Prolonged Hospital Research Articles

FP3.11 - Postoperative ileus (POI) in colorectal cancer resections: A cohort study

Abstract Aims Postoperative ileus (POI) has reported incidence of < 30 % in malignant colorectal surgery. POI leads to delayed recovery, increase morbidity, prolonged hepatization & increased healthcare costs. Aim of study is to assess management of POI at single centre. Methods Cohort study was carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative outcomes were evaluated for POI patients, with non-ileus used as controls. Results Ileus (n = 275) Non ileus (n = 1436) Mann Whitney U (p value) Age(yrs) 71.8 70.1 NS Sex(M:F) 191 : 84 766 : 670 < 0.0001 ASA(median) 2 2 NS BMI(kg/m2) 26.9 26.4 NS Elective () 209 1139 Emergency(n) 66 297 Laparoscopic(n) 140 819 Open(n) 135 617 LN harvest(n) 12 12 NS Complications (n) (%) Leaks 14 52 HAP 64 125 Anaemia (transfusions) 10 43 Wound infections 41 115 Collection 27 69 Sepsis 37 49 Operation time(mins) 186.0 172.8 < 0.05 LOS(days) 14 ± 6 7 ± 3.5 < 0.0001 POI onset(days) 5 ± 2 NG tube(days) 3 ± 1 POI diagnosis (n) Clinical 62 AXR 70 Gastrograffin 64 CT scan 113 Mortality (n) 30 day 10 48 60 day 16 68 90 day 18 80 Survival rates (%) 1st year 89.0 87.6 Logrank 5th year 73.5 70.5 P = NS 10th year 64.3 62.4 (uncensored) 15th year 62.1 59.2 Conclusion POI occurred in 15.6 % of all CRC resections. Prolonged operative time, resulted in ileus, but did not adversely affect survival. POI can be diagnosed clinically or radiologically. POI resulted in prolonged hospitalization. Early diagnosis & intervention (NG tube decompression, fasting, IV fluids, gastrograffin & prokinetics) is key to reducing the adversity of POI

WP1.1 - Examining the effectiveness of prescribing Tamsulosin before elective surgery for inguino-scrotal hernias - a case series

Abstract Aims Urinary retention following surgery is a common issue that can result in significant morbidity and prolonged hospital admissions. Tamsulosin is commonly used to manage patients at risk of urinary retention in the community but its usefulness at preventing retention following surgery is currently unclear. This case series describes the effectiveness of using short courses of tamsulosin to prevent post-operative urinary retention at a single centre. Methods Males aged over 70 who underwent elective surgery for an inguino-scrotal hernia between January 2022 and January 2024 were included in this series. Inclusion also required the patients to be planned as day case procedures under general anaesthetic. Patients with a known history of prostatic disease and/or who were already taking Tamsulosin or another alpha-1 adrenoceptor inhibitor were excluded. Results 67 patients who took 400 micrograms of Tamsulosin once daily for 2 days before and on the day of surgery were included in this series. The patients were aged between 70 - 89 years and all underwent elective open mesh hernia repairs under the same surgeon with the same materials. None of the patients suffered post-operative urinary retention and so were able to be discharged as day cases. Conclusions The absence of any instances of post-operative urinary retention in this series suggests that a course of Tamsulosin before elective inguino-scrotal hernia repair can effective as prophylaxis against the condition. This data alongside additional randomised control trials demonstrating the benefits of pre-operative Tamsulosin may result in it being used more widely.

Oral feeding challenges of infants of diabetic mothers.

The presence of diabetes before or during pregnancy can increase perinatal mortality and morbidities. It is well known an infant of a diabetic mother (IDM) may experience complications such as macrosomia, hypoglycemia, respiratory distress syndrome, cardiac anomalies, and other abnormalities of organogenesis. Medical providers including physicians, nurses, and speech therapists have experienced challenges with helping IDMs orally feed. Challenges with oral feeding can lead to prolonged hospital stays and placement of supplemental feeding devices. The etiology of an IDM's oral feeding delays is not well understood and does not necessarily affect all infants. This descriptive review explores what is known about potential contributing factors to feeding difficulty in IDMs, including differences in infant behavior and swallowing mechanics. Some IDMs are unable to maintain active alert states and have decreased autonomic regulation and motor control. Studies of sucking and swallowing demonstrate reduced sucking pressure, fewer sucking bursts, and slowing of esophageal sphincter function. The increasing prevalence of diabetes during pregnancy makes further investigations into the characteristics and trajectories of state, behavior, and oral feeding of IDMs imperative.

