Preoperative ASA Score Research Articles

Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period.

BackgroundDiverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure.Patients and methodsAt our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient’s preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate.Results218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient’s ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p<0. 05).ConclusionsTo reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.

P42. Can 6- and 12-month opioid usage predict long-term opioid use in ASD patients?

BACKGROUND CONTEXT Long-term opioid use is common among ASD patients, and it is a cause of significant morbidity. PURPOSE This study aims to evaluate whether opioid use at 6 and 12 months post-surgery are predictive of long-term use at 2 years following surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Retrospective review of all ASD surgical patients treated at a single center between January 1, 2013 and December 31, 2016 with 2-year follow-up. OUTCOME MEASURES Self-reported opioid use at 2-year follow-up. METHODS Retrospective review of all ASD surgical patients treated at a single center with 2-year follow-up. Patient demographics, surgical details and self-reported daily opioid use at each visit were collected. Clinical records were reviewed for the preoperative evaluation and each postoperative visit (1.5, 3, 6, 12 and 24 months). Patients who restarted opioid use in the follow-up period due to a revision or other surgery were excluded. Patients were classified as opioid-users if they reported taking opioid medications during their preoperative evaluation and as opioid-naive if they did not. Logistic regression including age, sex, preoperative opioid use, ASA score, and number of vertebral levels fused was used to evaluate 6- and 12-month postoperative opioid use as risk factors for 2-year opioid use. RESULTS A total of 60 patients met the inclusion criteria and had 2-year follow-up including self-reported opioid intake. Seventy-seven percent (46) of patients were classified as opioid-users and 23% (14) were classified as opioid-naive. Forty-nine percent (20/41) of patients reporting opioid use at 6 months post-surgery and 29% (9/31) of patients reporting use at 12 months ceased opioid use by 2-year follow-up. Opioid usage at 12-month follow-up independently predicts opioid use at 2-year follow-up (adjusted OR = 16.3, 95% CI: [4.0, 113.4], p CONCLUSIONS Opioid use at 12 months is a strong independent predictor of opioid use at 2-year follow-up, while nearly half of patients using opioids 6 months post-surgery successfully cease opioids within 2 years. ASD patients reporting preoperative opioid use have consistently higher rates of opioid use at a given time point compared to opioid-naive patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Risk factors for lymph nodes involvement in obese women with endometrial carcinomas

ObjectiveTo assess risk factors for lymph node involvement in patients with endometrial cancer and a body-mass index (BMI) ≥30 kg/m2. Materials and methodsA retrospective analysis was performed of obese patients diagnosed with endometrial carcinoma between 2007 and 2015, treated in a single center in Montreal. Preoperative variables evaluated were age, BMI, parity, and preoperative ASA score, grade, CA-125 and histology. Odds ratios (OR) and hazard ratios (HR) and their respective 95% confidence intervals (95%CI) were calculated using multivariable logistic regression and Cox proportional hazard models. ResultsThe study included 230 women with BMI ≥30, 223 (97.0%) had complete staging. Pelvic lymph node involvement was detected in 26 patients (11.3%). Sentinel node detection and pelvic lymph node dissection decreased with increasing BMI (adjusted OR 0.86, 95%CI 0.76–0.97 and 0.76, 95%CI 0.59–0.96, respectively, per 1 kg/m2 increment). Pelvic lymph node involvement was inversely correlated with BMI (adjusted OR 0.88, 95%CI 0.79–0.99) and present in 16/85 (18.8%), 6/56 (10.7%), and 4/82 (4.9%) of patients with a BMI of 30.0–34.9, 35.0–39.9, and ≥40.0 kg/m2, respectively. Preoperative CA-125 was associated with lymph node involvement (adjusted OR 2.77, 95%CI 1.62–4.73, per quartile increment). ConclusionPelvic lymph node dissection might be omitted in selected cases of morbidly obese patients with failed sentinel nodes mapping and a low CA-125.

