Preoperative Diabetes Mellitus Research Articles

The prognostic significance of modified frailty index-5 in patients undergoing pneumonectomy for lung cancer.

In some centrally located lung cancers, complete excision of the mass cannot be achieved with parenchymal-sparing procedures and pneumonectomy may be required. The mortality and morbidity rates of pneumonectomy were reported to be considerably high. Here, we investigated the effectivity of modified frailty index-5 (MFI-5) in patients undergoing pneumonectomy for non-small cell lung cancer. Data of patients who underwent pneumonectomy for non-small cell lung cancer between January 2018 and December 2023 were reviewed retrospectively. The MFI-5 score was determined by preoperative diabetes mellitus, hypertension, chronic obstructive pulmonary diseases, congestive heart failure and functional status. The effectiveness of the MFI-5 score for the presence of postoperative major complications and 30-day mortality was investigated by multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant. A total of 107 patients who met the inclusion criteria were included in the study. Eight (7.5%) of patients were female, and the mean age was 61.4 ± 8.7. The MFI-5 score was 0 in 48 patients (44.9%), 1 in 27 patients (25.2%) and 2 in 20 patients (18.7%). Postoperative 30-day mortality was detected in 4 patients (3.7%), and the major complications occurred in 42 patients (39.3%). In multivariate analysis, an MFI-5 score of 2 or higher (P = 0.008, OR: 4.9) was statistically significant for complications, whereas age, gender, side of the operation, <2 MFI-5 score, tumor diameter, type of surgery and lymph node metastasis status were not statistically significant (P > 0.05). The MFI-5 score is a significant indicator for predicting major postoperative events in patients who underwent pneumonectomy for non-small cell lung cancer. 2024-323, approved by Gazi University Local Ethics Committee.

Long-term changes in cardiac geometry and mechanics after bariatric surgery- insights from the FatWest study

Abstract Background Patients with severe obesity have a high prevalence of subclinical cardiac organ damage including impaired longitudinal and radial cardiac mechanics. Previous studies on the impact of bariatric surgery on cardiac remodeling, most of them with short patient follow-up, have yielded inconsistent results. Purpose To assess progressive changes in cardiac geometry and mechanics up to five years following bariatric surgery. Methods In the prospective Bariatric Surgery on the West Coast of Norway (FatWest) study, cardiac remodeling was assessed by 2D echocardiography preoperatively and at six months, one year and five years after Roux-en-Y gastric bypass in a cohort of 97 patients (44±10 years, 72% women, body mass index [BMI] 41.8±4.8 kg/m²). Excess weight loss (EWL) was calculated as: absolute weight loss/(initial weight-ideal weight)x100. Left ventricular (LV) size was assessed by the LV mass/ height^2.7, LV longitudinal mechanics by the peak global longitudinal strain (GLS) and radial mechanics by the midwall shortening (MWS). LV myocardial oxygen demand was estimated from the LV mass-wall stress-heart rate product. Right ventricular diameter was measured in the basal one-third of the ventricular cavity. Left atrial (LA) reservoir function was assessed by the LA emptying fraction. Results After a mean follow-up of 63±13 months, the average postoperative EWL was 66%. Overall, both right ventricular diameter, LV mass index, LV GLS, myocardial oxygen demand and LAEF (68% vs. 64%) improved significantly at the 5-year follow-up (all p&amp;lt;0.05), while MWS remained unchanged (Figure). Prevalence of normal LV geometry increased gradually from 56% to 80%, while that of LV hypertrophy fell from 36% to 16% (p&amp;lt;0.001). Analyses of temporal trends showed that improvement in BMI, LV mass and LV GLS occurred during the first postoperative year (Figure). In Cox regression analysis, a low 5-year GLS was associated with preoperative hypertension after adjustment for age, sex, preoperative diabetes mellitus, and postoperative changes in BMI, mean blood pressure and myocardial oxygen demand (p&amp;lt;0.01). In a similar linear model, after adjustment for the same covariates, LV mass index at the 5-year follow-up was independently related to the magnitude of the postoperative BMI reduction (R² = 0.58, p&amp;lt;0.001). Conclusion Ventricular size and longitudinal mechanics are significantly improved 5 years after bariatric surgery, with the reverse remodeling occurring during the first postoperative year. Residual abnormal 5-year LV geometry and mechanics are related to preoperative hypertension and suboptimal BMI reduction.Figure

Recurrence risk analysis for stage II and III colorectal cancer, and the implications of diabetes mellitus as a risk factor for the recurrence of stage III colorectal cancer.

