Prognostic Factors For Postoperative Complications Research Articles

Quality of Life, Sarcopenia and Nutritional Status in Patients with Esophagogastric Tumors before and after Neoadjuvant Therapy.

(1) Background: Health-related quality of life (HRQoL) gains importance as novel treatment options for individuals with esophagogastric tumors to improve long-term survival. Impaired HRQoL has been shown to be a predictor of overall survival. Sarcopenia is a known prognostic factor for postoperative complications. As the regular control of sarcopenia through CT scans might not always be possible and HRQoL and nutritional scores are easier to obtain, this study aimed to assess the relationship between nutritional scores, HRQoL and skeletal muscle mass in patients undergoing chemotherapy for cancers of the upper gastrointestinal tract. (2) Methods: Eighty patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaire, EORTC's QLQ-C30. Nutritional status was assessed using the MNA, MUST and NRS 2002 scores. Sarcopenia was determined semi-automatically based on the skeletal muscle index at the L3 vertebrae level in staging CT scans. (3) Results: In chemo-naïve patients, HRQoL summary scores correlated significantly with nutritional scores and SMI. SMI and HRQoL prior to neoadjuvant therapy correlated significantly with SMI after treatment. (4) Conclusions: HRQoL is a helpful tool for assessing patients' overall constitution. The correlation of HRQoL summary scores and SMI might allow for a rough assessment of skeletal muscle status through HRQoL assessment in chemo-naïve patients.

Preoperative hypoalbuminemia and severe acute malnutrition as prognostic factors for postoperative complications in major abdominal surgery: A single-center retrospective study

Background Hypoalbuminemia and malnutrition are common factors that can adversely affect wound healing and increase the risk of postoperative infections. Improvements in albumin and preoperative nutritional status are expected to reduce the incidence of complications following postoperative abdominal surgery.
 Objective To evaluate the roles of hypoalbuminemia and poor preoperative nutritional status as prognostic factors for postoperative complications in pediatric patients undergoing major abdominal surgery.
 Methods This retrospective cohort study included pediatric patients aged 1 month to 18 years who underwent major abdominal surgery and were treated in the pediatric intensive care unit (PICU) of Dr. Sardjito Hospital between January 1, 2017 to December 31, 2021. The primary was the incidence of postoperative complications within 14 days after the surgical procedure.
 Results Out of the 201 pediatric patients included in the study, 54.7% were male. We observed an overall complication rate of 21.3% following abdominal surgery, with sepsis as the most frequent, affecting 14.9% of the cases. On average, postoperative complications occurred approximately 10.9 days after surgery. Multivariate analysis identified severe acute malnutrition [hazard ratio (HR) 2.09 (95%CI 1.01 to 4.33); P=0.047], preoperative hypoalbuminemia of >2.5 to 3.0 g/dL [HR 3.64 (95%CI 1.57 to 8.41); P=0.003], preoperative hypoalbuminemia ?2.5 g/dL [HR 3.1 (95%CI 1.11 to 8.64); P=0.03], and age <1 year [HR 2.16 (95%CI 1.09 to 4.11); P=0.026] as significant prognostic factors for post-abdominal surgery complications in children.
 Conclusion Preoperative severe acute malnutrition and preoperative hypoalbuminemia of ?3 g/dL are significant prognostic factors for the occurrence of postoperative complications in pediatric patients undergoing abdominal surgery. Infants less than one year of age are at increased risk of such complications.

Surgical stress markers for postoperative complications: a prospective prognostic factor study

Background: Postoperative complications have previously been defined as “deviation from the normal postoperative course”. Although surgical advancements have reduced the postoperative mortality over the last few decades, the postoperative morbidity has remained high. Multiple factors as well as the severity of the surgical procedure itself are associated with adverse postoperative outcomes. Having prognostic factors established and available to assist with prognosis would be helpful in treatment planning and decision-making in post-operative patients. Objective of the study was to assess surgical stress markers as potential prognostic factors for postoperative complications. Methods: This is a prospective cohort study conducted in department of general surgery over a period of 4 months. A total of 120 patients were included in the study. Data entry and statistical analysis were done using statistical package for the social sciences (SPSS) version 23. Chi-square test was used. Area under curve (AUC) and logistic regression were applied and odd’s ratio was calculated in 95% confidence interval. Results: Serum C-reactive protein (CRP) levels done at 72 hours, ALB levels at 24 hours were most predictive postoperative levels compared to the other perioperative serum levels. Conclusions: Elevated serum CRP, albumin were associated with infective and non-infective complications and longer length of hospital stay and duration of the procedure.

