Rates Of Perioperative Adverse Events Research Articles

Laparoscopic ileocecal-sparing vs traditional right hemicolectomy for cancer of the hepatic flexure or proximal transverse colon: a dual-center propensity score-matched study.

Traditional right hemicolectomy (TRH) is the standard treatment for patients with nonmetastatic right colon cancer. However, the ileocecum, a vital organ with mechanical and immune functions, is removed in these patients regardless of the tumor location. This study aimed to evaluate the technical and oncological safety of laparoscopic ileocecal-sparing right hemicolectomy (LISH). Patients who underwent LISH at two tertiary medical centers were matched 1:2 with patients who underwent TRH by propensity score matching based on sex, age, body mass index, tumor location, and disease stage. Data on surgical and perioperative outcomes were collected. Oncological safety was evaluated in a specimen-oriented manner. Lymph nodes (LNs) near the ileocolic artery (ICA) were examined independently in the LISH group. Disease outcomes were recorded for patients who completed one year of follow-up. In all, 34 patients in the LISH group and 68 patients in the TRH group were matched. LISH added 8 minutes to the dissection of LNs around the ileocolic vessels (groups 201/201d, 202, and 203 LNs), without affecting the total operation time, blood loss, or perioperative adverse event rate. Compared with TRH, LISH had a comparable lymphadenectomy quality, specimen quality, and safety margin while preserving a more functional bowel. The LISH group had no cases of LN metastasis near the ICA. No difference was detected in the recurrence rate at the 1-year follow-up time point between the two groups. In this dual-center study, LISH presented comparable surgical and oncological safety for patients with hepatic flexure or proximal transverse colon cancer.

Sacrospinous Fixation and Vaginal Uterosacral Suspension-Evaluation in Uterine Preservation Surgery

ABSTRACT Although hysterectomy is traditionally performed at the time of pelvic organ prolapse repair for apical prolapse, women are increasingly interested in uterine preservation during pelvic organ prolapse surgical management. Approximately 36% to 60% of women indicate interest in uterine preservation, assuming equal efficacy. This has led to more uterus-preserving prolapse repairs (hysteropexy) being performed. After the removal of mesh products from the US market in 2019, transvaginal native tissue techniques are commonly used for hysteropexy. This study aimed to compare 6-week and 1-year anatomical failure rates between vaginal uterosacral ligament hysteropexy and sacrospinous ligament hysteropexy. Secondary outcomes included retreatment for prolapse, symptoms of recurrent prolapse, and perioperative adverse event rates in these 2 groups. This was a multicenter retrospective cohort study of patients undergoing vaginal uterosacral hysteropexy (USHP) or sacrospinous hysteropexy (SSHP) with a urogynecologist between January 1, 2015 and December 31, 2019. The pool of patient data was extrapolated from 4 geographically unique urban locations. Patient identification took place via querying the respective electronic medical records for the current procedural terminology codes of extraperitoneal colpopexy (57,282, SSHP) and intraperitoneal colpopexy (57,283, USHP). These operative reports underwent review in order to confirm that each patient had a uterus at time of surgery, underwent either USHP or SSHP, and did not undergo concurrent hysterectomy. Exclusion criteria included patients undergoing different types of uterine-preserving procedures or patients with less than 6 weeks of follow-up. The study included 147 patients undergoing SSHP and 114 having USHP over 5 years at the 4 clinical sites. The study population included mostly nonsmoking (179, 68.6%), White (224, 85.5%) patients with no history of pelvic surgery (142, 54.4%), and a mean Charleston Comorbidity Index score of 2. Overall, USHP patients exhibited a higher likelihood to undergo concurrent anterior repair, posterior repair, and incontinence procedures. The follow-up rate was 95% at 6 postoperative weeks with 4 anatomic failures. Not all patients had formal prolapse quantitation examinations recorded. However, only 32% (83/261) of patients were available for follow-up at 1 year after surgery when 10 patients met criteria for anatomic failure. Notably, although there was no statistically significant difference between failure rates for SSHP and USHP at either time point, there were roughly 3 times as many failures for USHP compared with SSHP, despite the SSHP representing a larger portion of the total cohort. At 1 year, however, 26 patients had undergone retreatment for prolapse, with 12 undergoing hysterectomy (11 due to prolapse, 1 due to colorectal cancer debulking). Of those undergoing hysterectomy, 10 were from the SSHP cohort, whereas 1 was from the USHP cohort. The 1 year anatomic outcomes presumably included prolapse assessments after these salvage surgeries. One year after vaginal native tissue hysteropexy, only 1 in 3 patients were available for follow-up, but this limited cohort demonstrated that no differences for prolapse recurrence between SSHP and UHSP. Adverse events incidence rates were low, with only 5% of patients undergoing subsequent hysterectomy for prolapse. Any next step in research should include more rigorous prospective trials.