The present study investigated the risk factors for recurrence in patients with stage II-III colorectal cancer (CRC) who underwent colorectal surgery. Data from 232 patients with stage II and III CRC who underwent primary tumor resection were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors for recurrence. The overall recurrence rate was 21.6% (n=50/232). Univariate Cox regression analysis identified diabetes mellitus (DM) (P=0.032) as a risk factor for recurrence. In addition, multivariate Cox regression analysis showed that DM was an independent risk factor for recurrence-free survival (RFS) (hazard ratio 2.40, P=0.016). The RFS curve obtained using the Kaplan-Meier method indicated that in patients with stage III colon cancer, the non-DM group demonstrated a significantly longer RFS than the DM group (P=0.012). In conclusion, the present study demonstrated that DM may be an independent risk factor for recurrence in patients undergoing curative resection for stage III CRC. Consequently, better postoperative therapy and careful monitoring might be required, especially in patients with stage III CRC and preoperative DM.

Partial pancreatoduodenectomy versus total pancreatectomy in patients with preoperative diabetes mellitus: Comparison of surgical outcomes and quality of life.

To reduce perioperative risks among patients with a preoperative diabetes mellitus (DM) a total pancreatectomy (TP) might be a alternative to pancreatoduodenectomy (PD). This study aimed to compare the postoperative quality of life (QoL) of patients with preoperative DM undergoing PD or TP. A single-centre retrospective study was conducted, all consecutive patients with preoperative DM undergoing PD or TP between 2011 and 2023 were identified in a prospective database. The primary endpoint was QoL, prospectively assessed using EORTC QLQ-C30 questionnaires at 3, 6, and 12months after surgery and then annually until death. Secondary endpoints were morbidity and mortality. Seventy-one patients were included, 17 after TP and 54 after PD. Insulin-dependent DM occurred in 21 (39%) of the PD patients. QoL was worse after TP, especially in terms of physical functioning (-31.7 points; 95% CI: -50.0 to -13.3; P < 0.001), role functioning (-41.3 points; 95% CI: -61.3 to -21.3; P < 0.001), emotional functioning (-27.5 points; 95% CI: -50.4 to -4.6; P = 0.019), fatigue symptoms (20 points; 95% CI: 2.7 to 37.4; P = 0.024) and pain symptoms (30.2 points; 95% CI: 4.1 to 56.3; P = 0.024). The rates of postoperative major complications (29% vs. 35%; P = 0.853) and mortality (11% vs. 7%; P = 0.857) were similar between TP and PD. Postoperative morbidity and mortality were comparable between PD and TP, however QoL is significantly lower after TP. Importantly, patients with preoperative DM have a 60% chance of remaining noninsulin-dependent after PD.

Association between diabetes status and long-term outcomes following open and endovascular repair of infrarenal abdominal aortic aneurysms