Nutritional And Functional Status As Prognostic Factor For Postoperative Complications In Patients With Pancreatic And Hepatobiliary Cancer.

Nutritional And Functional Status As Prognostic Factor For Postoperative Complications In Patients With Pancreatic And Hepatobiliary Cancer.

Analysis of prognostic factors for postoperative complications and mortality in elderly patients undergoing emergency surgery for intestinal perforation or irreversible intestinal ischemia.

Because the global geriatric population continues to increase, the assessment of emergency surgical outcomes in elderly patients with acute peritonitis will become more important. A retrospective review was conducted on the data of 174 elderly patients who underwent emergency surgery for intestinal perforation or intestinal infarction between June 2010 and November 2022. We conducted an analysis of the risk factors associated with postoperative complications and mortality by evaluating the characteristics of patients and their surgical outcomes. In our study, most patients (94.3%) had preexisting comorbidities, and many patients (84.5%) required transfer to the intensive care unit following emergency surgery. Postoperative complications were observed in 84 individuals (48.3%), with postoperative mortality occurring in 29 (16.7%). Multivariate analysis revealed preoperative acute renal injury, hypoalbuminemia, and postoperative ventilator support as significant predictors of postoperative mortality. When elderly patients undergo emergency surgery for intestinal perforation or infarction, it is important to recognize that those with preoperative acute renal injury, hypoalbuminemia, and a need for postoperative ventilator support have a poor prognosis. Therefore, these patients require intensive care from the early stages of treatment.

Effects of Sarcopenia on Postoperative Outcomes in Patients Who Underwent Gastrectomy for Gastric Cancer.

The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer. Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded. Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P=0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P=0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P=0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P=1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.02-7.52, P=0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P=0.006) were identified as independent prognostic factors for postoperative complications. Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications.

Analysis of Prognostic Factors for Postoperative Complications and Reinterventions After Open Surgical Repair and Endovascular Aneurysm Repair in Patients With Abdominal Aortic Aneurysm

A retrospective, single-center review was performed between 2006 and 2017. Although the operative mortality rate was the same (0.5%) for both groups, the 405 patients who had undergone endovascular aortic aneurysm repair (EVAR) had experienced significantly fewer postoperative complications (13%) than had the 176 patients who had undergone open surgical repair (OSR) for infrarenal abdominal aortic aneurysms (36%). Patients who had undergone hostile neck EVAR had a significantly lower 5-year reintervention-free survival rate (63%) than the patients who had undergone favorable neck EVAR (83%) and those who had undergone OSR (86%). Patients with hostile neck EVAR also had a significantly lower 5-year overall survival rate (52%) compared with favorable neck EVAR (73%) and OSR (79%). Age, hemodialysis, and modified frailty index (mFI) were the risk factors for complications, increased reintervention, and decreased 5-year survival on multivariate analysis. Age, mFI, hemodialysis, and hostile neck anatomy are useful predictors for reintervention and 5-year survival and could be useful for selecting treatment between OSR and EVAR.