Systematic review and meta-analysis of the treatment strategies for coronary artery bypass graft patients with concomitant carotid artery atherosclerotic disease

ObjectiveStroke is one of the devastating complications after coronary artery bypass graft (CABG). Underlying carotid artery atherosclerotic disease is reported to be an independent risk factor. The optimal treatment strategy for these patients remains under debate. MethodsWe aimed to perform a network meta-analysis to evaluate the safety and efficacy of additional carotid interventions for patients with concomitant carotid artery atherosclerotic disease who require CABG by comparing perioperative adverse event rates. All articles through February 2022 were searched using MEDLINE and EMBASE to identify studies that investigated outcomes of CABG only as well as additional staged vs combined carotid interventions by both carotid endarterectomy (CEA) and carotid artery stenting (CAS). ResultsTwo randomized controlled trials and 23 observational studies were included, yielding a total of 32,473 patients who underwent combined CEA and CABG (n = 20,204), CEA and staged CABG (n = 6882), CABG and staged CEA (n = 340), CAS and CABG regardless of timing and sequences (n = 1224), and CABG only (n = 3823). No strategy showed a significant advantage over CABG only in all perioperative outcomes. CEA and staged CABG was associated with the lowest perioperative stroke/transient ischemic attack (TIA) rate, significantly lower compared with CAS and CABG (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.36-0.76) as well as CABG and staged CEA (OR, 0.41; 95% CI, 0.23-0.74), but was also associated with the highest perioperative mortality (OR, 2.50; 95% CI, 1.67-3.85, vs CAS and CABG) and myocardial infarction rate (OR, 3.70 [95% CI, 1.16-12.5] and OR, 2.50 [95% CI, 1.35-4.55] vs CAS and CABG, vs combined CEA and CABG, respectively). ConclusionsCEA and staged CABG are associated with low perioperative stroke/transient ischemic attack rates with a tradeoff of higher mortality and myocardial infarction rate. No strategy showed a significant advantage over the CABG-only strategy in all perioperative outcomes, outlining the importance of a tailored approach and determining proper indications for carotid intervention in these patients.

3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

IntroductionLeft atrial appendage closure (LAAC) is a novel treatment for stroke prevention in high-risk patients with non-valvular atrial fibrillation (NVAF). However, the long-term outcomes after LAAC in Chinese NVAF patients are still lacking.MethodsThis was a single-center, bidirectional, nonrandomized registered study. Patients who underwent LAAC implantation from May 2014 to April 2021 in a large Chinese center were enrolled. The primary endpoint was combined all-cause death and stroke.ResultsFrom May 2014 to April 2021, a total of 673 NVAF patients were enrolled. The overall successful implantation rate was 97.62% (657 of 673). The rate of perioperative adverse events was 1.19% (8 of 673), including 3 cardiac tamponades, 2 ischemic strokes, one device-related thrombus (DRT) and 2 device dislocations. 604 (92.24%) patients completed the follow-up, the median follow-up period was 36.9 months (IQR 24.8–56.5 months). 16 stroke events occurred in 15 patients (one patient suffered from both hemorrhagic and ischemic strokes). 13 patients (2.15%) had ischemic stroke, and the fatal rate was 0.33% (2 of 604). 3 patients (0.15%) suffered from hemorrhagic stroke, and the fatal rate was 0.17% (1 of 604). The overall stroke rate was 0.74% per-year. The combined death and stroke rate was 1.93% per-year. In the multivariate Cox regression analysis, age ≥ 75 (hazard ratio 2.264, 95% CI 1.074–4.772, P = 0.032) and ventricular cardiomyopathy (hazard ratio 2.738, 95% CI 1.060–7.071, P = 0.037) were independent predictors of combined mortality and stroke.ConclusionThe overall successful implantation rate of LAAC was 97.62% and the rate of perioperative adverse events was 1.19% in this study, and the stroke rate was 0.74% per year during the long-term follow-up. Age ≥ 75 years and ventricular cardiomyopathy were independent predictors of the primary endpoint.Trial registration This study was retrospectively registered.

Prognostic nutritional index predicts perioperative adverse events in patients undergoing hemiarthroplasty after a hip fracture