ObjectiveCurrent literature reports conflicting findings regarding the effect of diabetes mellitus (DM) on outcomes of abdominal aortic aneurysm (AAA) repair. In this study we examined the effect of DM and its management on outcomes after open AAA repair (OAR) and endovascular AAA repair (EVAR). MethodsWe identified all patients undergoing OAR or EVAR for infrarenal AAA between 2003 and 2018 in the Vascular Quality Initiative registry data linked with Medicare claims. We excluded patients with missing DM status. Patients were stratified by their preoperative DM status, and then further stratified by DM management: dietary, noninsulin antidiabetic medications (NIMs), or insulin. Outcomes of interest included 1-year aneurysm sac dynamics, 8-year aneurysm rupture, reintervention, and all-cause mortality. These outcomes were analyzed with the χ2 test, Kaplan-Meier methods, and multivariable Cox regression analyses. ResultsWe identified 34,021 EVAR patients and 4127 OAR patients, of whom 20% and 16% had DM, respectively. Of all DM patients, 22% were managed by dietary management, 59% by NIM, and 19% by insulin. After EVAR, DM patients were more likely to have stable sacs, whereas non-DM patients were more likely to have sac regression at 1 year. Compared with non-DM, DM was associated with a significantly lower risk for 8-year rupture in EVAR (EVAR hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.51-0.92). Compared with non-DM, NIM was associated with lower risk of rupture within 8-years for both EVAR and OAR (EVAR HR, 0.64; 95% CI, 0.44-0.94; OAR HR, 0.29; 95% CI, 0.41-0.80), whereas dietary control and insulin had a similar rupture risk compared with non-DM. However, compared with non-DM, DM was associated with a higher risk of 8-year all-cause mortality after EVAR and OAR (DM vs non-DM: EVAR HR, 1.17; 95% CI, 1.11-1.23; OAR HR, 1.16; 95% CI, 1.00-1.36). After further DM management substratification, compared with non-DM, management with NIM and insulin were associated with a higher 8-year mortality in EVAR and OAR (EVAR: NIM HR, 1.12; 95% CI, 1.05-1.20; insulin: HR, 1.40; 95% CI, 1.26-1.55; OAR: NIM HR, 1.27; 95% CI, 1.06-1.54; and insulin: HR, 1.57; 95% CI, 1.15-2.13). Finally, there was a similar risk of reintervention across the DM and non-DM populations for EVAR and OAR. ConclusionsDM was associated with a lower adjusted risk of rupture after EVAR as well as OAR in patients managed with NIM. Nevertheless, just as in patients without AAA, preoperative DM was associated with a higher adjusted risk of all-cause mortality. Further study is needed to evaluate for differences in aneurysm-related mortality between DM and non-DM patients, and studies are planned to evaluate the independent effect of NIM on aneurysm-related outcomes.

Impact of Preoperative Diabetes Mellitus on Postoperative Outcomes in Elective Pancreatic Surgery and Its Implications for Prehabilitation Practice.

Patients with pancreatic disease(s) have a high risk of developing diabetes mellitus (DM). Diabetes mellitus is associated with adverse postoperative outcomes. This study aimed to investigate the prevalence and effects of DM on postoperative outcomes in pancreatic surgery. Subgroup analysis of a prospective cohort study conducted at an academic hospital. Patients undergoing pancreatoduodenectomy between January 2019 and November 2022 were included and screened for DM preoperatively using glycated hemoglobin (HbA1c). New-onset DM was diagnosed based on HbA1c ≥ 6.5% (48 mmol/mol). Postoperative outcomes were compared between patients with and without DM. From 117 patients, 29 (24.8%) were given a diagnosis of DM, and of those, 5 (17.2%) were diagnosed with new-onset DM, and 15 (51.8%) displayed poorly controlled preoperative DM (HbA 1c ≥ 7% [53 mmol/mol]). The incidence of surgical site infections (48.3% vs 27.3% in the non-DM group; P = 0.04) was higher for patients with DM. This association remained significant after adjusting for confounders (odds ratio, 2.60 [95% confidence interval, 1.03-6.66]; P = 0.04). One-quarter of the patients scheduled for pancreatoduodenectomy had DM; over half of them had poor glycemic control. The association between DM status and surgical site infections revealed in this study emphasizes the importance of adequate preoperative glycemic control.

Risk factors for ischemic osteonecrosis of the femoral head after internal fixation with multiple cannulated screws for Pauwels type III femoral neck fracture

Background/Aim. Numerous factors lead to hip fractures that are common and often devastating in the geriatric population. The aim of the study was to determine the risk factors for ischemic osteonecrosis of the femoral head (ONFH) in patients after internal fixation with multiple cannulated screws for Pauwels type III femoral neck fracture (FNF). Methods. A total of 212 patients with Pauwels type III FNF, who underwent internal fixation with multiple cannulated screws from January 2019 to September 2022 and received one-year follow-up after surgery, were selected. Based on their clinical data and the incidence of ONFH, they were divided into two groups: the group with ischemic ONFH occurrence (n = 30) and the ischemic ONFH non-occurrence group (n = 182). Logistic regression analysis was conducted to analyze the risk factors for postoperative ischemic ONFH. Results. Age, body mass index (BMI), time from injury to surgery, partial weight bearing (PWB) time after surgery, and preoperative diabetes mellitus (DM) were significantly different between the ischemic ONFH occurrence and ischemic ONFH non-occurrence groups (p &lt; 0.05), while other clinical data showed no significant differences (p &gt; 0.05). The results of logistic regression analysis revealed that age (&gt; 55 years), PWB time after surgery (? 3 months), BMI (? 24 kg/m2), time from injury to surgery (&gt; 2 days), and preoperative DM were independent risk factors for postoperative ischemic ONFH (p &lt; 0.05). Conclusion. The incidence of postoperative ischemic ONFH can be prevented by effectively controlling the following factors: age, BMI, PWB after surgery, and preoperative DM.