SP4.11 - Retrospective review of achalasia management in a tertiary UGI centre

Abstract Introduction Achalasia is a rare disorder significantly impacting quality of life (QoL). Medical management includes calcium channel blockers (CCB), Pneumatic dilatation (PD) and Peroral endoscopic myotomy (POEM). Surgical management includes laparoscopic Heller’s myotomy (HM) or more recently robotic assisted Heller’s Myotomy. Aim This is a retrospective study of management of patients with achalasia in a tertiary Upper GI centre. Material and method Data was collected retrospectively between 2013-2023 (10 years) and analysed using Prism 10. In this period, 193patients with suspected achalasia were analysed and only 89patients with confirmed diagnosis were included. Results Of these 89 patients, 46 were female (48%) and 43 were male (52%). The median age was 61years (range 21-94years). 64 patients (72%) were local referrals and 25 patients (28%) were referred via the network. 3 patients (3%) were acute admissions. 45 patients (50%) received medical therapy initiated by gastroenterologists. 6 patients (6.7%) received CCB, 17 patients (19%) received endoscopic Botox and 22 patients (25%) underwent PD. 6 patients (27%) developed perforation post PD; of these, 3 patients underwent surgical repair and had a prolonged hospital stay. Of the 66 patients (74%) who underwent surgery, 55 patients (61%) had laparoscopic HM, 8 patients (9%) underwent robotic assisted HM and 1 patient (1%) had open HM. Average Length of stay was 5.8 days for laparoscopic HM and 3.9 days for robotic HM. In the laparoscopic HM group 3 patients (5%) had iatrogenic oesophageal injury repaired perioperatively and a further 5 patients (8%) needed oesophageal dilation for residual dysphagia. No complication was noted in the robotic HM group. Conclusion Surgery remains the treatment of choice for achalasia. Early outcomes of robotic surgery look promising, with lesser complication rates thus improving quality of life.

EP442 - An Audit on the Application of Enhanced Recovery Post Emergency Laparotomy

Abstract Aim This audit aims to evaluate the efficiency of NG tube and catheter removal post emergency laparotomies, assess the occurrence of postoperative complications, and analyse hospital practices related to enhanced recovery in the context of emergency laparotomies. Methods Data was collected retrospectively from [Hospital Name] for a specified time period, including patient demographics, surgical details, time to NG tube and catheter removal, postoperative complications, and adherence to enhanced recovery protocols. The audit included a thorough review of medical records, nursing notes, and relevant documentation. Results Preliminary findings indicate variations in the time taken for NG tube and catheter removal across emergency laparotomy cases. The occurrence of postoperative complications, such as infections, delayed recovery, and prolonged hospital stays, was also assessed. Furthermore, an analysis of hospital practices, including the implementation of enhanced recovery protocols, was conducted. Conclusion The results of this audit will contribute valuable insights into the effectiveness of current practices related to NG tube and catheter management post emergency laparotomies. The findings may highlight areas for improvement in enhancing recovery, optimising patient outcomes, and minimising complications. Recommendations for refining hospital protocols and promoting timely interventions will be proposed based on the audit results, with the ultimate goal of improving the overall quality of care for patients undergoing emergency laparotomies.

Management of Large Ovarian Tumors in Elderly Patients Using the Aron Alpha Method and Principles of Enhanced Recovery after Surgery

Abstract Objectives: We performed preoperative evaluations of giant ovarian tumors in older adult patients using the comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS) scoring systems. We report a case in which the Aron Alpha method was performed, and perioperative management was performed using enhanced recovery after surgery (ERAS). Materials and Methods: We performed preoperative evaluations using the E-PASS scoring system and CGA on older adult patients with giant ovarian tumors, followed by the minimally invasive Aron Alpha method and perioperative management using ERAS. Results: The mean patient age was 75.8 ± 8.8 years; comorbidities included hypertension in three patients, hyperlipidemia in two, angina pectoris in one, cholecystitis in one, and lower extremity varicose veins in one. The mean tumor size was 21.0 ± 5.4 cm. The E-PASS scoring system showed a preoperative risk score of 0.7 ± 0.4, a surgical stress score of 0, and a comprehensive risk score of 0.3 ± 0.3. CGA showed that two patients had problems with activities of daily living and cognitive function. The mean duration of surgery was 89.0 ± 16.6 min, and the mean blood loss was 56.0 ± 65.4 mL. No surgery-associated complications were observed. No patients had prolonged hospitalization or a decline in activities of daily living. Conclusion: We showed the usefulness of performing detailed preoperative evaluations using CGA and the E-PASS system, followed by the minimally invasive Aron Alpha surgical method and perioperative management using ERAS in improving surgical outcomes in older adult patients with giant ovarian tumors.