The relation of the prognostic nutritional index (PNI) with perioperative adverse events (PE) has never been described in hip fracture surgery patients. Therefore, this study aimed to evaluate the impact of preoperative PNI on the outcome of patients undergoing hemiarthroplasty after a hip fracture. A total of 154 adult patients aged ≥ 65 years undergoing hemiarthroplasty after a hip fracture were included in this retrospective study. The outcomes of interest were the length of stay in hospital and PE during hospitalization, defined as death, surgical site infection, major bleeding, cardiopulmonary complications, acute renal failure, pneumonia, cerebrovascular accidents, and sepsis. PNI was calculated from the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Patients’ information, including demographic data, routine preoperative laboratory tests, and PNI, was collected to assess the association between these factors and the PE. Perioperative adverse events occurred in 21 (13.6%) of the patients. Older patients and those with more comorbid conditions such as heart failure, coronary artery disease, diabetes mellitus, cerebrovascular diseases, and chronic obstructive pulmonary diseases were tended to have a higher rate of PE. Patients with PE had lower PNI (45.2±4.2 vs. 51.6±5.4; p < 0.001) on admission. Multivariate analysis showed that age (OR: 2.23, 95% CI 1.15-4.45, p=0.042), presence of diabetes (OR: 2.34; 95% CI: 1.74–6.89; p =0.005) and PNI < 47.2 (OR 2.54, 95% CI 1.32-5.72, p = 0.004) were significant and independent predictors of PE. This study is the first to demonstrate that the lower preoperative PNI is associated with PE in patients undergoing hip fracture surgery.

A Noninferiority Analysis of 3- vs 2-Incision Techniques for Hypoglossal Nerve Stimulator Implantation.

The only hypoglossal nerve stimulation (HNS) device available for US clinical use is implanted through 3 incisions. A recently proposed 2-incision modification moved the respiratory sensing lead from the fifth to the second intercostal space to eliminate the third lower chest incision. This study compared perioperative data and therapeutic outcomes between the techniques. Noninferiority cohort analysis of a retrospective and prospective registry study. Tertiary care and community surgical centers. Patients with obstructive sleep apnea underwent HNS implantation via a modified 2-incision technique (I2). A cohort previously implanted via the standard 3-incision technique (I3) were 1:1 propensity score matched for a noninferiority analysis of postoperative outcomes. There were 404 I3 patients and 223 I2 patients across 6 participating centers. Operative time decreased from 128.7 minutes (95% CI, 124.5-132.9) in I3 patients to 86.6 minutes (95% CI, 83.7-97.6) in I2 patients (P < .001). Postoperative sleep study data were available for 76 I2 patients who were matched to I3 patients. The change in apnea-hypopnea index between the cohorts was statistically noninferior (a priori noninferiority margin: 7.5 events/h; mean difference, 1.51 [97.5% CI upper bound, 5.86]). There were no significant differences between the cohorts for baseline characteristics, perioperative adverse event rates, or change in Epworth Sleepiness Score (P > .05). In a multicenter registry, a 2-incision implant technique for a commercially available HNS device had a statistically noninferior therapeutic efficacy profile when compared with the standard 3-incision approach. The 2-incision technique is safe and effective for HNS implantation.

Perioperative outcomes in a nationwide sample of patients undergoing surgical treatment of ovarian endometriomas

To evaluate the perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for ovarian endometriomas (OMAs) and other benign neoplasms. Retrospective cohort study. Clinical database containing information from 580 US hospitals. Women 18 to 50 years old who underwent ovarian cystectomy or oophorectomy for benign indications between 2010 and2020. We compared procedure route, length of hospital stay, and complication rates by surgical indication (OMA vs. other benign neoplasms) and surgical procedure (cystectomy vs. oophorectomy). Thirty-day perioperative adverse events following adnexal surgery, including conversion to laparotomy, blood transfusion, ileus, urinary tract injury, bowel injury, readmission, and death. We identified 120,208 ovarian cystectomies (28,182 OMAs and 92,026 other indications) and 53,476 oophorectomies (8,622 OMAs and 44,854 other indications). During cystectomy, patients with OMAs more commonly experienced conversion to laparotomy (5.1% vs. 3.1%) and readmission (8.5% vs. 7.1%). For oophorectomies, patients with OMAs less frequently had minimally invasive surgery (55.8% vs. 64.8%) or outpatient procedures (33.8% vs. 41.8%). Urinary tract and bowel injuries were rare. Multivariable logistic regression demonstrated that the presence of OMA predicted composite complications during cystectomy (adjusted odds ratio [aOR] 1.23, 95% confidence interval [CI] 1.18-1.28) but not during oophorectomy (aOR 1.05, 95% CI 0.99-1.12). Patients with OMAs had 1.37 times the odds of a composite complication during oophorectomy than during cystectomy (95% CI 1.28-1.47). Patients undergoing ovarian cystectomy for OMAs had higher rates of perioperative adverse events than patients undergoing ovarian cystectomy for other benign neoplasms. Laparotomies were performed more often during oophorectomies for OMAs than for other benign indications.