Preoperative risk stratification of patient mortality following elective craniotomy; a comparative analysis of prediction algorithms

Factors associated with mortality following craniotomy for non-traumatic etiologies are not well studied. We performed a retrospective case-control study to investigate the utility of the Gupta, RCRI, KPS, ASA, and NSQIP risk calculators in predicting complication and mortality rates among a neurosurgical patient population undergoing elective craniotomy and used ROC curves to determine their relative predictive accuracy. We identified 17 patients who died following elective craniotomy and 17 control patients who survived, matched for sex, age, comorbid conditions, and intervention. The deceased cohort experienced a greater degree of surgical complications, with concordantly higher preoperative risk scores as assessed by Gupta, KPS, ASA, and NSQIP scales. Cause of death was secondary to a surgical complication in 11 (65%) cases and nonsurgical in 6 (35%) cases. When comparing our deceased and survival cohorts for specific complication profiles, higher RCRI score was significantly associated with postoperative cardiac death. Poor preoperative ASA and KPS score were both associated with mortality. NSQIP risk was significantly associated with mortality and nonsurgical and cardiopulmonary complications. ROC analyses comparing predictive scales found no clearly superior prediction algorithm for postoperative complications or mortality; NSQIP and RCRI were highly predictive of cardiac death, KPS and NSQIP with nonsurgical complications, and Gupta, ASA, KPS, and NSQIP with postoperative mortality. NSQIP scores correlated most broadly with nonsurgical complications and mortality. Future efforts at quality improvement in healthcare value will be rooted in the development of more accurate and specific risk assessment strategies specific to neurosurgery.

Factors influencing early postoperative complications following surgery for symptomatic spinal metastasis: a single-center series and multivariate analysis.

Patients presenting with neurological deficits and/or pain due to spinal metastasis usually require immediate or subacute surgical treatment. Nevertheless, it is unclear whether or not side effects of primary cancer location might influence postoperative complication rate. We therefore analyzed our spinal database to identify factors influencing early postoperative complications after surgery for symptomatic spinal metastases. From 2013 to 2017, 163 consecutive patients suffering from symptomatic spinal metastases were treated at our department. Early postoperative complications were defined as any postoperative event requiring additional medical or surgical treatment within 30days of spinal surgery. A multivariate regression analysis was performed to identify independent predictors for postoperative complications after surgery for spinal metastasis. Overall, 39 of 163 patients who underwent spinal surgery for spinal metastasis developed early postoperative complications throughout the treatment course (24%). Preoperative ASA score ≥ 3 (p = 0.003), preoperative C-reactive protein level > 10mg/l (p = 0.008), preoperative Karnofsky Performance Score < 60% (p = 0.03), radiation treatment within 2months of surgery (p = 0.01), presence of diabetes mellitus (p = 0.008), and preoperative complete neurological impairment (p = 0.04) were significant and independent predictors for early postoperative complications in patients with surgery for spinal metastasis. The ability to preoperatively predict postoperative complication risk is valuable to select critically ill patients at higher risk requiring special attention. Therefore, the present study identified several significant and independent risk factors for the development of early postoperative complication in patients who underwent surgery for spinal metastasis.

Short-term outcomes of laparoscopic hepatectomy in extremely elderly patients

Introduction: In developed countries, Laparoscopic hepatectomy has been widely performed in recent years. However, few studies have reported the outcome of laparoscopic hepatectomy in elderly patients. Herein we report short-term outcomes of laparoscopic hepatectomy in extremely elderly patients. Methods: From July 2006 to August 2017, 71 patients underwent laparoscopic hepatectomy at Jikei University Hospital. Of these, seven patients (10 %) were older than 80 years at surgery. We compared the short-term outcomes of laparoscopic hepatectomy in extremely elderly patients (≥ 80 years of age; (group A, n=7) and non-extremely elderly patients (< 80 years of age; (group B, n=64), as well as extremely elderly patients undergoing open minor hepatectomy during the same period (group C, n=13). Result: The mean age of Group A, B, and C were 82.6, 59.7 and 83.9 years, respectively. The preoperative ASA score (1/2/3) was 0/6/1 in group A, 11/46/7 in group B, and 0/12/1 in group C. The indications (primary cancer/metastatic/others) in group A, B, and C was 3/4/0, 32/18/14, and 8/5/0, respectively. The conversion rates from laparoscopy to laparotomy, and the postoperative hospital stay were comparable between group A and B (14% versus 16%, p=1.000; 9.7 days versus 8.8 days, p=0.802). The incidences of postoperative complications among three groups were comparable {14%, 8% versus 15%, p (A versus B) =0.559, p (A versus C) =0.948}, and there was no in-hospital mortality in these three groups. Conclusion: Laparoscopic hepatectomy seems to be safe and acceptable in extremely elderly patients.