Analysis of prognostic factors for postoperative complications and reinterventions after open surgical repair and endovascular aneurysm repair in patients with abdominal aortic aneurysm

A definitive treatment for patients with abdominal aortic aneurysm considering age and comorbidities has not been identified. In the present study, we retrospectively validated treatment outcomes in Japanese patients and proposed the treatment strategy of open surgical repair (OSR) and endovascular aneurysm repair (EVAR). We retrospectively analyzed data for patients undergoing EVAR or OSR between 2006 and 2017. Patients with ruptured abdominal aortic aneurysm were excluded. We examined post-operative complications, operative mortality, re-intervention and prognosis. Throughout the study period, 405 patients underwent EVAR and 176 patients underwent OSR. The percentage of patients with post-operative complications was 35.8% in the OSR group, compared with 13.1% in the EVAR group (P < 0.01). The operative mortality rate was 0.49% in the EVAR group and 0.57% in the OSR group (P=1.00). With a multivariate analysis, age, hemodialysis, modified Frailty Index (mFI), and OSR were risk factors for post-operative complications. The 5-year re-intervention free survival rate was 63.0 % with hostile neck EVAR compared with 83.1 % with favorable neck EVAR and 86.1 % with OSR group (P < 0.01). With a multivariate analysis, hemodialysis, mFI, and hostile neck EVAR were risk factors for re-intervention. The 5-year overall survival rate was 51.9 % with hostile neck EVAR compared with 73.2 % with favorable neck EVAR and 79.0 % with OSR group (P < 0.01). With a multivariate analysis, age, mFI, and hostile neck EVAR were poor prognostic factors. Age, mFI, hemodialysis and hostile neck anatomy are useful predictors of post-operative complications, re-intervention and overall survival, and could be useful for informing treatment selection between OSR and EVAR.

Is Serum D-lactate a New Biomarker of Postoperative Complications after Liver Resection?

Introduction: L-lactate is considered a prognostic factor for postoperative complications. However, the role of D-lactate produced by intestinal bacteria is not known in patients undergoing liver resection. The aims of the study were to assess factors related to the increase of serum lactates values and investigate the association between lactate isoforms and postoperative complications. Methods: From February 2018 through October 2018, perioperative data of 68 consecutive patients underwent hepatic resection at the Division of Hepatobiliary Surgery, Verona University Hospital were prospectively collected. Serum levels of both L- and D-lactate were evaluated by arterial sampling before (T0) and after (T1) general anesthesia induction, before (T2) and after (T3) Pringle maneuver, during laparotomy suture (T4), 2-(T5) and 4-(T6) hours after surgery, in postoperative day 1(T7), 2(T8), 3(T9) and at discharge (T10). Results: Complication Clavien-Dindo grade ≥ 3 and mortality were 20.6 and 1.5%, respectively. Factors related to the increase of perioperative serum lactates were major liver resection (T7, L-lactate p=0.001 and D-lactate p=0.018), hilar clamping (D-lactate, T3 p=0.004; T4, p=0.013), operative time > 300 minutes (L-lactate, T7 p=0.005; T9 p=0.034), and mean arterial pressure < 80 mmHg (L-lactate, T3 p=0.031; T4 p=0.021). Higher L-lactate values were associated to overall postoperative complications (T4, p=0.049; T9, p=0.002). Instead, higher D-lactate values resulted specifically associated only to postoperative infections (T7, p=0.007). Conclusion: In this preliminary study we observed that surgery-related factors increase both isoforms of serum lactate. L-lactate raise if postoperative complications whereas higher D-lactate values may be used as biomarker of postoperative infections.

Prognostic factors for postoperative complications after K-wire fixation for paediatric forearm fractures: a multivariate analysis.

Although osteosynthesis using K-wires is a commonly performed procedure, the outcome is not always preferable. We aimed to identify the prognostic factors for postoperative complications in paediatric patients with both-bone forearm fractures. We reviewed 160 paediatric patients who underwent K-wire osteosynthesis for either distal or diaphyseal forearm fractures. We defined the occurrence rate of postoperative complications as the primary outcome and performed a multivariate logistic regression analysis. Variables such as age, sex, mechanism of injury, presence of an open fracture, ulnar or radial fracture and the associated procedure, the K-wire tip procedure and operation time, the duration from injury to operation and operation to implant removal, and duration of casting were included into the model as possible prognostic factors. The mean follow-up period was 51.2 weeks. The total number of complications was 43 (26.2%). Results of the logistic regression analysis indicated that a shorter duration from surgery to K-wire removal caused a significantly higher rate of postoperative complications [odds ratio (OR), 0.99; 95% confidence interval (CI), 0.97-1.0]. The subgroup analyses revealed that intramedullary K-wire fixation for radial fractures (OR, 1.07 × 10-5; 95% CI, 5.46 × 10-10 to 0.211) and a longer casting duration (OR, 0.84; 95% CI, 0.72-0.99) resulted in fewer postoperative infections. An exposed wire tip in the ulna contributed to more postoperative displacement (OR, 6.87; 95% CI, 1.76-26.9). To decrease the risk of postoperative complications, surgeons should bury the wire tip beneath the skin to facilitate a longer duration of K-wire placement.