Perioperative outcomes of inpatient laparoscopic Heller myotomy and per-oral endoscopic myotomy in the United States

BackgroundPer-oral endoscopic myotomy is an alternative to pneumatic dilation and laparoscopic Heller myotomy to treat lower esophageal sphincter diseases. Laparoscopic Heller myotomy and per-oral endoscopic myotomy perioperative outcomes data come from relatively small retrospective series and 1 randomized trial. We aimed to estimate the number of inpatient procedures performed in the United States and compare perioperative outcomes and costs of laparoscopic Heller myotomy and per-oral endoscopic myotomy using a nationally representative database. MethodsCross-sectional retrospective analysis of hospital admissions for laparoscopic Heller myotomy or per-oral endoscopic myotomy from October 2015 through December 2018 in the National Inpatient Sample. Patient and hospital characteristics, concurrent antireflux procedures, perioperative adverse events (any adverse event and those associated with extended length of stay ≥3 days), mortality, length of stay, and costs were compared. Logistic regression evaluated factors independently associated with adverse events. ResultsAn estimated 11,270 patients had laparoscopic Heller myotomy (n = 9,555) or per-oral endoscopic myotomy (n = 1,715) without significant differences in demographics and comorbidities. A concurrent anti-reflux procedure was more frequent with laparoscopic Heller myotomy (72.8% vs 15.5%, P < .001). Overall adverse event rate was higher with per-oral endoscopic myotomy (13.3% vs 24.8%, P < .001), and mortality was similar. Per-oral endoscopic myotomy had higher rates of adverse events associated with extended length of stay (9.3% vs 16.6%, P < .001), infectious adverse events (3.5% vs 8.2%, P < .001), gastrointestinal bleeding (3.4% vs 5.8%, P = .04), accidental injuries (3% vs 5.5%, P = .03), and thoracic adverse events (4.5% vs 9%, P < .01). Rates of adverse events of both procedures remained similar during the years of the study. Per-oral endoscopic myotomy was independently associated with adverse events. Length of stay (laparoscopic Heller myotomy: 3.2 ± 0.1 vs per-oral endoscopic myotomy: 3.7 ± 0.3 days, P = .17) and costs (laparoscopic Heller myotomy: $15,471 ± 406 vs per-oral endoscopic myotomy: $15,146 ± 1,308, P = .82) were similar. ConclusionIn this national database review, laparoscopic Heller myotomy had a lower rate of perioperative adverse events at similar length of stay and costs than per-oral endoscopic myotomy. Laparoscopic Heller myotomy remains a safer procedure than per-oral endoscopic myotomy for a myotomy of the distal esophagus and lower esophageal sphincter in the United States.

Female gender increases risk of stroke and readmission after carotid endarterectomy and carotid artery stenting

ObjectiveCarotid endarterectomy (CEA) has historically demonstrated a higher rate of perioperative adverse events for female patients. However, recent evidence suggests similar outcomes for CEA between genders. In contrast, fewer studies have examined gender in carotid artery stenting (CAS). Using contemporary data from the American College of Surgeons National Surgical Quality Improvement Program database, we aim to determine if gender impacts differences in postoperative complications in patients who undergo CEA or CAS. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2017 using Current Procedural Terminology and International Classification of Diseases codes for retrospective review. Patients with carotid intervention (CEA or CAS) were stratified into asymptomatic vs symptomatic cohorts to determine the effect of gender on 30-day postoperative outcomes. Symptomatic patients were defined as those with perioperative transient cerebral ischemic attack or stenosis of carotid artery with cerebral infarction. Descriptive statistics were calculated. Risk-adjusted odds of 30-day postoperative outcomes were calculated using multivariate regression analysis with fixed effects for age, race, and comorbidities. ResultsThere were 106,568 patients with CEA or CAS (104,412 CEA and 2156 CAS). The average age was 70.9 years, and female patients accounted for 39.9% of the population. For asymptomatic patients that underwent CEA or CAS, female gender was associated with significantly higher rates of cerebrovascular accident (CVA)/stroke (13%; P = .005), readmission (10%; P = .004), bleeding complication (32%; P = .001), and urinary tract infection (54%; P = .001), as well as less infection (26%; P = .001). In the symptomatic cohort, female gender was associated with significantly higher rates of CVA/stroke (32%; P = .034), bleeding complication (203%; P = .001), and urinary tract infection (70%; P = .011), whereas female gender was associated with a lower rate of pneumonia (39%; P = .039). Subset analysis found that, compared with male patients, female patients <75 years old have an increased rate of CVA/stroke (21%; P = .001) and readmission (15%; P < .001), whereas female patients ≥75 years old did not. In asymptomatic and symptomatic patients that underwent CEA, female gender was associated with significantly higher rates of CVA/stroke (13%; P = .006 and 31%; P = .044, respectively), but this finding was not present in patients undergoing CAS. ConclusionsIn patients undergoing carotid intervention, female gender was associated with significantly increased rates of postoperative CVA/stroke in the asymptomatic and symptomatic cohorts as well as readmission in the asymptomatic cohort. Female gender was associated with higher rates of CVA/stroke following CEA, but not CAS. We recommend that randomized control trials ensure adequate representation of female patients to better understand gender-based disparities in carotid intervention.

