous lumbar spine (SLS) index. This measurement was then analyzed in association with recorded surgical complications. ResultsThe SLS index was found to be a significant risk factor for total complications (0.292, p=.041), perioperative complications (0.202, p=.015), and need for revision surgery (0.285, p<.001). The SAD alone proved to be negatively associated with perioperative complications (−0.075, p=.034) and need for revision surgery (−0.104, p=.001), with no predictive association seen for total or postoperative complications. Linear regression revealed an SLS index of 3.43 as a threshold value associated with a higher risk of total complications, 5.8 for perioperative complications, and 3.81 for the need for revision surgeries. ConclusionBody mass distribution of the surgical site as indicated by SAD to SPH (SLS index) is significantly associated with increasing risk of postoperative and perioperative complications as well as increased likelihood for necessary revision surgery. This relationship was shown to be a more accurate indication of perioperative risk than previous standards of body mass index and SAD alone, and may allow spine surgeons to assess surgical risk when considering lumbar spine surgery using simple calculations from standard preoperative MRI results.

Upfront Nephrectomy for the Treatment of Wilms Tumor: Outcomes and Predictors of Complications

Wilms tumor (WT) is the most common kidney tumor in children. Upfront nephrectomy and preoperative chemotherapy, the two different treatment strategies, have not shown considerable differences in the outcomes. Research focus has turned into decreasing the incidences of posttreatment morbidity. The aim of this study is to determine the existence of prognostic factors and the predictors of surgical complications with upfront surgery following COG protocol. Medical records of patients with WT treated with upfront surgery between 2003 and 2013 were retrospectively reviewed focusing on surgical aspects and complications. Forty-five patients were identified. The mean age at diagnosis was 3.8 years (2–154 months). Thirteen of them had stage I disease (28.9%), 12 stage II (26.7%), 15 stage III (33.3%), and 5 stage IV (11.1%). Mean follow-up was 4.5 years (2–132 months). The 4-year overall survival (OS) and event-free survival (EFS) was 100 and 91.1%, respectively. There were 4 cases of disease progression (3 lung disease and 1 locoregional relapse). We had two cases of intraoperative tumor rupture (4.4%), one partial colectomy, and a distal pancreatectomy. The most common complication was associated with blood transfusion (44.4%). The existence of anaplasia was a risk factor for progression (p = 0.01). Clinical stage and tumor size positively correlated with transfusion (p = 0.001); this relationship was not observed for other complications. Clinical stage and tumor size are predictors of surgical complications and anaplasia for progression. Standardized surgical complications scales such as Clavien–Dindo should be used to properly compare surgical outcomes between different treatment approaches.

Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study

BackgroundBody surface area (BSA) is a biometric unit to measure the body size. Its clinical significance in video-assisted thoracoscopic surgery (VATS) was rarely understood. We aimed to estimate the predictive value of BSA for surgical complications following VATS anatomical resections for lung adenocarcinoma (LAC).MethodsA single-center retrospective analysis was performed on the consecutive patients between July 2014 and January 2016 in our institution. The differences in mean BSA values were evaluated between groups of patients classified by the development of postoperative surgical complications (PSCs), overall morbidity and cardiopulmonary complications, respectively. Receiver operating characteristic (ROC) analysis was performed to determine a threshold value of BSA on prediction of PSC occurrence. A multivariate logistic-regression model involving this optimal cut-off value and other significant parameters was established to identify the predictors for PSCs.ResultsDuring the study period, a total of 442 patients undergoing VATS anatomical resections for LAC were enrolled in this study. There were 135 patients developed with one or more complications (rate = 30.5%). PSCs occupied the largest percentages of all these complications (n = 81, rate = 18.3%). The mean BSA in PSC group was significantly higher than that in non-PSC group (1.76 ± 0.15 m2 vs 1.71 ± 0.16 m2; P = 0.016). No difference was found in mean BSA values between groups classified by any other complication. The ROC analysis determined a BSA value of 1.68 m2 to be the threshold value with the maximum joint sensitivity of 72.8% and specificity of 48.5%. Compared to patients with BSA ≤ 1.68 m2, patients with BSA > 1.68 m2 had significantly higher incidences of prolonged air leak (P = 0.006) and chylothorax (P = 0.004). Further multivariate logistic-regression analysis indicated that BSA > 1.68 m2 could be an independent risk factor for PSCs (odds ratio: 2.03; P = 0.025).ConclusionsBSA is an excellent categorical predictor for surgical complications following VATS anatomical resections for LAC. It may be considered when informing patients about surgical risks and selecting cases in the early learning curve. Large-scale and multi-institutional studies are expected to confirm and modify our findings in the future.

67S-ICD implantation in the young: low BMI as a predictor of surgical complications

67S-ICD implantation in the young: low BMI as a predictor of surgical complications