326 Poster - Muscle quality is a prognostic factor for postoperative complications after DIEP-flap breast reconstruction

326 Poster - Muscle quality is a prognostic factor for postoperative complications after DIEP-flap breast reconstruction

The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study

BackgroundAccurate prognostic biomarkers would substantially improve surgical planning and decisions making yet no studies have been reported exploring the inflammatory response in surgically treated older patients with cancer. The aim of this study was to explore inflammatory biomarkers as potential prognostic factors for postoperative complications within 30 days in older patients with cancer. MethodPatients 65 years and older undergoing surgery for removal of a solid malignant tumour were included in an observational cohort study. All complications occurring up to 30 days postoperatively were documented prospectively. Inflammatory markers were measured in plasma samples pre- and postoperatively: C-reactive protein (CRP), Interleukin-1 beta (IL-1β), IL-6, IL-10, IL-12, and Tumour necrosis factor-alpha (TNF-α). Associations between inflammatory markers and postoperative complications were explored using logistic regression analysis. ResultsBetween July 2010 and April 2014, plasma samples of 224 patients were collected. Median age was 72 (65–89) years and 116 (51.8%) patients were female. Approximately half of the patients developed postoperative complications (49.6%) of whom 62 patients (55.9%) developed >1 complication. An independent prognostic effect was observed for the inflammatory biomarkers IL-6 and IL-10 for the occurrence of postoperative complications. ConclusionThe perioperative inflammatory response is associated with complications, independently from patient and surgical factors which are also associated with outcome. Research is warranted towards further exploration of the perioperative inflammatory response with the aim to improve perioperative care and outcome, and might help to improve surgical planning and decision making for older patients with cancer.

Sarcopenia does not affect postoperative complication rates in oesophageal cancer surgery: a systematic review and meta-analysis.

The high morbidity and mortality rates after oesophagectomy indicate the need for rigorous patient selection and preoperative risk assessment. Although muscle mass depletion has been proposed as a potential prognostic factor for postoperative complications and decreased survival in gastrointestinal cancer patients, available data are conflicting. The purpose of the present meta-analysis is to determine whether sarcopenia predicts postoperative outcomes in patients undergoing oesophagectomy. The databases MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on the effect of sarcopenia on postoperative outcomes following oesophageal cancer surgery. Outcomes included surgical complications, anastomotic leakage, respiratory complications, cardiovascular complications, postoperative infections, major complications and overall complications. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. A total of eight studies involving 1488 patients diagnosed with oesophageal cancer and who underwent oesophagectomy were included in the meta-analysis. The presence of sarcopenia did not significantly increase the rate of surgical complications (odds ratio, OR, 0.86, 95% confidence interval, CI, 0.40-1.85), anastomotic leakage (OR 0.75, 95% CI 0.42-1.35), respiratory complications (OR 0.56, 95% CI 0.21-1.48), cardiovascular complications (OR 0.94, 95% CI 0.31-2.83), postoperative infection (OR 1.14, 95% CI 0.52-2.50), major complications (OR 0.81, 95% CI 0.23-2.82) or overall postoperative complications (OR 0.80, 95% 0.32-1.99). Sarcopenia does not seem to affect postoperative complication rates of patients undergoing oesophagectomy for oesophageal cancer. Future research should focus on determining whether prognosis differs according to muscle mass in this patient population.

