Presence Of Postoperative Complications Research Articles

Platelet-to-Albumin Ratio: The Prognostic Utility in the Prediction of 2-Month Postoperative Heart Transplant Complications.

The platelet-to-albumin ratio (PAR), leucocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), and monocyte-to-albumin ratio (MAR) represent easily reproducible markers, which may predict the outcomes in various diseases. Early postoperative complications might appear after heart transplantation, such as infections, diabetes mellitus type 2 (DM2), acute graft rejection, and atrial fibrillation (AFib). The aim of our study was to investigate the PAR, LAR, NPAR, and MAR values before and after heart transplantation, and the associations of the preoperative levels of these markers with the presence of postoperative complications in first two months after surgery. Our retrospective research was directed from May 2014 to January 2021, with a total number of 38 patients being included. We used cut-off values for the ratios from previously published studies, as well as our own determination of these levels by using a receiver operating characteristic (ROC) curve. By ROC analysis, the optimal preoperative PAR cut-off value was 38.84 (AUC: 0.771, p = 0.0039), with 83.3% sensitivity, and 75.0% specificity. Applying a Chi square (χ2) test, PAR > 38.84 represented an independent risk factor for complications, regardless of cause, and postoperative infections. Preoperative PAR > 38.84 was a risk factor of developing complications of any cause, and postoperative infections in the first two months after heart transplantation.

Lumbar Drain Use during Middle Fossa Approaches for Nonneoplastic Pathology of the Skull Base.

Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol ( n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05-2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25-2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48-4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant ( p = 0.07). Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies.

Combination of peripheral blocks as a part of enhanced rehabilitation in total knee replacement: a prospective comparative open randomized study

BACKGROUND: The patients recovery after total knee replacement (TKR) is long and is associated several potentially serious complications. The optimal solution to this problem is the introduction of regional blocks of the lower limb into anesthesiologic practice, which can contribute to enhanced rehabilitation and fewer complications.
 AIM: To perform a prospective comparative analysis of the anesthesia outcomes of patients who received a combination of prolonged femoral nerve blockade (CFNB) with catheter insertion and infiltration between the popliteal artery and capsule of the knee (IPACK), with the results in patients receiving prolonged epidural analgesia (PEA) as postoperative analgesia for TKR.
 MATERIALS AND METHODS: Eighty patients were included and distributed according to the required planned surgical intervention (TKR). The duration of the inclusion period was 3 months (from March to May 2022). Patients were observed up to 48 h after surgery, with control points every 8 h. The patients were divided into two groups: group 1 (PEA, n=40) underwent subarachnoid anesthesia in combination with PEA, and group 2 (n=40) underwent subarachnoid anesthesia as a combination of CFNB and IPACK. To compare the groups, the following main indicators were used: severity of pain syndrome (visual analog scale [VAS], from 0 to 10 cm), muscle strength on the Medical Research Council (MRC) scale, duration of patients stay in the intensive care unit, duration of hospitalization, and presence of postoperative complications.
 RESULTS: The highest average score for VAS was recorded at 32 h in group 1, and it was 3.6 cm. The lowest average score for VAS (1.11.2 cm) was noted in the first 8 h and after 48 h in group 1. In group 2, this value was 0.91.5 cm in the first 16 h, and at 48 h, the pain syndrome was more pronounced in group 2, making up 2 cm on VAS. Compared with the PEA group, the CFNB group had statistically higher values of the indicators of the motor strength of the leg muscles on the MRC scale at all stages of the study. The PEA group stayed in the intensive care unit statistically significantly longer than the PBN group: 210 (189260) and 180 (154185) min, respectively (p 0.001).
 CONCLUSION: The results of this study showed that the use of multimodal analgesia as a combination of CFNB and IPACK is a reliable anesthetic support for TKR, with an efficiency not inferior to classical epidural analgesia. The use of this combination of peripheral blockades contributes to the early activation and rehabilitation of patients after TKR.