Significance of poor performance status after resection of colorectal liver metastases

BackgroundPerformance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer patients. The aim of the present study was to analyze factors associated with poor PS assessed after resection for colorectal liver metastases and the impact on survival.MethodsAll patients undergoing curative resection for colorectal liver metastases between 2010 and 2015 in a single center were reviewed retrospectively.ResultsA total of 284 patients were included, out of whom 74 patients (26%) presented with a postoperative PS WHO > 2 precluding administration of adjuvant chemotherapy. These patients had a shorter recurrence-free survival (P = 0.002) and shorter overall survival (P < 0.001). Multivariable analysis showed that patients with PS > 2 after surgery had higher preoperative ASA score, had a higher frequency of major complications after surgery, and had more frequently synchronous liver and lung metastases. PS was found to be the strongest independent factor predicting survival (hazard ratio 0.45). When patients with postoperative PS > 2 developed recurrent disease (54 of 74), 43 (80%) received tumor specific treatment.ConclusionsPatients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased recurrence-free and overall survival after liver resection for colorectal liver metastases. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment.

Minimally invasive liver resection for primary and metastatic liver tumors: influence of age on perioperative complications and mortality.

As minimally invasive technique becomes more popular, an increasing number of elderly patients were considered for minimally invasive liver resection (MILR). Limited physiologic reserve remains a major concern, which frequently leads surgeons to recommend nonresectional alternatives. We sought to evaluate complications and outcomes of elderly patients undergoing MILR. Eight hundred and thirty-one patients who underwent MILR were classified into groups A, B, and C based on age [(< 70, n = 629), (70-79, n = 148), (≥ 80, n = 54) years old, respectively]. Gender distribution, BMI, and cirrhotic status were comparable among all groups. Groups B and C had higher MELD (p = 0.047) and ASA (p = 0.001) scores. Operative time (170, 157, 152min; p = 0.64) and estimated blood loss (145, 130, 145ml; p = 0.95) were statistically equal. Overall postoperative complications were greater in groups B and C (12.9 and 9.3 vs. 6.5%, respectively). Complications in group C were all minor. Clavien-Dindo grade III-IV complications were higher in group B when compared to group A (6.8 vs. 2.7%, p = 0.43). There was no significant difference in cardiopulmonary complications, thromboembolic events, ICU admissions, and transfusion rates seen in groups B and C when compared to group A. Duration of hospital stay was statistically longer in groups B and C (3.6, 3.5 vs. 2.5 days, p = 0.0012). 30- and 90-day mortality rates were comparable among the groups, irrespective of age. In spite of greater preoperative comorbidities and ASA score, there was no significant increase in postoperative morbidity after minimally invasive liver resection in patients ≥ 70years of age.

Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy.

BackgroundWe aimed to evaluate postoperative recovery and short-term outcomes of patients undergoing partial hepatectomy managed with a nonstrict and individual enhanced recovery after surgery (ERAS) program.MethodsA retrospective analysis of 168 partial hepatectomy patients in our institution was included. The discharged day and the respective impact of element application throughout the duration were analyzed.ResultsWhen all the required elements of ERAS were fully implemented, the median discharge day was 6. The more deviation occurred, the more delayed the patient discharged (P < 0.01). Preoperative ASA score, basic conditions of patients and ages were revealed closely associated with discharge day (P < 0.001). Without or an early removal of tubes and early oral feeding reduced hospital stay statistically (P < 0.01). Early discharge of patients (<3 days) did not show an increased complication incidence or readmission (P > 0.05).ConclusionNonstrict and individual use of ERAS in partial hepatectomy reduced postoperative length of stay without increasing complication rate. Our study proposes a modulation of ERAS according to the needs and acceptance of patients. In a word, better optionally required rather than mandatorily meet.

Is arthroplasty preferable to internal fixation for the treatment of extracapsular fracture of the upper femur in the elderly?