Complications du traitement chirurgical des carcinomes basocellulaires après 75 ans. Étude rétrospective des facteurs pronostiques sur 158 cas

Basal cell carcinoma (BCC) is a pathology that evolveslocally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications. This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified. A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P=0.006), long-term use of anticoagulant treatment (P=0.02), the presence of at least one comorbidity (P=0.018), a conventional hospitalization (P=0.002), and the use of general anesthesia (P=1.2e-10). Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.

Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

BackgroundElective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery.MethodsMedline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes.ResultsOf the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03–33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29–3.62) and cognitive impairment (OR 2.01, 95% CI 1.44–2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00–1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78–8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22–2.56) and smoking (OR 2.43, 95% CI 1.32–4.46), were also associated with developing postoperative complications.ConclusionGeriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care.

Impact of Lifestyle Diseases on Postoperative Complications and Survival in Elderly Patients with Stage I Non-Small Cell Lung Cancer.

BackgroundThe influence of lifestyle diseases on postoperative complications and long-term survival in patients with non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to determine whether lifestyle diseases were significant risk factors of perioperative and long-term surgical outcomes in elderly patients with stage I NSCLC.MethodsBetween December 1995 and November 2013, 110 patients aged 65 years or older who underwent surgical resection of stage I NSCLC at Dong-A University Hospital were retrospectively studied. We assessed the presence of the following lifestyle diseases as risk factors for postoperative complications and long-term mortality: diabetes, hypertension, chronic obstructive pulmonary disease, stroke, and ischemic heart disease.ResultsThe mean age of the patients was 71 years (range, 65 to 82 years). Forty-six patients (41.8%) had hypertension, making it the most common lifestyle disease, followed by diabetes (n=23, 20.9%). The in-hospital mortality rate was 0.9% (n=1). The 3-year and 5-year survival rates were 78% and 64%, respectively. Postoperative complications developed in 32 patients (29.1%), including 7 (6.4%) with prolonged air leakage, 6 (5.5%) with atrial fibrillation, 5 (4.5%) with delirium and atelectasis, and 3 (2.7%) with acute kidney injury and pneumonia. Univariate and multivariate analyses showed that the presence of a lifestyle disease was the only independent risk factor for postoperative complications. In survival analysis, univariate analysis showed that age, smoking, body mass index, extent of resection, and pathologic stage were associated with impaired survival. Multivariate analysis revealed that resection type (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.08 to 4.49; p=0.030) and pathologic stage (HR, 1.89; 95% CI, 1.02 to 3.49; p=0.043) had independent adverse impacts on survival.ConclusionThis study demonstrated that the presence of a lifestyle disease was a significant prognostic factor for postoperative complications, but not of survival, in elderly patients with stage I NSCLC. Therefore, postoperative complications may be influenced by the presence of a lifestyle disease.

The FIB-4 score predicts postoperative short-term outcomes of hepatocellular carcinoma fulfilling the milan criteria

BackgroundThe fibrosis score 4 (FIB-4) score is a useful tool to determine the degree of hepatic fibrosis. Liver fibrosis and cirrhosis are well-known predictors of postoperative complications after hepatectomy. This study examined the impact of FIB-4 on postoperative short-term outcomes of patients with hepatocellular carcinoma (HCC). MethodsThree hundred and fifty patients undergoing hepatectomy for HCC between 2008 and 2013 were enrolled. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the FIB-4. Univariate and multivariate analysis was performed to identify the risk factors. The correlation of the preoperative FIB-4 value with clinicopathological parameters was examined. ResultsPostoperative complications were observed in 202 (57.7%) patients. The optimal cutoff value of the FIB-4 was set at 2.88 and 3.85 for postoperative complications and intraoperative blood loss respectively. It was also an independent prognostic factor for postoperative complications (hazard ratio [HR], 1.202; 95% CI, 1.076–1.344; P = 0.001) and intraoperative blood loss (HR, 1.196; 95% CI, 1.091–1.343; P < 0.001) by multivariate analysis. The FIB-4 was significantly correlated with age, liver function, coagulation function, blood loss, intraoperative blood transfusion (all P < 0.05). ConclusionPreoperative FIB-4 is a useful index to predict postoperative outcomes in patients with HCC. The FIB-4 should be assessed routinely for hepatocellular carcinoma patients.

Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer.

The prevalence of colorectal cancer in the elderly is increasing and, therefore, surgical interventions with a risk of potential complications are more frequently performed. This study investigated the role of low skeletal muscle mass (sarcopenia), muscle quality, and the sarcopenic obesity as prognostic factors for postoperative complications and survival in patients with resectable colon cancer. We conducted a retrospective chart review of 91 consecutive patients who underwent an elective open colon resection for cancer with primary anastomosis between 2011 and 2013. Skeletal muscle mass was measured as total psoas area (TPA) and total abdominal muscle area (TAMA) at three anatomical levels on the preoperative CT scan. Skeletal muscle quality was measured using corresponding mean Hounsfield units (HU) for TAMA. Their relation with complications (none vs one or more), severe complications, and survival was analyzed. The study included 91 patients with a mean age of 71.2 ± 9.7years. Complications were noted in 55 patients (60%), of which 15 (16.4%) were severe. Lower HU for TAMA, as an indicator for impaired skeletal muscle quality, was an independent risk factor for one or more complications (all P ≤ 0.002), while sarcopenic obesity (TPA) was an independent risk factor for severe complications (all P ≤ 0.008). Sarcopenia was an independent predictor of worse overall survival (HR 8.54; 95% confidence interval (CI) 1.07-68.32). Skeletal muscle quality is a predictor for overall complications, whereas sarcopenic obesity is a predictor for severe postoperative complications after open colon resection for cancer. Sarcopenia on itself is a predictor for worse overall survival.

Laparoscopic Surgery for Perforated Duodenal Ulcer Disease: Analysis of 70 Consecutive Cases From a Single Surgeon.

In the surgical treatment of perforated duodenal ulcer disease, laparoscopic surgery has become a key technique. However, difficult cases are not eligible for laparoscopic surgery. The purpose of this study was to evaluate the risk factors for postoperative complications and to examine the safety and effectiveness of laparoscopic surgery. Seventy duodenal ulcer perforation patients who underwent laparoscopic surgery between July 2010 and March 2014 were reviewed. The type of surgery was chosen on the basis of the size of the perforation. All patients were classified into 2 groups according to the surgical treatment method: primary repair with omentopexy (PR group, n=56) and distal gastrectomy with truncal vagotomy (DG group, n=14). No conversions to open surgery occurred. Three deaths (mortality rate, 4.1%) occurred within 90 postoperative days. Postoperative complications, including 5 severe complications, occurred in 9 patients. There were no differences between the PR and DG groups, except in the mean operation time. In univariate analysis, history of nonsteroidal anti-inflammatory drug use, American Society of Anesthesiologist score (over 3), presence of shock, and time to surgery from symptom onset until surgery (over 48 h) were prognostic factors for postoperative complications. Of particular note, the different perforation sizes were not significantly different. Multivariate analysis showed that history of nonsteroidal anti-inflammatory drug use and treatment delay (48 h) were independent risk factors for overall postoperative complications. The presence of shock on admission was a risk factor for severe postoperative complications. Our results suggest that laparoscopic surgery may be applied to all duodenal ulcer perforations. However, because of the learning period, we believe that laparoscopic surgery may not be suited to every surgeon. However, when performed by laparoscopic experts, laparoscopic surgery can be a valuable approach for treating difficult duodenal ulcer perforations.

Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies

Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy. A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed. Of the 152 patients (89 male and 63 female; mean age 49.8±17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p=0.004), anemia (p=0.03), leukocytosis (p=0.016), and blood transfusions (p<0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p=0.001). Related to mortality, negative prognostic factors were age (p=0.003), leukocytosis (p=0.048), American Society of Anesthesiologists (ASA) score (p<0.001), blood transfusion (p<0.001), pleural effusion (p=0.031), and pneumonia (p=0.001). Pneumonia remained an independent prognostic factor of mortality (p=0.024). Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.