Epithelial tumors of the thymus with pleural dissemination: the potential role of surgery

Background. Pleural metastases of thymic epithelial tumors are detected in 5–7 % of patients at initial diagnosis and in 10 % of patients during a follow-up after radical surgery for the primary tumor. Partial pleuroectomy is the cornerstone of treatment strategy in this group of patients.The aim of the study was to assess the role of surgery in the treatment of patients with thymic epithelial tumors with pleural dissemination.Material and Methods. From January1, 2010 to June 30, 2021, 21 patients with thymic epithelial tumors (thymoma – 13, thymic cancer – 8) and pleural implants (stage IVA – 11, isolated pleural metastases as tumor progression after radical surgery – 10) underwent partial pleuroectomy with resection of the diaphragm and lung if necessary. Four patients underwent inthraoperative photodynamic therapy and another 4 patients received intrapleural hyperthermic chemotherapy.Results. R0 resection was performed on 12 (57.2 %) patients. Postoperative complications were observed in 6 (28.6 %) patients. The mortality rate was 7.5 %. The overall 1-, 3- and 5-year survival rates were 78 % (95 % CI 61–95), 49 % (95 % CI 23–75), and 41 % (95 % CI 15–67), respectively. The median overall survival time was 29 months (95 % CI 0–60.6). Recurrence occurred in 10 (47.6 %) cases. One-year recurrence-free survival was 60 % (95 % CI 30–90). Independent negative predictors for overall survival were: thymic cancer, incomplete resection, presence of postoperative complications and local recurrence.Conclusion. Surgery is the mainstay of treatment for patients with pleural metastases (stage IVA thymomas and recurrent thymomas). Metastasectomy of pleural implants will be suffcient to achieve a complete resection.

Preoperatif Aneminin Hiatal Herni Cerrahisi ve Postoperatif Komplikasyonlara Etkisi

Aim: Anemia is associated with increased mortality and morbidity in all patients undergoing surgery. This study aimed to reveal to what extent anemia caused postoperative complications before hiatal hernia surgery. Material and Methods: One hundred and ninety-two patients operated for hiatal hernia in our clinic between 2015 and 2019 were analyzed retrospectively. Patients were compared according to demographics, preoperative laboratory values, preoperative Charlson comorbidity index score, hiatal hernia type, postoperative intensive care requirement, presence of postoperative complications, Clavien-Dindo score, blood transfusion need, and length of hospital stay. Results: Of the patients, 109 were female and 83 were male. The mean age was 50.1±9.1 years. Fifty-four (28.2%) of the patients were in the anemic group, and 138 (71.8%) were in the non-anemic group. There was no statistically significant difference between the groups in terms of gender distribution (p=0.663). When the groups were compared in terms of age distribution, it was found that the anemic group was older than the non-anemic group and the difference was statistically significant (p<0.001). There was a significant difference between the groups in terms of the postoperative complications rate and it was more common in the anemic group (p<0.001). There was a significant difference between the groups in terms of the need for intensive care and blood transfusion in the postoperative period (p=0.020, p<0.001, respectively). Conclusion: Preoperative anemia increases postoperative complications in hiatal hernia surgery. Therefore, the presence of anemia should be investigated before hiatal hernia surgery and patients with anemia should be followed up closely postoperatively.

A Retrospective Comparative Study Between Early (≤ 72 hrs) and Late (> 72 hrs) Laparoscopic Cholecystectomy after ERCP in St. Paul’s Hospital Iloilo