Impact of preoperative diabetes mellitus on postoperative outcomes in elective pancreatic surgery and its implications for prehabilitation practice

Impact of preoperative diabetes mellitus on postoperative outcomes in elective pancreatic surgery and its implications for prehabilitation practice

A model to determine factors influencing intraoperative complications in sleeve gastrectomy.

The study presents a logistic regression model describing the factors leading to intraoperative complications in laparoscopic sleeve gastrectomy (LSG) and a detailed description of the intraoperative complications that occurred in our operations. The study was designed as a retrospective and cohort study. It includes patients who underwent laparoscopic sleeve gastrectomy between January 2008 and December 2020. The study included 257 patients. The mean (SD) age of all patients included in the study was 40.28 (9.58) years. The body mass index of our patients ranged from 31.2 to 86.6 kg/m2. The Stepwise Backward model was used (Cox and Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, df = 4, p = 0.742, overall model accuracy of 70.4%). The model shows that pre-operative diabetes mellitus or hypertension Stage 3 significantly increases the probability or risk of intraoperative complications. The study shows which intraoperative complications occur in LSG, how they can be remedied and which factors can lead to them and influence the outcome of the operation itself. The recognition and successful treatment of intraoperative complications are very important as they reduce the number of reoperations and treatment costs.

EP07.03-10 Effects of Preoperative Diabetes Mellitus on Postoperative Outcomes after Robotic-Assisted Video-Thoracoscopic Pulmonary Lobectomy

EP07.03-10 Effects of Preoperative Diabetes Mellitus on Postoperative Outcomes after Robotic-Assisted Video-Thoracoscopic Pulmonary Lobectomy

Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion

Abstract Objectives To explore the risk factors and nursing measures of early surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). Methods A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study. According to the occurrence of early SSI, the patients were divided into two groups, and the general data were analyzed by univariate analysis. Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures. Results Among 468 patients with PLIF, 18 patients developed early SSI (3.85%). The proportion of female, age, diabetes mellitus and urinary tract infection (UTI), operation segment, operation time, post-operative drainage volume, and drainage time were significantly higher than those in the uninfected group, with statistical significance (P &lt; 0.05), whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group, with statistical significance (P &lt; 0.05). There was no significant difference between the two groups in the American Society of Anesthesiologists (ASA) grading, body mass index (BMI), complications including cardiovascular and cerebrovascular diseases or hypertension (P &gt; 0.05). Logistic regression analysis showed that preoperative diabetes mellitus (OR = 2.109, P = 0.012)/UTI (OR = 1.526, P = 0.035), prolonged drainage time (OR = 1.639, P = 0.029) were risk factors for early SSI. Men (OR = 0.736, P = 0.027) and albumin level (OR = 0.526, P = 0.004) were protective factors in reducing early SSI. Conclusions Women, preoperative diabetes/UTI, hypoproteinemia, and prolonged drainage time are risk factors for early SSI after PLIF. Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.