Perioperative Outcomes in a Nationwide Sample of Patients Undergoing Surgical Treatment of Ovarian Endometriomas

Study Objective Surgery for deep infiltrating and bowel endometriosis involves risks of organ injury, reoperation, and prolonged hospital stay. Surgical outcomes following surgery for ovarian endometriosis (endometrioma, OMA) are currently unknown. The objective of this study was to evaluate perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for OMAs compared to other benign ovarian neoplasms. Design Retrospective cohort study. Setting Vizient Clinical Database, which contains information from 580 participating hospitals across the United States. Patients or Participants Patients ages 18-50 who underwent ovarian cystectomy or oophorectomy for benign indications 2010-2020 were identified. OMAs included ICD-9/10 codes for ovarian endometriosis. We excluded patients who received concomitant hysterectomy or obstetric or oncologic care. Interventions We abstracted clinical data, including surgical route, length of stay, and 30-day postoperative complication rates. Procedures performed for OMA were compared to other surgical indications. Measurements and Main Results We identified 58,874 patients who underwent oophorectomies (10,464 OMAs vs. 48,410 for other indications) and 125,911 ovarian cystectomies (30,058 OMAs vs. 95,853 other). During oophorectomy, patients with OMAs were less likely to undergo minimally invasive surgery (63% vs. 67%, p<0.001) and more likely to require conversion to laparotomy (4.3% vs. 3.4%, p<0.001) and extended hospitalization 2+ days (40% vs. 37%, p<0.001). Among women undergoing cystectomy, conversion to laparotomy (5.3% vs. 3.3%, p<0.001) and readmission (8.5% vs. 7.2%, p<0.001) were more common with OMAs. In multivariable logistic regression, OMA predicted conversion to laparotomy during oophorectomy (aOR 1.3, 95% CI=1.1-1.4) and cystectomy (aOR 1.6, 95% CI=1.5-1.7). Urinary tract injury was infrequent and occurred more often during surgery for indications other than endometriosis (oophorectomy 1.7% vs. 0.95%, cystectomy 0.74% vs. 1.3%, all p<0.001). Bowel injury was exceedingly rare (0.01% of all procedures). Conclusion We present population-level data demonstrating that patients undergoing ovarian cystectomy or oophorectomy for endometriomas had higher rates of perioperative adverse events, including conversion to laparotomy, extended hospital stay, and readmission. Surgery for deep infiltrating and bowel endometriosis involves risks of organ injury, reoperation, and prolonged hospital stay. Surgical outcomes following surgery for ovarian endometriosis (endometrioma, OMA) are currently unknown. The objective of this study was to evaluate perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for OMAs compared to other benign ovarian neoplasms. Retrospective cohort study. Vizient Clinical Database, which contains information from 580 participating hospitals across the United States. Patients ages 18-50 who underwent ovarian cystectomy or oophorectomy for benign indications 2010-2020 were identified. OMAs included ICD-9/10 codes for ovarian endometriosis. We excluded patients who received concomitant hysterectomy or obstetric or oncologic care. We abstracted clinical data, including surgical route, length of stay, and 30-day postoperative complication rates. Procedures performed for OMA were compared to other surgical indications. We identified 58,874 patients who underwent oophorectomies (10,464 OMAs vs. 48,410 for other indications) and 125,911 ovarian cystectomies (30,058 OMAs vs. 95,853 other). During oophorectomy, patients with OMAs were less likely to undergo minimally invasive surgery (63% vs. 67%, p<0.001) and more likely to require conversion to laparotomy (4.3% vs. 3.4%, p<0.001) and extended hospitalization 2+ days (40% vs. 37%, p<0.001). Among women undergoing cystectomy, conversion to laparotomy (5.3% vs. 3.3%, p<0.001) and readmission (8.5% vs. 7.2%, p<0.001) were more common with OMAs. In multivariable logistic regression, OMA predicted conversion to laparotomy during oophorectomy (aOR 1.3, 95% CI=1.1-1.4) and cystectomy (aOR 1.6, 95% CI=1.5-1.7). Urinary tract injury was infrequent and occurred more often during surgery for indications other than endometriosis (oophorectomy 1.7% vs. 0.95%, cystectomy 0.74% vs. 1.3%, all p<0.001). Bowel injury was exceedingly rare (0.01% of all procedures). We present population-level data demonstrating that patients undergoing ovarian cystectomy or oophorectomy for endometriomas had higher rates of perioperative adverse events, including conversion to laparotomy, extended hospital stay, and readmission.