Objective: The study was performed to assess and compare the effect of early (≤ 72 hours) and late (>72 hours) laparoscopic cholecystectomy after Endoscopic retrograde cholangio pancreatography (ERCP) in terms of duration of operation, conversion to open cholecystectomy, intraoperative complicating factors, duration of hospital stay from the date of ERCP, hospital expenses, and presence of postoperative complications. Methods: This is a retrospective study from 2010 up to July 2019. Outcomes (duration of operation, rate of conversion, intraoperative complicating factors, length of hospital stay, hospital expenses and post-operative complications) were compared between patients who had ERCP then cholecystectomy within 72 hours (Early Group) and those who had ERCP then cholecystectomy after more than 72 hours (Late Group). Results: A total of 19 patients were included in this study. There were 10 patients in the Early Group and 9 in the Late Group. Early laparoscopic cholecystectomy after ERCP had a shorter statistically significant duration of hospital. Shorter operative time, fewer intraoperative complicating factors, no conversion to open cholecystectomy, cheaper hospital expenses and no post-operative complications were also noted in the Early Group as compared to the Late Group. Conclusion: Early laparoscopic cholecystectomy is safe and results in a shorter hospital stay compared to late laparoscopic cholecystectomy. Key words: early laparoscopic cholecystectomy, cholecystectomy after ERCP, choledocholithiasis, cholecystolithiasis

Comparison of malnutrition screening tests in predicting postoperative complications in elderly patients with femur fracture

BackgroundMalnutrition is an important and widespread problem in hospitalised elderly orthopaedic patients. It is an important predictor of morbidity and mortality and has been associated with an increased risk of complications. Although it is a common problem in the elderly, there is neither a universally accepted criterion for the diagnosis of malnutrition nor a screening tool accepted as the gold standard to detect patients at risk of malnutrition. There is still no consensus on which is the most recommended for screening hospitalised patients for nutritional risk. The aim of this study was to search body mass index (BMI) and commonly used nutrition screening tools to detect malnutrition and malnutrition-related complications in elderly femur fracture patients. One hundred nineteen patients of the American Society of Anesthesiologists status I–IV, aged ≥ 65 years undergoing hip surgery, were included in the study.ResultsMini Nutritional Assessment Short Form (MNA-SF) and Subjective Global Assessment (SGA) have a moderate agreement in the diagnosis of malnutrition. There was a statistically significant relationship between malnutrition and the presence of complications according to MNA-SF. But there was no statistically significant relationship between malnutrition and the presence of complications according to SGA.ConclusionsAccording to MNA-SF, there was no significant relationship between malnutrition and the presence of postoperative complications. However, MNA-SF has higher sensitivity than predicting postoperative complications according to SGA. Although both tests can be used for screening malnutrition in elderly patients, complications can be more predicted with the MNA-SF test.

Мікробіологія простого та деструктивного апендициту в дітей

The purpose - to analyze bacteriological cultures from the abdominal cavity in various forms of appendicitis, to recommend a rational scheme of antibiotic prophylaxis and empirical therapy in children diagnosed with acute appendicitis. Materials and methods. The study based on bacteriological cultures of the abdominal cavity contents of operated children (laparotomy and laparoscope) with acute appendicitis. Patients were treated in the surgical department of the Zhytomyr Regional Children’s Clinical Hospital in 1997-2020. Results. We analyze 4255 (2334 children; 54.9% - positive) abdominal content cultures of children with acute appendicitis and its complications who were treated in the period 1997-2020. A total of 4965 children were treated, of which 31.3% of children underwent laparoscopic surgery. If we analyze by years, the number of laparoscopic appendectomies compared to 2001 increased by 57.34%. In the microbiological aspect of simple appendicitis, the five leaders are: E. coli - sown in 57.97% of all positive results, Ent. faecalis - 13.36%, S. aureus - 7.6%, Klebsiella spp. - 5.76%, Str. spp - 5.63%. Whereas in destructive forms of appendicitis: E. coli - 57.83%, E. faecalis - 13.58%, Ps. aeruginosa - 8.95%, S. aureus - 8.68%, Str. spp - 3, 38%. The structure of the isolated microflora in complicated appendicitis includes: S. aureus (8.03%), E. coli (48.7%), Ent. faecalis (28.3%), Ps. aeruginosa (7.8%), other pathogens - 7.17%. Cases of mixed infection in the focus of inflammation do not exceed 10.0%. The percentage of susceptibility of pathogens, which are most often sown from the abdominal cavity, to antibiotics in different periods of observation is different. It is important to remember that adequate antibacterial therapy should cover the anaerobic spectrum in destructive forms treatment. The widest range is protected by beta-lactams, carbapenems and chloramphenicol, but the use of the latter two groups is limited in pediatric practice, especially chloramphenicol due to its toxicity. You can create beneficial combinations of metronidazole, to which aerobes are not sensitive, together with cephalosporins, which in turn do not have clinically significant antianaerobic activity. Conclusions. After analyzing the microbiological structure of simple and destructive appendicitis, it is advisable in each surgical hospital to study its own bacterial mirror. It is rational to attribute acute phlegmonous appendicitis without peritonitis to a simple (uncomplicated) form, and in the presence of peritonitis - to a destructive form of appendicitis. Simple and destructive forms of appendicitis have different microbiological picture. In the presence of postoperative complications in the microbiological picture, four pathogens are in the lead: E. coli, Ent. faecalis, S. aureus, Ps. aeruginosa. It is efficient to change treatment tactics, avoid monotherapy as such, in particular, cephalosporins, use more combinations, as well as use other groups of antibiotics, such as protected penicillins. Thus, we will be able to inhibit the growth of antibiotic resistance, reduce the frequency and intensity of postoperative complications, reduce the length of stay of the patient in the hospital. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent was obtained from parents (or guardians). No conflict of interests was declared by the authors.