Rapid bone destruction caused by multidrug-resistant Pseudomonas aeruginosa septic arthritis: A case report.

Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are strongly associated with poor outcomes, including prolonged hospitalization and an increased risk of mortality. Antimicrobial options for the treatment of severe infections due to MDR P aeruginosa are quite limited, and treatment remains challenging. A 65-year-old woman presented to our orthopedic clinic with a 3-month history of progressive pain and stiffness in her left knee. Her primary care provider administered a hyaluronic acid injection, which unfortunately resulted in worsening symptoms. Subsequent treatment included a 1-month course of intravenous gentamicin and ceftriaxone, which failed to alleviate her symptoms. MDR P aeruginosa septic arthritis of the knee. The culture isolate was tested for susceptibility to multiple antibiotics. Magnetic resonance imaging evaluations were conducted, showing notable erosive and osteolytic changes around the joint surfaces that had progressed significantly. The patient underwent arthroscopic irrigation and synovectomy. The treatment regimen included a combination of intravenous colistin and piperacillin/tazobactam administered over a 6-week period. Total knee arthroplasty was performed 6 months later without additional antibiotic treatment. Patient's knee condition remained continuously stable without abnormal findings of inflammation. The patient's knee range of motion increased 0 to 125 degrees, her pain almost disappeared, and she was able to maintain activities of daily life. This case underscores the challenges of managing infections with MDR organisms in complex clinical scenarios, emphasizing the need for timely intervention and appropriate antibiotic therapy.

Machine learning-based risk prediction model construction of difficult weaning in ICU patients with mechanical ventilation

In intensive care unit (ICU) patients undergoing mechanical ventilation (MV), the occurrence of difficult weaning contributes to increased ventilator-related complications, prolonged hospitalization duration, and a significant rise in healthcare costs. Therefore, early identification of influencing factors and prediction of patients at risk of difficult weaning can facilitate early intervention and preventive measures. This study aimed to strengthen airway management for ICU patients by constructing a risk prediction model with comprehensive and individualized offline programs based on machine learning techniques. This study involved the collection of data from 487 patients undergoing MV in the ICU, with a total of 36 variables recorded. The dataset was divided into a training set (70% of the data) and a test set (30% of the data). Five machine learning models, namely logistic regression, random forest, support vector machine, light gradient boosting machine, and extreme gradient boosting, were compared to predict the risk of difficult weaning in ICU patients with MV. Significant influencing factors were identified based on the results of these models, and a risk prediction model for ICU patients with MV was established. When evaluating the models using AUC (Area under the Curve of ROC) and Accuracy as performance metrics, the Random Forest algorithm exhibited the best performance among the five machine learning algorithms. The area under the operating characteristic curve for the subjects was 0.805, with an accuracy of 0.748, recall (0.888), specificity (0.767) and F1 score (0.825). This study successfully developed a risk prediction model for ICU patients with MV using a machine learning algorithm. The Random Forest algorithm demonstrated the highest prediction performance. These findings can assist clinicians in accurately assessing the risk of difficult weaning in patients and formulating effective individualized treatment plans. Ultimately, this can help reduce the risk of difficult weaning and improve the quality of life for patients.

Malnutrition and other associated factors among the hospitalized elderly in Vietnam: A cross-sectional study.

Malnutrition is common among older inpatients and can lead to severe consequences such as disability, assisted living, increased mortality, and prolonged hospital stays. Given the rapidly aging population in Vietnam, limited data is available regarding the nutritional status of the geriatric. This research aimed to determine the prevalence of malnutrition and associated factors among the hospitalized elderly. A prospective observational study with a cross-sectional design was conducted on 108 older inpatients at University Medical Center in Ho Chi Minh City, Vietnam. Patients aged 60 years or older admitted to the hospital were recruited. Malnutrition was assessed using a validated Mini Nutritional Assessment Short Form. Sociodemographic characteristics were measured using interview-administered questionnaires. Data about patients' biochemical parameters were retrieved from records with the newest results. Among 108 hospitalized patients (mean age 74.6 ± 9.8 years; 50% female), 72.2% of patients had malnutrition (n = 78) while 27.8% had normal nutritional status (n = 30). Age group, education level, cohabitation, serum albumin, hand-drip strength, physical inactivity, and frailty were associated with malnutrition. The prevalence of malnutrition in the elderly accounts for a very high proportion. Nutritional status assessment is essential for the elderly; therefore, more attention should be paid to those risk factors in old age health care in order to improve medical outcomes.