180. Did The National Ban On Bacitracin Irrigation Affect Infection Rates In Implant-based Breast Reconstruction? An Analysis Of A National Database

PURPOSE: The current standard of practice in implant-based breast reconstruction is irrigation of the mastectomy pocket with antimicrobial solution before implant placement. Prior to being banned and formally recalled in January 2020, bacitracin was a very commonly utilized antibiotic. This study characterizes the effects of the national bacitracin ban on implant-based breast reconstruction infection rates by using a nationwide database to compare complication rates before and after bacitracin was banned. METHODS: The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried retrospectively for all patients who underwent implant-based breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020). Demographics, comorbidities, and complications were collected. Univariate analysis and multivariate analysis were conducted to determine if there were significant changes in wound complications, local wound infections, and systemic infections between the two case-control matched cohorts. RESULTS: A total of 37,126 patients were in the pre-ban cohort and 6,333 patients were in the post-ban cohort. Before matching, there were significant differences in race distribution, BMI, ASA class, inpatient versus outpatient status, preoperative smoking, and preoperative diabetes mellitus (all p<0.05). After case-control matching, there were 6,313 patients in each cohort. Univariate analysis revealed differences in postoperative superficial and organ space surgical site infection, wound complications/infections, all cause complications, and reoperations (all p<0.05). Multivariate analysis showed that patients who underwent breast reconstruction before the ban had decreased odds of having wound infections, related infections, all cause complications, and reoperations (all p<0.05). CONCLUSION: This study provides a macroscopic view into the effects of the formal injectable bacitracin ban on breast reconstruction outcomes. Patients who underwent implant-based breast reconstruction after the ban of injectable bacitracin had higher odds of developing wound infections, related infections, and reoperations. More study into suitable alternatives to injectable bacitracin for surgical site antimicrobial irrigation is warranted.

The association between diabetes mellitus and its management with outcomes following endovascular repair for descending thoracic aortic aneurysm

ObjectivePrior literature is conflicted regarding the effect of diabetes mellitus (DM) on outcomes after endovascular repair of aortic aneurysms. In this study, we aimed to examine the association between DM and outcomes after thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm (TAA). MethodsWe identified patients who underwent TEVAR for TAA of the descending thoracic aorta in the Vascular Quality Initiative between 2014 and 2022. We created two cohorts, DM and nonDM, based on the patient’s preoperative DM status, and secondarily substratified patients with DM by management strategy: dietary management, noninsulin medications, and insulin therapy cohorts. Outcomes included perioperative and 5-year mortality, in-hospital complications, indications for repair, and 1-year sac dynamics, which were analyzed with multivariable cox regression, multivariable logistic regression, and χ2 tests, respectively. ResultsWe identified 2637 patients, of which 473 (18%) had DM preoperatively. Among patients with DM, 25% were diet controlled, 54% noninsulin medications, and 21% insulin therapy. Within patients who underwent TEVAR for TAA, the proportions of ruptured presentation were higher in the dietary-managed (11.1%) and insulin-managed (14.3%) cohorts relative to noninsulin therapy (6.6%) and those without DM (6.9%). After multivariable regression analysis, we found that DM was associated with similar perioperative mortality (odds ratio, 1.14; 95% confidence interval [CI], 0.70-1.81) and 5-year mortality compared with patients without DM (hazard ratio, 1.15; 95% CI, 0.91-1.48). Furthermore, all in-hospital complications were comparable between patients with DM and patients without DM. Compared with patients without DM, dietary management of DM was significantly associated with higher adjusted perioperative mortality (OR, 2.16; 95% CI, 1.03-4.19) and higher 5-year mortality (hazad ratio, 1.50; 95% CI, 1.03-2.20), although this was not the case for other DM subgroups. All cohorts displayed similar 1-year sac dynamics, with sac regression occurring in 47% of patients without DM vs 46% of patients with DM (P = .27). ConclusionsPreoperatively, patients with DM who underwent TEVAR had a higher proportion of ruptured presentation when treated with diet or insulin medications than when treated with noninsulin medications. After TEVAR for descending TAA, DM was associated with a similar risk of perioperative and 5-year mortality as nonDM. In contrast, dietary therapy for DM was associated with significantly higher perioperative mortality and 5-year mortality.