Diagnostic challenges and treatment options in patients with solitary fibrous tumor: A single-center observational study.

IntroductionSolitary fibrous tumor (SFT) is an extremely rare disease with a high misdiagnosis rate and a potentially malignant biologic nature. We have collected and analyzed data from 18 SFT patients to provide a deeper insight into this uncommon disease entity.MethodsIn our study, 18 patients who had undergone surgery between April 2014 and December 2021 for the diagnosis of SFT were evaluated. The collected data for each patient included the location of the SFT, the preoperative diagnosis, the definitive histological diagnosis, the presence of postoperative complications, the time of recurrence, the time of systemic progression, the type of treatment, and the survival rate. The median follow-up was 36 months.ResultsIn three patients, the preoperative diagnosis did not correlate with the definitive histology of SFT. In patients with the limb location of SFT, no signs of recurrence nor distant metastases were seen within the study period. In total, 50% of the postsurgical complications were associated with the abdominal location of the SFT. In newly diagnosed SFT patients, two patients (20%) developed local recurrence, and the median time until recurrence was 22.5 months. Out of patients that were admitted and operated on for recurrent SFT, 67% relapsed, and the median time to relapse was 9.5 months. The systemic progression of the disease was observed in 33% of patients treated for recurrent SFT.ConclusionIn our study, the misdiagnosis rate was high and correlated with previously published studies. Postsurgical complications were associated with the extrathoracic location of SFT. The mainstay of SFT treatment remains radical surgery, although radiotherapy alone can significantly improve overall survival. Clinical trials are urgently needed to evaluate the potential effect of other treatment modalities, such as immunotherapy and targeted therapy, in SFT patients.

Risk Factors for 30-day Unplanned Readmission following Surgery for Lumbar Degenerative Diseases: A Systematic Review.

Systematic review. Surgical procedures for lumbar degenerative diseases (LDD), which have emerged in the 21-century, are commonly practiced worldwide. Regarding financial burdens and health costs, readmissions within 30days following surgery are inconvenient. We performed a systematic review to integrate real-world evidence and report the current risk factors associated with 30-day readmission following surgery for LDD. The Cochrane Library, Embase, and Medline electronic databases were searched from inception to April 2022 to identify relevant studies reporting risk factors for 30-day readmission following surgery for LDD. Thirty-six studies were included in the review. Potential risk factors were identified in the included studies that reported multivariate analysis results, including age, race, obesity, higher American Society of Anesthesiologists score, anemia, bleeding disorder, chronic pulmonary disease, heart failure, dependent status, depression, diabetes, frailty, malnutrition, chronic steroid use, surgeries with anterior approach, multilevel spinal surgeries, perioperative transfusion, presence of postoperative complications, prolonged operative time, and prolonged length of stay. There are several potential perioperative risk factors associated with unplanned readmission following surgery for LDD. Preoperatively identifying patients that are at increased risk of readmission is critical for achieving the best possible outcomes.