IntroductionAlthough internal fixation is the reference treatment for extracapsular fracture of the upper femur, indications for arthroplasty are broadening, especially in unstable comminutive fracture in fragile bone. The present study hypothesis was that arthroplasty reduces early mortality and morbidity and provides better recovery of autonomy in over-80 year-old patients than does internal fixation. Material and methodsA prospective multicenter study was conducted on 8 sites. Internal fixation was systematically used in 5 centers; arthroplasty was used systematically in 1 center, and reserved for unstable fracture in 2 centers. A total of 697 patients aged over 80 years (mean age, 85±5 years), presenting with extracapsular fracture, were included; 521 were treated by internal fixation and 176 by arthroplasty. Results were studied on multivariate analysis of ASA score, blood loss, transfusion, and also of treatment modality as an independent factor for early (first 6 months) mortality and morbidity (mechanical, general and nutritional complications) and functional outcome (autonomy and dependence). ResultsOverall mortality was 19.2%. Autonomy deteriorated in 56% of patients alive at 6 months and dependence worsened in 44%. Two percent of those managed by internal fixation underwent revision for disassembly (n=8) or infection (n=1). Eight percent of those managed by arthroplasty underwent revision for dislocation (n=4), implant loosening (n=3) or infection (n=7). On univariate analysis, mortality was higher in the arthroplasty group (25%) than with internal fixation (17%; P=0.002), as were blood loss (425±286mL versus 333±223mL; P<0.0001), transfusion rate (61% versus 32%; P<0.0001) and infection (4% versus 0.2%; P<0.001). On multivariate analysis, however, treatment modality no longer showed impact on mortality or on morbidity and autonomy at 6 months. Nutritional status was better conserved at 6 months following arthroplasty, but dependence worsened. Poor preoperative autonomy, ASA score, and nutritional status and time to treatment were independent factors for mortality. Transfusion, associated with onset of mechanical complications, significantly increased dependence. ConclusionType of treatment had little impact on mortality, morbidity or functional outcome. Differences seemed more related to preoperative functional and nutritional status. Level of evidenceIII, prospective case-control study.

Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty.

Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss.

MP11-02 IMPACT OF RESIDENT TRAINEE INVOLVEMENT ON ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP) OUTCOMES.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2016MP11-02 IMPACT OF RESIDENT TRAINEE INVOLVEMENT ON ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP) OUTCOMES. Eric Schommer, Kolbi Tonkovich, Zhou Li, and David Thiel Eric SchommerEric Schommer More articles by this author , Kolbi TonkovichKolbi Tonkovich More articles by this author , Zhou LiZhou Li More articles by this author , and David ThielDavid Thiel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2373AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study examines peri-operative outcomes of RARP and their association with resident trainee involvement in different steps of RARP. METHODS RARP was divided into 7 steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens (sv/vas), pedicle/nerve sparing, apex, and anastomosis. 372 RARP performed by a single surgeon from July 2007 to February 2015 were analyzed. Resident console time (RCT) during each of the 7 key steps was recorded. Peri-operative variables were compared between surgeon-only (SO) and resident-involved (RI) cases. Vital outcomes of trainee performance on the key steps were compared using two sample t-test or Wilcoxon rank sum test. RESULTS Residents performed on the console for 232 of 372 cases (62.4%). Preoperative BMI (mean 28.4), PSA (mean 6.7), Gleason score (6-7 88.7%, 8-10 11.3%), ASA score (mean 2.4), AUA score (mean 8.9) and SHIM score (mean 15.9) were similar between SO and RI cases. 2nd year resident status (P <0.0001) and pre-operative PSA > 10 (P=0.0093) were associated with no RCT. Estimated blood loss (P=0.09), transfusion (P=0.11), and complications (P=.33) were no different between SO and RI cases. Mean OR time (ORT) was less for the SO cases (190.4 vs. 206.4 min, P=0.003). There was no difference in positive margins (P=0.79), length of stay (LOS) (P=0.30), catheter days (P=0.17), readmission (P=0.33), reoperation (P=0.73), home with drain (P=0.88), or undetectable 6 month PSA (P=0.07) when comparing SO to RI cases. Residents performing BN step had no effect on BN margins (P=0.73), prolonged catheterization (P=0.62), home with drain (P=0.4121), or 6 month undetectable PSA (P=0.1070). ORT was not affected by resident performing anastomosis (P=0.08) or sv/vas (P=0.82), but was significantly prolonged if BTD performed by trainee (233.0 vs. 191.7min, P <0.0001). Residents performing anastomosis had no effect on prolonged catheter time (P=0.62), home with drain (P=0.41), or LOS (P=0.20). Residents were more likely to be involved in at least one portion of the case (74.0% vs. 56.6%, P=0.0012), in BN (63.4% vs. 30.6% P <0.0001), and anastomosis (48.0% vs. 15.3%, P <0.0001) following purchase of Mimic simulator (Mimic Technologies, Inc., Seattle, WA, USA) in January 2012. CONCLUSIONS Supervised RCT in RARP does not negatively affect peri-operative patient outcomes although it prolongs ORT compared to SO cases with the BTD step adding the most operative time. The acquisition of a robotic simulator appears to have increased RCT in various steps of RARP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e111 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eric Schommer More articles by this author Kolbi Tonkovich More articles by this author Zhou Li More articles by this author David Thiel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The anaesthetic assessment, management and risk factors of bariatric surgical patients requiring postoperative intensive care support: a state-wide, five-year cohort study.