Predictors of Prolonged Hospital Stay After Microsurgery for Vestibular Schwannoma: Analysis of a Decade of Data.

Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients. Determine predictors of increased LOS for VS patients undergoing microsurgical resection. Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020. Database review. All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included. Analyzing perioperative factors that can predict prolonged hospital stay. A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32-3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09-4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1-1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31-11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18-3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18-3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62-15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76-2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54-0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39-5.53, p = 0.004.). Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.

Prognostic impact of CONUT score in older patients with chronic heart failure

BackgroundMalnutrition is common in older patients with chronic heart failure (HF) and often accompanies a deterioration of their condition. The Controlling Nutritional Status (CONUT) score is used as an objective indicator to evaluate nutritional status, but relevant research in this area is limited. This study aimed to report the prevalence, clinical correlates, and outcomes of malnutrition in elder patients hospitalized with chronic HF.MethodsA retrospective analysis was conducted on 165 eligible patients admitted to the Department of Cardiology at Huadong Hospital from January 2021 to December 2022. Patients were categorized based on their CONUT score into three groups: normal nutrition status, mild risk of malnutrition, and moderate to severe risk of malnutrition. The study examined the nutritional status of this population and its relationship with clinical outcomes.ResultsFindings revealed that malnutrition affected 82% of the older patients, with 28% experiencing moderate to severe risk. Poor nutritional scores were significantly associated with prolonged hospital stay, increased in-hospital mortality and all-cause mortality during readmissions within one year (P < 0.05). The multivariable analysis indicated that moderate to severe malnutrition (CONUT score of 5–12) was significantly associated with a heightened risk of prolonged hospitalization (aOR: 9.17, 95%CI: 2.02–41.7).ConclusionsMalnutrition, as determined by the CONUT score, is a common issue among HF patients. Utilizing the CONUT score upon admission can effectively predict the potential for prolonged hospital stays.

Thermographic assessment of skin temperature after lumbar spine surgery: Useful method for detection of wound complications? A pilot study.

Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area. Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05). This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.

Signal mining of adverse events of proteasome inhibitors in multiple myeloma based on FAERS.

To mine and analyze adverse events (AEs) related to proteasome inhibitors in multiple myeloma based on the FDA Adverse Event Reporting System (FAERS), providing references for rational clinical medication. AE data related to multiple myeloma proteasome inhibitors were collected from the FAERS from the first quarter of 2010 to the first quarter of 2024. Signal mining of AEs was conducted using the reporting odds ratio method and Bayesian confidence propagation neural network method. A total of 8,805 reports for bortezomib, 5,264 for carfilzomib, and 8,771 for ixazomib were collected, with corresponding AE signals of 474, 279, and 287, respectively, involving 23, 21, and 22 System Organ Classes (SOCs). The report information for the three drugs tended to be consistent: more cases were reported in males than in females; the majority of patients were 65 years and over; AEs mostly occurred within 6months of medication; the outcomes primarily consisted of hospitalization, prolonged hospital stay, and other serious adverse events; the primary reporting country was the United States. The most affected SOCs were infections and infestations, general disorders and administration site conditions, and blood and lymphatic system disorders. The overall distribution of AEs for the three multiple myeloma proteasome inhibitors was consistent, but there were certain differences in specific AE signal characteristics, which should be noted in clinical applications.

Preventing and Treating Diabetic Foot Infections

Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to morbidity, prolonged hospital stays, and increased healthcare costs. This paper explores the epidemiology, pathophysiology, and clinical presentation of DFIs, while emphasizing strategies for prevention and treatment. Comprehensive care, including glycemic control, patient education, proper footwear, regular foot examinations, and early intervention, is critical. Treatment options span from conservative measures like antibiotics to surgical interventions. Emerging therapies and the role of multidisciplinary teams in managing DFIs are also discussed.