Kingsnorth's modified score as predictor of complications in open inguinal hernia repair

PurposeThis study aims to analyse the postoperative complications (30 days) on unilateral primary inguinal hernia repair and prove their correlation with the preoperative modified scoring system of Kingsnorth (KN).MethodsProspective study design collecting data from patients who underwent surgery for unilateral primary inguinal hernia in a University Hospital. The data were collected in the National Inguinal Hernia Registry (EVEREG). A statistical analysis to assess the association between the presence of postoperative complications and the preoperative and intraoperative variables was performed. The patients were classified depending on their KN score. Surgical complications and their relationship with the classification were specifically analysed. Study design was performed following STROBE statements.ResultsThe sample included 403 patients who met the inclusion criteria from which 62 (15.3%) subjects presented postoperative complications. The variables that presented a statistically significant relationship with the appearance of complications were a KN score of 5–8 (OR 2.7; 95% CI 1.07–4.82; P = 0.03) and the involvement of a member of the abdominal wall surgery unit in the procedure (OR 0.28; 95% CI 0.08–0.92; P = 0.03). The KN score correlated with a longer duration of surgery (Pearson's correlation 0.291; P < 0.0001).ConclusionThe KN classification can predict the onset of surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5–8 has a higher probability of wound complications. When surgery is performed by the abdominal wall surgery unit, the chances of postoperative complications decrease.

Features of the pathomorphosis of fire bullet wounds of the abdomen with damage of the colon

The article shows the features of the pathomorphosis of gunshot bullet wounds to the abdomen with damage to the colon. Various options for the course of repair and regeneration of the colon after surgical treatment and in the presence of postoperative complications in wounded patients with and without concomitant pathology of the colon are provided. It is shown that the etiology and pathogenesis of a penetrating gunshot wound of the intestine has mechanical and metabolic aspects. It has been proven that the greatest impact force on the intestine falls on the outside, on the peritoneum, which is often worn away from the longitudinal layer of the muscle wall of the intestine. It is given that the restructuring of the structure and function of the colon in chronic colitis after a gunshot wound leads to an exacerbation of the chronic process in all membranes. It is shown that damage to the intestinal mucosa occurs simultaneously with the destruction of intestinal tissues, but depends on general and local immunity. Infiltration of the site of the lesion by neutrophil granulocytes leads to the disposal of the entire wound or the development of complications. The structural and functional state of intestinal lymphatic follicles makes it possible to maintain intestinal immune protection, bacterial microflora and digestion. The method of choice for surgical repair of the consequences penetrating into the abdominal cavity of a gunshot wound will be the maximum resection of necrotic foci, large hemorrhages to avoid adhesion disease. At different levels, depending on the wound process, the structural and functional reconstruction is completely different, which is due to the individual feature of the structure and function, which affects the surgeon's desire for a justified radical or, on the contrary, for an organ-preserving operation. Keywords: histological examination, gunshot wound, colon injury.

Evaluation of clinical parameters affecting the prognosis in surgically treated patients with descending necrotizing mediastinitis – A retrospective study

ObjectivesDescending necrotizing mediastinitis (DNM) is the most serious complication of maxillofacial infections followed with high mortality. The objective of this retrospective study was to evaluate possible prognostic clinical factors for survival of patients with DNM based on single center clinical data. MethodsThe study enrolled patients admitted to the Emergency Center of Vojvodina with the diagnosis of DNM either as the primary diagnosis or with discharged diagnosis after surgical treatment during 11-years period. The data were obtained from patient medical records. ResultsAfter final analysis total of 28 charts were randomized for statystical analysis, 19 charts in survivors and 9 in non-survivors group. The most common cause of infection in survivors group was odontogenic and in non-survivors group pharyngeal infection. On multivariate regression analysis of collected data results of control computed tomography, preoperative Endo status, early postoperative C-reactive protein (CRP) and procalcitonine (PCT) values and postoperative complications were statistically significant predictors for mortality. ConclusionsBased on results of this study, extent of infection in the mediastinum based on Endo's criteria, progression of infection on control cervicothoracic CT, increase of CRP and PCT values in immediate postoperative period and presence of postoperative complications and septic shock provide poor prognosis for patients with DNM.

Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries.

Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations. A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044). We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes. Level III-these data represent a retrospective comparative study of clinical and functional outcomes.

Predictors of Complications and Unfavorable Outcomes of Minimally Invasive Surgery Treatment in Elderly Patients With Degenerative Lumbar Spine Pathologies (Case Series).

IntroductionThe use of minimally invasive surgery (MIS) results in fewer adverse and more improved outcomes. However, the literature data describing the factors increasing the number of complications, reoperation frequency and unscheduled re-hospitalizations in older patients after MIS are contradictory. In this study, a large number of patients was investigated for the complications of minimally invasive surgical treatment of degenerative disease of the lumbar spine in older patients. The objective of the study was to determine the predictors of unfavorable outcomes in such patients.Materials and Methods1,013 patients underwent MIS (decompression alone, TLIF, LLIF, ALIF) in 2013-2017. All operations were performed with the participation of the authors (neurosurgeons). The patient's average age was 66. The following data were collected: BMI; CCI; presence of postoperative complications according to the Dindo-Clavien classification; unplanned readmission at 90 days; hospital length of stay (LOS); surgical complexity (low, intermediate, and high); surgical time; and risk factors. The cumulative reoperation rate was determined at 5-years follow-up.ResultsA total of 256 patients suffered a complication (25.2%), 226 classified as mild (grade I, II, IIIA), and 30 - as severe (IIIB, IVA). Such factors as the surgical complexity, BMI > 30, surgical time, number of operated levels were associated with a significant risk of developing a complication. For patients with and without complications, LOS was 9.3 and 6.3 days, respectively (p < 0.0001), the unplanned readmission rate was 1.3%. 104 patients underwent 133 revision operations. The 5-year cumulative reoperation rate was 15.2%, and the reoperation index was 12.1%. The CCI had no statistically significant effect on the complication incidence after MIS. A higher risk of complications was found in patients who underwent intermediate-complexity surgery (MIS TLIF) compared with uncompounded (decompression alone) and more complex (MIS LLIF, MIS ALIF) surgical procedures (p < 0.001 and p = 0.001, respectively).ConclusionA register of postoperative complications is an important tool for health quality assessment and choosing the best surgical option that helps to establish measures to reduce such complications. Using MIS for the treatment of elderly patients reduces the number of severe complications.

Factors Which Predict Adverse Outcomes in Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population.

Retrospective cohort. The largest published cohort of anterior cervical discectomy and fusion (ACDF) patients was queried to better characterize demographic and operative factors that predict 90-day complication and 2-year reoperation risk. The MarketScan Database was queried from 2007 to 2016 to identify adult patients until 65 years, who underwent an ACDF procedure using International Classification of Diseases 9th Version (ICD-9) and Current Procedural Terminology (CPT) codes. MarketScan is a national insurance claims database that contains millions of patient records across all 50 states. Multivariate logistic regression was used to identify factors associated with complications until 90 days and reoperations until 2 years. Of 138,839 ACDF procedures, 8500 patients (6.1%) experienced a complication within 90 days of the ACDF, and 7433 (5.4%) underwent surgical revision by 2 years. While the use of anterior cervical plating did not predict 2-year reoperation, it was associated with dramatically reduced 90-day complication risk (adjusted odds ratio [aOR]: 0.32; 95% confidence interval [CI]: 0.30-0.34; P <0.001). Upon multivariate analysis, female sex (aOR: 0.83; 95% CI: 0.79-0.87; P <0.001) was associated with decreased risk of 2-year reoperation, while depression predicted a 50% increase in reoperation risk (aOR: 1.51; 95% CI: 1.43-1.59; P <0.001). The single largest factor associated with reoperation risk, however, was the presence of a 90-day postoperative complication (aOR: 1.79; 95% CI: 1.66-1.94; P <0.001). Increased patient comorbidities and the use of bone morphogenic protein were found to increase the risk for postoperative complications, while cervical plating was associated with a strong decline in this risk. In addition, poor patient mental health outweighed the adverse of impact of other comorbidities on 2-year revision risk. The presence of a postoperative complication was the key modifiable risk factor associated with reoperation risk. Conclusions from this study may help surgeons better identify high-risk ACDF patients for more careful patient selection, counseling, informed consent, and management.