Bariatric surgery is a rapidly growing and dynamic discipline necessitating a specialised anaesthetic approach coordinating high-risk patients with appropriate post-operative intensive care (ICU) support. The relationship between the anaesthetic and ICU utilisation after bariatric surgery is poorly understood. All adult bariatric surgery patients admitted to any ICU over a five-year period between 2007 and 2011 in Western Australia were identified from hospital admission records and cross-referenced against the Western Australian Department of Health Data Linkage Unit database. During the study period 12,062 patients under went bariatric surgery with 581 (4.8%) patients admitted to ICU immediately following surgery. The mean pre-operative ASA score was 3.3 [standard deviation 1.1] with 76.9% of patients were assessed by their anaesthetist for the first time on the day-of-surgery. Blood pathology (75%) and ECG (46.3%) were the most common preoperative investigations. Intra-operatively, 2.1% of patients had a grade 4 intubation with only 3.4% of patients requiring a videoscopic assisted intubation. Despite being deemed at high risk, 23.6% of patients were managed with 20 gauge or smaller intravenous access. Anaesthetic complications were extremely uncommon (0.5% of all bariatric cases) but accounted for 9.7% of all postoperative ICU admissions. Smoking history, but not body-mass-index (P=0.46), was the only significant prognostic factor for respiratory or airway related anaesthetic complications (P=0.012). In summary, the anaesthesia management of bariatric surgery varied widely in Western Australia, with smoking as the only significant preoperative risk factor for respiratory or airway related anaesthesia complications.

Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours; group 2 patients treated between 48 to 96 hours; group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value < 0.05 was regarded significant. Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06); patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.

Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors

BackgroundProximal femoral fractures are often seen in older patients and are associated with high mortality. Introduction to old age population is latening due to advancements in medical sciences and increasing life expectancy. ObjectivesThe aim of the study was to evaluate factors affecting mortality in patients above 75 years of age who had been operated because of proximal femur fractures. Patients and methodsPatients with age 75 and over who suffers from post-fall proximal femoral fracture who underwent surgery with one of following three methods (hemiarthroplasty, proximal femoral nail or total hip arthroplasty) were evaluated retrospectively. Effects on mortality were examined for factors such as type of surgery, type of anesthesia, preoperative ASA score (American Society of Anesthesiologists Score), need for intensive care, need for blood transfusion, operation waiting time and hospitalization duration. 115 patients who met inclusion criterion were included in the study out of 224 overall. 75 patients were women and 40 were males. ResultsMortality rate after first year was found to be 40%. Patients over 85 years old had higher rates of mortality (p = 0,0003) than respectively younger patients (75–85). Sex was found to have no impact on mortality (p = 0.5039). There was no statistically significant difference in terms ASA score (p = 0.1518). Order of applied surgical methods with mortality risk rates was found to be total hip arthroplasty > hemiarthroplasty > proximal femoral nail (p = 0.0003). Type of anesthesia, the use of cement during arthroplasty, operation waiting time and hospitalization duration was not directly related with mortality rate (type of anesthesia p = 0.63, the use of cement during arthroplasty p = 0.223, operation waiting time p = 0.5 and hospitalization duration p = 0.19). ConclusionsAge is the primary risk factor on first year mortality in patients older than 75 years old with hip fractures. Addition to older age, more need to blood transfusions, and arthroplasty are other risk factors for first year mortality. It should be kept in mind that after 75 years old first year mortality may be higher if the patient is treated with arthroplasty.