Perioperative outcomes and survival in elderly women with ovarian cancer

Objectives: The rate of perioperative adverse events, postoperative outcomes and survival between patients aged 60-69 yo versus those ≥70 yo undergoing surgery for the primary treatment of advanced ovarian cancer (OC). Methods: We retrospectively identified all patients ≥60 years old treated surgically for primary advanced high-grade OC at our institution between January 2016 and December 2018. Institutional National Surgical Quality Improvement Program data were obtained for post-operative complications. Additional data were abstracted from medical records. Results are stratified based on the treatment approach: primary debulking surgery (PDS) or neo-adjuvant chemotherapy followed by interval debulking surgery (NACT/IDS). Appropriate statistical tests were performed. Results: A total of 77 patients were analyzed; 45 were between 60-69 years and 32 were ≥70 years. There were no differences in preoperative BMI, ECOG, ASA, CCI, polypharmacy, baseline bloodwork and stage (Table 1). Only 2 patients ≥70 years (0.6%) saw a geriatric oncology specialist prior to treatment. A total of 32 patients underwent PDS (60-69yo: n=18, ≥70yo: n=14), and 45 patients had NACT/IDS (60-69yo: n=27, ≥70yo: n=18). In both PDS and NACT/IDS groups, there were no differences in the post-operative adverse events between the two age groups. Older patients in the NACT/IDS group received less total platinum and taxane chemotherapy before and after surgery compared to NACT/IDS patients aged 60-69 years (p Download : Download high-res image (144KB) Download : Download full-size image Download : Download high-res image (263KB) Download : Download full-size image Conclusions: Although baseline characteristics were comparable between younger and older OC patients, reasons for PDS versus NACT/IDS were difficult to extrapolate from the medical record. Age was not a factor influencing perioperative outcomes of advanced ovarian cancer patients and the main predictor of outcomes was treatment approach. Since PDS is the main predictor of survival, a standardized, multi-disciplinary approach to optimize the management of older patients with ovarian cancer is necessary. Use of a formal assessment tool and consultation with a geriatric specialist may facilitate more patients undergoing PDS.

NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA

Background:Hip arthroscopy is most commonly performed utilizing general anesthesia. Studies in hip and knee arthroplasty have shown an association between neuraxial anesthesia and lower rates of perioperative adverse events, lower post-operative pain scores, and lower dosing of postoperative systemic analgesics when compared to general anesthesia. A direct comparison between neuraxial and general anesthesia in hip arthroscopy has not previously been investigated.Hypothesis/Purpose:We sought to identify the immediate post-operative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure.Methods:Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were retrospectively reviewed. The primary outcome was PACU opioid administration, measured by morphine equivalents (MEQ). Secondary parameters included total LOS, post-incision LOS, PACU LOS and PACU arrival/discharge pain scores. Analyses conducted were t-tests, Wilcoxon rank sum tests, or chi-square tests.Results:A total of 129 patients met inclusion criteria for this study; 54 males and 75 females, with an average age of 28 (±10.1) years. 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower MEQ in both the operating room (30.0 vs 53.9, p = 0.001) and PACU (18.2 vs 31.2, p = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, p = 0.001, 3.0 vs. 4.0, p = 0.013). There was no statistically significant difference in post-incision LOS, or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs. 1.3 hrs, p = 0.005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group.Conclusion:Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia.Tables

102 Is advanced preoperative imaging associated with lower perioperative adverse outcomes in women undergoing laparoscopic hysterectomy?

Traditionally, ultrasound is the gold standard imaging study prior to pelvic surgery. It is not well characterized how advanced imaging affects rates of perioperative adverse events in women undergoing laparoscopic hysterectomy for benign indications. Our goal was to compare the rate of perioperative adverse events in women who underwent ultrasound only versus advanced imaging (ultrasound plus CT or MRI) prior to laparoscopic hysterectomy for benign indications. We conducted a retrospective cohort study of patients undergoing either total laparoscopic hysterectomy (TLH), laparoscopic assisted vaginal hysterectomy (LAVH), or robotic assisted total laparoscopic hysterectomy (RA-TLH) between January 2016 and December 2018 who have undergone ultrasound only or advanced imaging within one year prior to their procedure. Subjects were identified through the billing query of the electronic medical record based on Current Procedural Terminology codes. Patients with a diagnosis of malignancy prior to surgery or intraoperatively were excluded. After screening, demographic and perioperative data were extracted from patient records. Postoperative adverse events were categorized according to the Clavien-Dindo classification. Our primary outcome was the rate of intraoperative and postoperative adverse events with Clavien-Dindo grade II or greater. Data were analyzed using unpaired t-test and two sample test of proportions where appropriate. Query of the medical record resulted in 151patients who met inclusion criteria with 51 patients in the advanced imaging and 100 patients in ultrasound only cohorts. Patients in the advanced imaging cohort had lower Charlson Comorbidity Index scores as compared to patients without advanced imaging. These were nonassociated with decreased likelihood of adverse events. The occurrence of adverse perioperative events among ultrasound only and advanced imaging were 31.00% (n = 31) and 17.64% (n = 9), respectively. Using chi square analysis for correlation, there is no statistically significant difference in perioperative adverse events in ultrasound only and advanced imaging cohorts (P = 0.20). There was no statistically significant difference in the overall rate of perioperative adverse events Clavien-Dindo Grade II or higher. The time increases from first imaging study to day of surgery and overall operative time for the advanced imaging groupware statistically significant (P = 0.02, P = 0.17). Women undergoing advanced imaging for laparoscopic hysterectomies do not have increased rates of adverse events when compared to their ultrasound only counterparts. Ultrasound only imaging can be safely offered to patients as the only imaging modality prior to laparoscopic hysterectomy without delay in delivery of care, increased operative time, or increased rate of adverse events.