Kinesiophobia in patients after cardiac surgery: a scoping review

BackgroundThis paper reviews the scope of research on kinesiophobia in patients after cardiac surgery. Further, it reviews the current situation, evaluation tools, risk factors, adverse effects, and intervention methods of kinesiophobia to provide a reference for promoting early rehabilitation of patients after cardiac surgery.MethodsGuided by the scoping methodology, the Web of Science, PubMed, CINAHL, Cochrane Library, China Biomedical Literature Database, VIP Database, Wanfang Database, CNKI, and other databases were searched from database inception until July 31, 2024. The studies obtained were screened, summarised and systematically analysed by two researchers.ResultsEighteen studies (16 cross-sectional studies, one qualitative study, and one randomised controlled trial) were included. The incidence of kinesiophobia in patients after cardiac surgery was 39.20–82.57%, and the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to evaluate this incidence. The influencing factors of kinesiophobia in patients after cardiac surgery included demographic characteristics, pain severity, frailty, exercise self-efficacy, disease-related factors, and psychosocial factors. Kinesiophobia led to adverse health outcomes such as reduced recovery, prolonged hospital stays, and decreased quality of life in patients after cardiac surgery, and there were few studies on intervention methods for postoperative kinesiophobia.ConclusionThe kinesiophobia assessment tools suitable for patients after cardiac surgery should be improved, and intervention methods to promote the early recovery of patients after major clinical surgery and those with difficult and critical diseases should be actively researched.

A modern approach to multiple pulmonary resections in children with recurrent metastatic pulmonary disease.

Implications of repeated resections of pulmonary metastasis (PM) are not well documented in the modern era. Fifteen children underwent two (n=8), three (n=3), or four or more (n=3) resections (total=38 procedures), most commonly for osteosarcoma (71%). Operative approach included muscle-sparing thoracotomy (71%), non-muscle-sparing thoracotomy (18%), and video-assisted thoracoscopy (11%). Median resected nodules per procedure was four (range = 1-95). Prolonged air leaks were the most common postoperative complication (29%). Median hospital stay was 4days, and no children were discharged with or have required oxygen. Event-free survival is 67% at median follow-up time of 54months, with an overall survival rate of 64%. Repeat resection of PM appears to be well tolerated, without prolonged hospital stays or compromised pulmonary function.

Surgical Site Infections: Prospective Study in a Medical College Teaching Hospital at Port Blair, India

Abstract Objectives: Surgical site infections (SSIs) continue to be a prevalent and pervasive issue, contributing to healthcare expenditures, extended hospital stays, and significantly increased morbidity and death. The purpose of the current study was to evaluate the risk factors and prevalence of SSIs amongst patients undergoing various surgical procedures at a tertiary care facility in Port Blair, India. Materials and Methods: This prospective study was conducted at a tertiary medical college hospital setting in Port Blair, India, within the Department of Microbiology. The study was conducted from January 2018 to June 2018. Results: During the study period, 776 individuals underwent various surgeries, including both elective and emergency procedures. The total prevalence of the SSI rate during the study period was 12.88% (n = 776) based on the documentation of approximately 100 SSIs. Amongst these, 44% were associated with obstetrics and gynaecology surgery. The category of post-lower segment caesarean section (LSCS) stitch line had the greatest prevalence rate of SSIs (34 patients out of 175 developed infections; LSCS approximately 19.42% of these patients developed SSIs). Conclusions: In Indian adult patients undergoing any form of surgical procedure, the SSI prevalence was 12.88%. SSIs occurred more frequently after obstetrics and gynaecology operations. Following any type of surgery, patients who are women, younger, had emergency surgery, have diabetes, and require a lengthy hospital stay are more likely to experience SSIs. The most commonly encountered pathogens were Staphylococcus aureus and coagulase negative Staphylococcus.

Comparing the Efficacy of Robotic Versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant metabolic bariatric surgery. With a growing number of studies evaluating the feasibility of robotic sleeve gastrectomy (RSG), it becomes imperative to ascertain whether the outcomes of both techniques are comparable. This study endeavors to synthesize existing evidence and juxtapose the surgical outcomes of LSG and RSG. We collected articles comparing LSG and RSG published between 2011 and 2024. The compiled data included author names, study duration, sample size, average age, gender distribution, geographical location, preoperative body mass index (BMI), bougie diameter, duration of hospitalization, surgical duration, readmission rates, conversion rates, costs, postoperative percentage of excess weight loss (%EWL), postoperative BMI, mortality rates, and complications. We incorporated 21 articles. Both the RSG and LSG cohorts exhibited comparable rates of readmission, conversion, mortality, and incidence of complications (p > 0.05). Moreover, the efficacy of weight loss was similar between RSG and LSG. Nonetheless, RSG was linked to longer operative duration (WMD, -27.50 minutes; 95% confidence interval [CI], -28.82 to -26.18; p < 0.0001), prolonged hospitalization (WMD, -0.15 days; 95% CI, -0.25 to -0.04; p = 0.006), and elevated expenses (WMD, -5830.9 dollars; 95% CI, -8075.98 to -3585.81; p < 0.0001). While both RSG and LSG demonstrated positive postoperative clinical outcomes, RSG patients experienced extended hospital stays, longer operative times, and increased hospitalization costs compared to LSG patients. Using the robotic platform for sleeve gastrectomy (SG) in patients with obesity did not appear to offer any clear benefits.

Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients.

Intrahepatic cholangiocarcinoma (iCC) is an aggressive tumor, usually detected at an advanced stage. Our aim was to investigate the potential of body composition analysis (BCA) derived from presurgical staging computed tomography (CT) in predicting perisurgical complications. In this retrospective cohort study, we enrolled 86 patients who underwent CT imaging prior to liver surgery. Cox and logistic regression were performed to assess risk factors for prolonged hospital and intensive care unit (ICU) stays, as well as the occurrence of various complications. BCA parameters served as covariates besides conventional risk factors. Postoperative complications after resection of iCC significantly prolonged the overall length of hospitalization (p < .001). Presence of sarcopenia was associated with longer ICU stays. Complications were common, with 62.5% classified as Clavien-Dindo grade IIIa or lower and 37.5% as more severe. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were identified as risk factors for complications, including bile leakage (in 24 cases, p = .025), pleural effusions (in 26 cases, p = .025), and intra-abdominal abscess formation (in 24 cases, p = .043). SAT was associated with severe complications requiring interventional therapy, whereas VAT was correlated with abscess formation. Despite normal prevalence of obesity (22%), body mass index (BMI) did not have an impact on the development of perioperative complications. BCA is a useful tool for preoperative risk stratification in patients with iCC and is superior to BMI assessment. Increased SAT and VAT were associated with the risk of perisurgical complications, prolonging hospitalization. Therefore, BCA derived from routine staging CT should be considered in the preoperative assessment of patients with iCC.

Abstract P131: Effect of uncontrolled systolic blood pressure in hypertensive patients as a risk factor for CIN after coronary angiography with preventative management of CIN : single center prospective study

Background: Contrast induced nephropathy(CIN) is associated with poor outcomes like dialysis and prolonged hospitalization and risk of death. Clinical factor for CIN include advanced age, diabetes (DM), female, heart failure(HF) and hypertension(HTN). Many prophylaxis strategies for CIN(normal saline hydration, N-acetylcysteine, NAHCO3) had been studied and their preventive effects had been known to be no difference. Purpose: We tried to evaluate the effects of uncontrolled systolic blood pressure(defined as SBP&gt;160mmHg) in hypertensive patients as a risk factor for CIN after coronary angiography(CAG) with various preventative management of CIN (normal saline hydration, N-acetylcysteine, NAHCO3). Methods: This study included 41patients who performed CAG combined with various preventative management of CIN in single center. All patients were evaluated with serum creatinine(SCr), creatinine clearance(CrCl) before and after coronary angiography at day0, day1, day2 and day30. Definition of CIN include; SCr increase of ≥0.5 mg/dL, a SCr increase ≥25%, an CrCl decrease of ≥25%, or the composite, occurring 48 to 72 hours after contrast exposure. We also analyzed preexisting renal insufficiency(GFR&lt;60ml/min), DM and HTN, age, sex, anemia, contrast volume and HF which are known risk factors for CIN. Results: 11 of 41 patients developed CIN. There was no statistical differences between the two groups in the aspect of baseline Cr, age, sex, body weight, contrast volume and the prevalence of known risk factor for CIN (DM, HTN, HF and preexisting renal failure). Mean baseline SBP in the CIN group was higher than non-CIN group(166.3±31.9 vs142.4±25.7, P-value=0.018). Among 23 patients with HTN, 11 patients (47.8%) had uncontrolled SBP. The multivariable logistic regression analysis showed that an uncontrolled SBP (odds ratio [OR] 12.63, 95% confidence interval [CI] 1.83-87.07) was the independent risk factor for CIN. Conclusions: CIN associate with variety of short-term and long-term complication after CAG. Hypertension is well known as one of the risk factors for CIN. Even if appropriate preventative management of CIN are taken before and after CAG, uncontrolled SBP in hypertensive patients could increase the risk of CIN.