Risks and Outcomes Associated with Pleural Space Infections After Lung Transplantation

<h3>Purpose</h3> Pleural space infections (PSI) are a serious complication after lung transplantation (LT) however there is limited data on the associated risk factors and outcomes of PSI. We examined: 1) risk factors associated with PSI after LT; 2) effect of PSI on LT outcomes. <h3>Methods</h3> This is a retrospective single center cohort study of 74 consecutive LT recipients (1/2018- 6/2020). Patients were divided into infected and non-infected groups, where PSI were defined as post-LT pleural effusions with pathogen(s) isolated from pleural fluid. Data were collected and compared between two groups with two-sample t-test or Fisher-exact. Multivariable logit model was performed with estimations of odds ratio (OR) and its confidence interval [CI]. <h3>Results</h3> Among 74 LT recipients, 38 (51%) developed pleural effusions requiring drainage; of them 16 (42%) had PSI. Baseline demographics were similar in patients with and without PSI (Table). Notably, 88% of PSI group received steroids pre-LT compared to 55% in the non-infected group (p<0.05); 88% of the PSI group had an underlying diagnosis of interstitial lung disease versus 45% of the non-infected group (p<0.01). Overall post-operative complications occurred more frequently in the PSI group vs. non-infected group 77% vs. 25% (p<0.01) and airway complications in 86% vs. 44% (p<0.01). Hospital length of stay was longer in the PSI group with the median of 78 versus 31 days in the non-infected group (p<0.01). Results of logistical modeling showed high risk of PSI with presence of post-LT airway complications (OR =10.8 95% CI 1.7- 72.5) and presence of post operative complications (OR=10.6, 95% CI 1.8-63.5). There was no difference in the incidence of readmissions, acute cellular rejection or 1 year mortality between the two cohorts. <h3>Conclusion</h3> PSI remain a prevalent yet under-studied complication. Airway or post-operative complications after LT were associated with PSI. One-year outcomes were similar in LT recipients with and without PSI.

Preoperative neutrophil-to-lymphocyte ratio behaves as an independent prognostic factor even in patients with postoperative complications after curative resection for gastric cancer

PurposeThe aim of this study was to determine if the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) could be modified by the presence of postoperative complications (POC) and their severity in patients with gastric adenocarcinoma resected with curative intent.MethodsA retrospective study based on a prospective database of patients with resectable gastric adenocarcinoma treated with radical intention (R0) between January 1998 and February 2012. The primary endpoint was overall survival according to preoperative peripheral blood NLR and postoperative complications. Clinicopathological variables, preoperative blood tests, POC and its severity (Clavien–Dindo classification), type of POC (infectious or not infectious) and mortality were registered. A univariate and multivariate analysis (step forward Cox regression) was performed. The Kaplan–Meier method was used to assess overall survival.ResultsThe 147 patients with gastric cancer who had undergone radical resection were included from an initial cohort of 209 patients. Univariant analysis: type of surgery, pT, pN, postoperative complications (Clavien–Dindo ≥ 3) and preoperative NLR ≥ 2.4 were significantly associated with survival (p < 0.05). Patients with POC showed worse long-term survival (p = 0.000), with no difference (p = 0.867) between infectious or non-infectious POC. NLR ≥ 2.4 was associated with infectious POC (p < 0.001). Patients with preoperative NLR ≥ 2.4 (p = 0.02) had a worse prognosis. Multivariate analysis: pN (p < 0.001), postoperative complications (p < 0.001) (HR 3.04; 95% CI: 1.97–4.70) and NLR ≥ 2.4 (p = 0.04) (HR = 1.55; 95% CI: 1.02–2.3) were independent prognostic factors.ConclusionThe preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.