The management of displaced femoral neck fractures: a narrative review.

This article serves to review the existing clinical guidelines, and highlight the most recent medical and surgical recommendations, for the management of displaced femoral neck fractures (FNFs). It stresses the need for multi-disciplinary intervention to potentially improve mortality rates, limit adverse events and prevent further economic liability.Globally, the incidence of FNFs continues to rise as the general population ages and becomes more active. The annual number of FNFs is expected to exceed six million by 2050. The increased burden of FNFs exacerbates the demand on all services associated with treating these injuries.The management of FNFs may serve as an indicator of the quality of care of the geriatric population. However, despite escalating health costs, a significant 30-day and one-year mortality rate, increased rate of peri-operative adverse events and sub-optimal functional clinical outcomes, continued controversy exists over optimal patient care.Much debate exists over the type of surgery, implant selection and peri-operative clinical care and rehabilitation. FNF care models, systematized clinical pathways, formal geriatrics consultation and specialized wards within an established interdisciplinary care framework may improve outcomes, mitigate adverse events and limit unnecessary costs.Cite this article: EFORT Open Rev 2021;6:139-144. DOI: 10.1302/2058-5241.6.200036

Efficacy of an Oxycodone-Propofol Combination versus a Fentanyl-Propofol Combination in Conscious Sedation during Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients

Background: With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. Objectives: This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. Methods: A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, n = 97) and a “fentanyl combined with propofol” group (group FP, n = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. Results: There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO₂ <90% for >10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. Conclusions: Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

Anesthetic Management of Patients After Scoliosis Surgery: A Single-Center Retrospective Study.

PurposeTo evaluate the effect of anesthetic management on scoliosis surgery and review the incidence rate of perioperative adverse events.MethodsThis was a retrospective study and approved by the ethics committee. Patients who underwent scoliosis surgery from April 2011 to March 2018 in the Third Hospital of ChengDu were enrolled in this study. Characteristics of patients were obtained from the hospital's electronic records. The following information on patients was collected: preoperative assessment details, premedication, type of anesthesia and operation, the main postoperative outcome, and complications. Data were presented as the mean ± standard deviations (SD) for normally distributed continuous variables and numbers for categorical variables. Statistical analyses were performed using SPSS version 22.0.ResultsIn total, 513 patients were enrolled in the present study. The main preoperative complication was cardiopulmonary dysfunction (386 cases, 75.24%). Anesthesia induction was performed with conscious tracheal intubation after oral surface anesthesia. In total, the common postoperative complications involved anesthesia (24 cases, 4.68%), surgery (23 cases, 4.48%), the respiratory system (138 cases, 26.90%), and the gastrointestinal tract (nine cases, 1.75%). The majority of postoperative complications were postoperative hypoxemia and hypercapnia, caused by poor cardiopulmonary function. Rare and serious complications still occurred. Three patients died in hospital.ConclusionOur study demonstrated a high incidence of complications in scoliosis surgery, especially postoperative complications. Extreme postoperative vigilance is required and high‐level monitoring of conditions is highly recommended.

Prognostic Nutritional Index Predicts Perioperative Adverse Events in Patients Undergoing Noncardiac Surgery

Although the relation of preoperative prognostic nutritional index (PNI) with perioperative adverse events has been investigated in patients undergoing cardiac surgery and various solid organ cancer surgeries, it has never been investigated in patients undergoing noncardiac surgery as a distinct group. A retrospective analysis of 811 consecutive patients, older than 18 years old and undergoing an elective, noncardiac, and nonvascular surgery between November 2015 and February 2019 was performed. Patients’ information, including demographic data, routine preoperative laboratory tests, and PNI were collected to assess the association between these factors and the perioperative complications. PNI was calculated from the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The outcomes of interest were perioperative complications during hospitalization. The perioperative adverse event rate was 9.0% (73 patients). Older patients and those with more comorbid conditions such as atrial fibrillation, history of malignancy, and diabetes mellitus tended to have a higher rate of perioperative complications. Patients with complicated hospital course had lower albumin (3.1 ± 0.41 vs. 3.7 ± 0.62 g/dL; p < 0.001) and PNI levels (45.1 ± 4.4 vs. 51.8 ± 5.8; p < 0.001) at admission compared to patients without complications. Multivariate analysis showed that age (OR, 2.13; 95% CI, 1.14–4.45; p < 0.01), PNI < 47.5 (OR, 2.51; 95% CI, 1.19–5.46; p = 0.005), and history of malignancy (OR, 3.11; 95% CI, 1.14–5.33; p < 0.01) were significant and independent predictors of perioperative complications. This study demonstrated that the lower preoperative PNI is associated with increased rate of perioperative complications in patients undergoing noncardiac surgery.