The modified Harrington procedure for metastatic peri-acetabular bone destruction

We describe the outcome in a series of patients treated for metastatic peri-actetabular and iliac bone destruction using a modified technique of Harrington's procedure. Between 2006 and 2012, nine patients with a mean age of 62.2 years (42-75 years) were treated using a modified Harrington technique. Thereby, total hip replacement implants augmented by two to three threaded pins and cement were used to restore bony continuity of the pelvis and to achieve a stable construction allowing immediate full-weight bearing mobilisation. Acetabular destruction was graded according to Harrington's classification of peri-acetabular metastatic destruction, as class IV in one case, class III in six, and class II in two cases. The pre-operative ASA score ranged from II-IV. There were no intra-operative deaths or major complications such as excessive haemorrhage, deep infections, lesions of the femoral nerve, loss of fixation, or dislocations at final follow-up. Eight patients achieved an improvement of their functional status postoperatively. One reconstruction required revision and four patients died due to their underlying disease ten to 36 months after surgery. We found this technique an effective, reproducible, and long-lasting method to relieve pain and improve or restore function in patients with destructive metastatic lesions of the peri-acetabular bone and the iliac wing. Although we performed surgery even in severely ill patients with extended, generalised metastatic disease we had no intra- or postoperative death and observed no major complications.

Predictors of blood transfusion in patients undergoing elective surgery for degenerative conditions of the spine

The requirement of blood in the surgery of degenerative conditions of lumbar spine is around 10 %. Preoperative autologous blood donation is an effective method that is used in surgeries with an important blood loss. This is an expensive method because of the great number of predonated blood units not used in the postoperative period (around 70 % in our practice). To know the risk factors associated with transfusion in the postoperative period in patients who undergo surgeries of degenerative conditions of the lumbar spine. We designed a retrospective study of 142 cases of patients operated for degenerative conditions of the lumbar spine (not including simple disk hernia or adult degenerative scoliosis). Female sex, age >60 years, preoperative ASA score 3 and preoperative hemoglobin ≤136 g/L are the risk factors related to the need of blood transfusion in the postoperative period. After application of a statistical study, female sex and preoperative ASA score 3 were the most important variables to explain transfusional risk. A woman with ASA score 3 has a 61 % foretold probability to be transfused in the postoperative period, while a man with ASA < 3, only 1.1 %. For this reason, application of this method to patients with these risk factors is more cost-effective. Females, ASA 3, preoperative hemoglobin ≤136 g/L and age older than 60 years increase the risk to be transfused in the postoperative period for degenerative conditions of the spine.

The impact of preoperative ASA score and serum albumin on early complication and survival rate of patients undergoing radical cystectomy for bladder cancer.

4576 Background: American Society of Anesthesiologist Score (ASA-S) is used to evaluate patient physical status before surgery. Serum albumin (Alb) is also a marker of nutritional status. We evaluated the impact of preoperative ASA-S and Alb on early complication rate and survival of patients who underwent radical cystectomy for bladder cancer. Methods: 1964 patients with primary bladder cancer underwent radical cystectomy between 1971 and 2008 at USC. Preoperative serum Alb and ASA-S were available in 1471 and 1140 patients respectively. Post cystectomy early complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission within 90 days of surgery. Recurrence free survival (RFS) and overall survival (OS) for these cohorts were reviewed using a Kaplan-Meier and Cox proportional hazards models. Results: The demographic data of patients based on their serum Alb and ASA-S is presented in the Table. The median follow up was 12.4 years (0 - 36.6 yrs). Low serum Alb (&lt;3.4 g/dL) and high ASA-S (3 or 4) were associated with higher early complication rate (43% vs. 33%, p= 0.03 and 40% vs. 28%, p= 0.0001 respectively). In multivariable analysis, low serum Alb level was an independent predictor of RFS (HR 1.35, 95% CI 1.00-1.81) and OS (HR 1.62, 95% CI 1.29-2.04). High ASA-S was an independent predictor of OS (HR 1.45, 95% CI 1.13-1.85), but not RFS. Conclusions: Preoperative low serum Alb and high ASA-S are independently predictive of post cystectomy decreased OS. Low serum Alb is also a risk factor for recurrence after cystectomy. These parameters potentially could be used in nomograms to predict post-cystectomy prognosis. [Table: see text]