Impact of Pre-operative Diabetes Mellitus on Postoperative Outcomes in Elective Pancreatic Surgery and its Implications for Prehabilitation Practice

Impact of Pre-operative Diabetes Mellitus on Postoperative Outcomes in Elective Pancreatic Surgery and its Implications for Prehabilitation Practice

Did the National Ban on Bacitracin Irrigation Affect Infection Rates in Implant-Based Breast Reconstruction? An Analysis of a National Database

IntroductionThe current standard of practice in implant-based breast reconstruction is irrigation of the mastectomy pocket with antimicrobial solution before implant placement. Prior to being banned and formally recalled in January 2020, bacitracin was a very commonly utilized antibiotic. This study characterizes the effects of the national bacitracin ban on implant-based breast reconstruction infection rates by using a nationwide database to compare complication rates before and after bacitracin was banned. Materials and MethodsThe American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried retrospectively for all patients who underwent implant-based breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020). Demographics, comorbidities, and complications were collected. Univariate analysis and multivariate analysis were conducted to determine if there were significant changes in wound complications, local wound infections, and systemic infections between the 2 case-control matched cohorts. ResultsA total of 37,126 patients were in the pre-ban cohort and 6333 patients were in the post-ban cohort. Before matching, there were significant differences in race distribution, BMI, ASA class, inpatient vs. outpatient status, preoperative smoking, and preoperative diabetes mellitus (all P < .05). After case-control matching, there were 6313 patients in each cohort. Univariate analysis revealed differences in postoperative superficial and organ space surgical site infection, wound complications/infections, all cause complications, and reoperations (all P < .05). Multivariate analysis showed that patients who underwent breast reconstruction before the ban had decreased odds of having wound infections, related infections, all cause complications, and reoperations (all P < .05). ConclusionThis study provides a macroscopic view into the effects of the formal injectable bacitracin ban on breast reconstruction outcomes. Patients who underwent implant-based breast reconstruction after the ban of injectable bacitracin had higher odds of developing wound infections, related infections, and reoperations. More study into suitable alternatives to injectable bacitracin for surgical site antimicrobial irrigation is warranted.

LONG-TERM OUTCOMES FOLLOWING FREY'S PROCEDURE FOR CHRONIC PANCREATITIS – A TEN-YEARS OF SINGLE-CENTER EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Background/Aim: Chronic pancreatitis (CP) is surgically treated in selected patient populations. Frey's procedure (FP) is the most commonly described procedure for CP with head mass. This study is being conducted to determine the long-term outcome and efcacy of FP in patients with CP in South India of various etiologies. Methods: This is a retrospective study of patients who underwent FP at our institution. Clinical features, perioperative ndings, and follow-up results were evaluated. A subgroup analysis of pain relief was performed between alcoholics and non-alcoholic groups and between patients receiving FP alone and FP with additional procedures. Results: Of the 181 patients, alcohol was the causative factor in 99 (54.69%), gallstones in 20 (11.04%), and idiopathic in 62 (34.25%). With a median follow-up of 43.49 months (range 12-72 months), 78 (43.09%) patients experienced complete pain relief. Due to persistent pain and the presence of preoperative diabetes mellitus (DM), pain relief in patients with postoperative complications was incomplete. New DM and exocrine dysfunction were reported in 25 years (13.81%) and 15 (8.28%) patients. Patients with a history of alcohol abuse, smoking, weight loss, and postoperative complications are associated with newly developed diabetes. Conclusion: FP is a safe surgical option for CP with acceptable perioperative complications and appropriate short-term and long-term pain management in properly selected patients. Continuous pain and preoperative DM were independent predictors of incomplete pain relief after FP. Symptoms associated with alcohol abuse, smoking, and weight loss were associated with the development of post-FP DM in the study population.

Impact of diabetes mellitus on long-term clinical and graft outcomes after off-pump coronary artery bypass grafting with pure bilateral skeletonized internal thoracic artery grafts