Batten disease and perioperative complications: a retrospective descriptive study.

Batten disease or neuronal ceroid lipofuscinosis is the most prevalent neurodegenerative disorder of childhood. Previously reported perioperative complications in children with Batten disease have come mainly from single case reports. The primary aim of the current study was to investigate perioperative complications of patients with Batten disease in the largest cohort known to date. The secondary objective was to characterize the anesthetic management including the use of propofol and to assess its association with adverse events. We conducted a single center, retrospective descriptive study by querying the hospital's electronic medical record to identify patients with a diagnosis of Batten disease or ICD10 E75.4 who received anesthetic care from December 2014 to May 2019. Thirty-five patients who underwent a total of 93 anesthetic encounters (range 1-11) were included in the analysis. A total of 29 adverse events were identified. Hypotension (N = 6, 6.5%) and bradycardia (N = 7, 7.5%) requiring treatment with medications were the most common adverse events. Other adverse events include oxygen desaturation (N = 4, 4.3%), seizures (N = 4, 4.3%), unanticipated hospital or ICU admission (N = 1, 1.1%), PACU phase 1 stay > 120min (N = 2, 2.2%), hypothermia (N = 4, 4.3%), agitation (N = 1, 1.1%), and laryngospasm requiring treatment (N = 1, 1.1%). The number of preoperative anti-epileptic drugs (AEDs) had a positive correlation with the rate of perioperative adverse events. There was no statistical relationship of adverse events with intraoperative use of propofol (odds ratio 1.03, 95% CI 0.42-2.51). The majority of these patients were managed without clinically significant perioperative complications. As previously reported, bradycardia, hypotension, and hypothermia were the most common adverse events. Routine avoidance of propofol in patients with Batten disease does not appear warranted.

Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy.

Pelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding perioperative adverse events in older women undergoing robot-assisted sacrocolpopexy (RASC) specifically. The aim of this study was to compare the rate of perioperative adverse events in younger (age <65years) versus older (age>65years) women who underwent RASC. We conducted a retrospective cohort study of women who underwent RASC between 2013 and 2018. Postoperative adverse events were categorized according to the Clavien-Dindo classification. Our primary outcome was the rate of intraoperative adverse events and postoperative adverse events with Clavien-Dindo grade II or greater. Outcomes were compared using univariate and multivariate analysis. Of the 327 patients included in the study, 227 were <65years of age and 100 were≥65years of age. Women ≥65years of age had higher rates of hypertension, higher American Society of Anesthesiologist (ASA) class, and higher Charlson Comorbidity Index (CCI) scores compared with women <65years of age; these were not associated with increased likelihood of adverse events. The overall rate of any perioperative adverse event was 18.3%. There was no statistically significant difference in the overall rate of perioperative adverse events between younger and older women (18.5% vs 18.0%, p = 0.91). There is no difference in rate of adverse events between women ≥65years of age undergoing RASC and their younger counterparts.

Εndovascular Repair of Extracranial Carotid Artery Aneurysms: A Systematic Review.

Both true and false extracranial carotid artery aneurysms (ECAA) are a potential source of morbidity and mortality. While ECAA have historically been treated surgically, endovascular reconstruction with stenting is an emerging treatment option. The aim of our study was to report clinical/radiologic outcomes following endovascular repair of ECAAs. A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A total of 68 case reports and case series, comprising 162 patients, were included. Most patients presented with at least one symptom or sign related to the ECAA (89.5%; N = 145/162). In 42.6% (N = 69/162) and 46.3% (N = 75/162) of the cases polytetrafluoroethylene covered and uncovered stents were deployed respectively. Immediate post-procedural imaging demonstrated complete aneurysm exclusion in 86.4% (N = 140/162) of the cases and minimal filling of the aneurysm sack in 10.5% (N = 17/162) of all cases. Perioperative adverse event rates were 3.1% for stroke, 1.2% for transient ischemic attack (TIA) and 4.3% for mortality. During a mean follow-up of 21.8months, there were additionally observed one stroke, two TIAs and three deaths. Overall 88.6 % of the patients (N = 117/132) remained asymptomatic, partially recovered or at least did not suffer from new neurologic deficits during follow up, with no signs of stenosis or occlusion of the carotid artery. Endovascular stenting for the treatment of ECAAs is feasible with acceptable short- and long-term clinical and radiologic outcomes. Prospective real-world studies are needed to further validate the safety and the long-term patency of endovascular repair.