Short- and long-term predictive power of the preoperative Geriatric Assessment components in older cancer patients undergoing high-risk abdominal surgery

IntroductionThe pathological stage of the cancer and presence of postoperative complications are the most important predictors of survival in older oncologic patients. Therefore, determining biological age, and risks connected with it, should be the key factor in the preoperative assessment. It may be accomplished by using a Geriatric Assessment (GA). However, it is not established which components are most useful for predicting short- and long-term postoperative outcomes in cancer patients undergoing high-risk abdominal surgery. Materials and methodsA total of 334 consecutive cancer patients aged ≥70 years underwent elective abdominal surgery and were followed-up prospectively for 12 months. The preoperative GA consisted of eight domains: functional, physical activity, comorbidity, polypharmacotherapy, nutritional, cognition, mood, and social support. Logistic regression analyses were used to analyse the predictive ability. ResultsAll components of GA were independent risk factors of 30-day major morbidity apart from ADL, BOMC, Polypharmacy (OR 0.6–1.3; p < 0.001). However, ADL, TUG, the polypharmacy and the MOS-SSS turned out to be significant predictors of 30-day mortality (OR 0.72–1.46; p < 0.001). In turn, only ADL, CDT and MOS-SSS were valid predictors of 12-months mortality (OR 0.46–0.85; p < 0.001). Frailty (surrogate of the biological age), not the chronological age, were also independent predictors of all outcomes (OR 4.71–8.56 p < 0.001). ConclusionNot the chronological age but components of GA and frailty are significant predictors of both 30-day postoperative outcome and 12-months mortality in older cancer patients undergoing high-risk abdominal surgery.

The role of neutrophil-to-lymphocyte ratio in predicting disease progression and emergency surgery indication in benign intestinal obstructions.

The physiological response of the immune system to various stress factors results in an increase in neutrophil count and a decrease in lymphocyte count. In the light of this information, some studies have suggested using the ratio of these two parameters as an infection marker. The aim of this study was to investigate the role of neutrophil-to-lymphocyte ratio (NLR) derived from complete blood count, a very cost-effective and rapidly measurable parameter, in predicting the urgency of the surgical indication and disease progression in intestinal obstructions secondary to benign causes. The data of patients who were admitted with the diagnosis of intestinal obstruction secondary to benign causes and underwent surgical intervention between January 2010 and January 2021 in Başkent University, Faculty of Medicine, Department of General Surgery, Konya Practice and Research Hospital were retrospectively analyzed. The data of 109 patients who met the study criteria and were included in the study were statistically analyzed. The correlation of admission NLR with factors indicating the severity of the disease such as intraoperatively detected ischemia, perforation, resection requirement, post-operative morbidity and mortality, and length of hospital stay was examined. Moreover, the diagnostic value of the NLR was compared with that of other infection markers (such as C-reactive protein [CRP] and leukocyte). It was observed that the high NLR during admission to the hospital due to benign intestinal obstruction causes significantly increased the risk of ischemia, resection requirement, post-operative complications, and mortality during surgery (p<0.05). Furthermore, increased NLR was found to be associated with prolonged hospitalization. In correlation analysis, consistent with the literature, a positive correlation was found between NLR and hospitalization time (p=0.03), CRP value (p<0.001), ischemia (p<0.001), perforation (p=0.007), presence of post-operative complications (p=0.009), and mortality (p=0.002). Our results show that the NLR has a very important role in predicting the course of the disease and surgical indication in benign intestinal obstructions.