BackgroundThe effect of diabetes mellitus (DM) on the long-term outcomes of coronary artery bypass graft (CABG) remained debatable and various strategies exist for CABG; hence, clarifying the effects of DM on CABG outcomes is difficult. The current study aimed to evaluate the effect of DM on clinical and graft-related outcomes after CABG with bilateral internal thoracic artery (BITA) grafts.MethodsFrom January 2001 to December 2017, 3395 patients who underwent off-pump CABG (OPCAB) with BITA grafts were enrolled. The study population was stratified according to preoperative DM. The primary endpoint was cardiac death and the secondary endpoints were myocardial infarction (MI), revascularization, graft failure, stroke, postoperative wound infection, and a composite endpoint of cardiac death, MI, and revascularization. Multiple sensitivity analyses, including Cox proportional hazard regression and propensity-score matching analyses, were performed to adjust baseline differences.ResultsAfter CABG, the DM group showed similar rates of cardiac death, MI, or revascularization and lower rates of graft failure at 10 years (DM vs. non-DM, 19.0% vs. 24.3%, hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.549–0.925; P = 0.009) compared to the non-DM group. These findings were consistent after multiple sensitivity analyses. In the subgroup analysis, the well-controlled DM group, which is defined as preoperative hemoglobin A1c (HbA1c) of < 7%, showed lower postoperative wound infection rates (well-controlled DM vs. poorly controlled DM, 3.7% vs. 7.3%, HR 0.411, 95% CI 0.225–0.751; P = 0.004) compared to the poorly controlled DM group, which was consistent after propensity-score matched analysis.ConclusionsOPCAB with BITA grafts showed excellent and comparable long-term clinical outcomes in patients with and without DM. DM might have a protective effect on competition and graft failure of ITA. Strict preoperative hyperglycemia control with target HbA1c of < 7% might reduce postoperative wound infection and facilitate the use of BITA in CABG.

Preoperative NLR and PLR are predictive of clinically relevant postoperative pancreatic fistula

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a dreaded complication following pancreatic surgery. Several scores attempt to predict CR-POPF occurrence to better manage outcomes in patients undergoing pancreaticoduodenectomy (PD). In our study, we investigate the prognostic role of several demographic and clinico-pathological variables. We focus on clinical biomarkers, the Neutrophil-to-Lymphocytes Ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR), which can be easily used in predicting CR-POPF occurrence. Patients who underwent a PD with curative intent at our institution, between 2008 and 2018 were reviewed. Statistical analysis was conducted to determine the association between various demographic and clinico-pathological variables, with the occurrence of clinically significant POPF. 117 patients underwent a PD at our institution. Statistically significant associations on multivariate analysis were observed for the absence of preoperative diabetes mellitus, a pathological stage ≥III, an elevated NLR (> 4) and an elevated PLR (> 158). The NLR and PLR are predictive of CR-POPF occurrence following PD. These readily available biomarkers can add value to risk stratification tools to assess CR-POPF occurrence and individualize patient care plans.

Risk Factors and Prognosis of Acute Kidney Injury after Cardiac Surgery in Patients with Chronic Kidney Disease

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most prevalent complications of cardiac surgery, while the renal and overall prognoses of chronic kidney disease (CKD) patients with CSA-AKI are extremely poor. However, there is little published information on the occurrence of CSA-AKI in patients with CKD. The purpose of this study was to investigate the risk factors and prognostic factors of cardiac surgery-related AKI in patients with CKD. Methods: A retrospective study was performed on CKD patients who underwent cardiac surgery at a tertiary referral teaching hospital. CSA-AKI was defined based on the KDIGO criteria. The risk factors for CSA-AKI and the factors affecting renal function recovery at discharge or death in patients with AKI were investigated. Results: Among 1638 CKD patients enrolled, the incidence of CSA-AKI was 50.55%. AKI patients’ in-hospital mortality was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.9%, p < 0.001). Multivariate logistic regression analysis showed that male (odds ratio [OR] 1.479), preoperative hypertension (OR 1.548), preoperative hemoglobin <110 g/L (OR 2.389), and aortic clamping time >58 min (OR 1.567) were independent risk factors for AKI after cardiac surgery in patients with CKD. Factors affecting renal function recovery of AKI patients included preoperative diabetes mellitus (OR 0.306), hyperchloremia (OR 0.927), estimate of the glomerular filtration rate (OR 1.034), and AKI progression. Compared with patients with AKI stage 1, the rate of renal function recovery in patients with AKI stage 2 and stage 3 was reduced by 78.9% and 82.3%, respectively. Conclusions: In the population of patients with CKD, the incidence of CSA-AKI was high, which significantly affected renal and overall prognosis. The prompt intervention of modifiable factors may help improve the prognosis of patients with CKD.

Compliance with preoperative glucose testing and USPSTF diabetes screening guidelines in gynecologic oncology patients on an enhanced recovery pathway (408)

Compliance with preoperative glucose testing and USPSTF diabetes screening guidelines in gynecologic oncology patients on an enhanced recovery pathway (408)