2162 A PROSPECTIVE RANDOMIZED TRIAL COMPARING TRANSURETHRAL HOLMIUM LASER ENUCLEATION OF THE PROSTATE WITH TRANSURETHRAL ELECTROCAUTERY RESECTION OF THE PROSTATE FOR THE TREATMENT OF BLADDER OUTLET OBSTRUCTION SECONDARY TO BENIGN PROSTATIC HYPERPLASIA IN LARGE GLANDS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122162 A PROSPECTIVE RANDOMIZED TRIAL COMPARING TRANSURETHRAL HOLMIUM LASER ENUCLEATION OF THE PROSTATE WITH TRANSURETHRAL ELECTROCAUTERY RESECTION OF THE PROSTATE FOR THE TREATMENT OF BLADDER OUTLET OBSTRUCTION SECONDARY TO BENIGN PROSTATIC HYPERPLASIA IN LARGE GLANDS Hosni Khairy Salem, Enmar Habib, Ashraf Aggour, Sherif Abd El Rahman, and Mohammed El Gammal Hosni Khairy SalemHosni Khairy Salem Cairo, Egypt More articles by this author , Enmar HabibEnmar Habib Cairo, Egypt More articles by this author , Ashraf AggourAshraf Aggour Cairo, Egypt More articles by this author , Sherif Abd El RahmanSherif Abd El Rahman Cairo, Egypt More articles by this author , and Mohammed El GammalMohammed El Gammal Cairo, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2335AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail WITHDRAWN © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e872 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hosni Khairy Salem Cairo, Egypt More articles by this author Enmar Habib Cairo, Egypt More articles by this author Ashraf Aggour Cairo, Egypt More articles by this author Sherif Abd El Rahman Cairo, Egypt More articles by this author Mohammed El Gammal Cairo, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2167 CAN WE PREDICT THE OUTCOME OF GREEN LIGHT LASER PVP (PHOTOSELECTIVE VAPORIZATION OF PROSTATE)? TIME TO EVENT ANALYSIS

INTRODUCTION AND OBJECTIVES: PVP has an established efficacy for treatment of BPH related LUTs. This work aims at objective assessment of the surgical outcome of green laser PVP using standardized tools with time to reintervention analysis. METHODS: A retrospective analysis of single surgeon series including 268 PVP procedures was done. Patients’ charts were reviewed for demographic data, perioperative variables & details of follow up visits. Perioperative and late complications were recorded and graded over modified Clavien scale. The time of reintervention was reported and analyzed to the date of surgery. Independent variables with an influence on complications were studied. Contingency and logistic regression were used for univariate and multivariate analysis. RESULTS: Mean age at time of surgery was 69.2 Ys, ASA score 2 or more was found in 11.2% and mean prostate size was 43.9ml (15-129). Mean preoperative Q max, PVR, IPSS & QOL scores was (8ml/sec, 263ml, 19.3 & 3.6). Mean energy utilization was 156.8KJ (12.5-581). Auxiliary measures to complete the procedure were indicated in 12% of cases; 7.1% for hemostasis and 5.9% for resection of residual tissue. Mean Q max, PVR, IPSS& QOL scores at 1 month, 1 year & 5 years was (18.7ml/sec, 68.1ml, 9.2, 1.9), (18.36ml/sec, 71.6ml, 7.2, 1.4) & (14.5ml/sec, 61ml, 6.8, 1.1) respectively. After mean of 76.4 ms follow up, low grade complications occurred in 27.6% & high grade (G3b-5) in 0.4% Table 1. Among G3 complications 70% of reinterventions were in the 1st year postoperative Figure 1. High preoperative ASA score ( 2) was the only significant predictor for reintervention (odds ratio 2.65, 95% CI 1.08-6.5, P 0.03). Post operative diagnosis of prostate cancer occurred in 1.5%. CONCLUSIONS: Green laser PVP has sustained good functional outcome with negligible high grade complications. However, reoperation rate may reach up to 10% with most of reintervention in the 1st postoperative year with significant association with morbidity index suggesting the need to shorten the operative time. Table 1. Modified Clavien assessment of complications