Risk Factors For Postoperative Complications Research Articles

IS POTENTIAL MALNUTRITION ASSOCIATED WITH INCREASED MORBIDITY IN TOTAL HIP AND KNEE ARTHROPLASTY?

Malnutrition is considered a risk factor for postoperative complications in total hip and knee arthroplasty, though prospective studies investigating this assumption are lacking. The aim of this study was to prospectively analyse the 90-day postoperative complications, postoperative length of stay (LOS) and readmission rates of patients undergoing primary total hip and total kneearthroplasty using albumin, total lymphocyte count (TLC) and transferrin as serum markers of potential malnutrition.603 primary hip and 823 primary knee arthroplasties over a 3-year period from a single centre wereprospectively analysed. BMI, demographic and comorbidity data were recorded. Complications werecategorised as surgical site infection, venous thromboembolism (deep vein thrombosis andpulmonary embolus), implant related (such as dislocation), and non-implant related (such aspneumonia). Outcomes were compared between groups, with malnutrition defined as serumalbumin <3.5g/dL, transferrin <200 mg/dL, or TLC <1,500 cells/mm³.Potential malnutrition was present in 9.3% of the study population. This group experienced a longeraverage LOS at 6.5 days compared to the normal albumin group at 5.0 days (p=0.003). Surgical siteinfection rate was higher in the malnourished group (12.5 vs 7.8%, p=0.02). There was no differencebetween the two groups in implant related complications (0.8 vs 1.0%, p=0.95) medicalcomplications (7.8 vs 13.3%, p=0.17), rate of venous thromboembolism (2.3 vs 2.7%) or 90-dayreadmission rate (14.1 vs 17.0%, p=0.56). TLC and transferrin were not predictive of any of theprimary outcomes measured (p<0.05). Pacific Island (p<0.001), Indian (p=0.02) and Asian (p=0.02) patients had lower albumin than NZ European.This study demonstrates an association between low albumin levels and increased postoperativeLOS and surgical site infection in total joint arthroplasty, providing rationale for consideration ofpreoperative nutritional screening and optimisation.

P371 Assessment Of Postoperative Complications Following Ileocecal Resection In Crohn’s Disease From A Low-To-Middle Income Country

Abstract Background Our study aims to assess risk factors of postoperative complications following ileocecal resection of Crohn’s disease from a low-to-middle income country perspective. We aimed to provide local data demonstrative of inner conditions and challenges. Methods This was a retrospective study conducted in a referral colorectal center in a low-to-middle income country from 2014 to 2020. We included all patients with Crohn’s disease admitted to our department for ileocecal resection. Patient’s and Crohn’s disease, surgical and postoperative characteristics were collected using chart review. We excluded all patients with missing data. We defined perioperative hemorrhage as blood loss≥200cc. Our primary outcome was immediate<90-days post-operative complications risk factors assessment. Results We included 83 patients with complete data. The median age was 34(18-75) and 54.2%(n=45) were female. Patients were 94.6%from urban areas and 5.4%(n=4) rural. Among all included surgeries, 83.1%(n=69) were elective and 16.9%(n=14) were emergency cases. Open surgery was conducted in 46 cases(55.4%), 30patients had laparoscopic ileocecal resection (36.1%), and 7(8.4%) had conversion. Immediate postoperative complications were reported in 16.9%(n=14);anastomotic leak 2(2.4%), surgical site infection 8(9.6%), entero-cutaneous fistula 2(2.4%), and postoperative hemorrhage 2(2.4%). Long-term outcomes with surgical reoperation were conducted in 5 cases(5.8%) excluding stoma removal. The total length of stay median was 6 days (4-31). Immediate postoperative complications were associated with postoperative bleeding(OR=27.8; 95% CI[1.26-614];p=0.001,Fisher’s=0.027), required transfusion during surgery or at postoperative follow-up(OR=18.3;95% CI[3.09-109];p<0.001,Fisher’s=0.001), hospital length of stay(t-test<0.001), pre-operative hemoglobin(t-test0.031). Conclusion Considering the accessibility of hemoglobin management in a low-to-middle income country, it represents an impactful tool in surgical quality enhancement.

A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction

The efficacy and safety of self-expanding metallic stent (SEMS) placement as a bridge to elective surgery versus emergency surgery to treat malignant colonic obstruction is debated. This study aimed to evaluate the outcomes of patients with malignant colonic obstruction treated using different procedure. Subjects admitted to the authors’ department with colonic obstruction (n = 87) were studied. They underwent colonic stenting as a bridge to elective surgery (SEMS group: n = 14) or emergency surgery (ES group: n = 22).Their demographic characteristics, stoma rate, laparoscopy rate and postoperative complications were analyzed, and the potential risk factors of postoperative complications and the optimal time interval from SEMS implantation to elective surgery were explored. The stoma rate was 15.4% in the SEMS group versus 60.0% in the ES group (P = 0.015), and the postoperative complication rate was 7.7% in the SEMS group versus 40.0% in the ES group (P = 0.042). The proportion of patients undergoing laparoscopy in SEMS group was significantly higher than that in ES group (69.2% vs. 15.0%; P = 0.003).The effect of ASA grade on postoperative complications was statistically significant (OR = 24.565; P = 0.008). The Receiving operating characteristic (ROC) curve could not determine the optimal time interval between SEMS implantation and elective surgery (AUC = 0.466). SEMS implantation has the advantages of lower temporary stoma rate, less postoperative complications and higher laparoscopy rate compared with ES in the treatment of left malignant intestinal obstruction. ASA grade is a risk factor for postoperative complications. However, larger sample size prospective randomized controlled trials (RCT) are still needed to confirm long-term oncological outcomes.

Preoperative controlling nutritional status score (CONUT) predicts postoperative complications of patients with bronchiectasis after lung resections.

The Controlled Nutritional Status (CONUT) score is a valid scoring system for assessing nutritional status and has been shown to correlate with clinical outcomes in many surgical procedures; however, no studies have reported a correlation between postoperative complications of bronchiectasis and the preoperative CONUT score. This study aimed to evaluate the value of the CONUT score in predicting postoperative complications in patients with bronchiectasis. We retrospectively analyzed patients with localized bronchiectasis who underwent lung resection at our hospital between April 2012 and November 2021. The optimal nutritional scoring system was determined by receiver operating characteristic (ROC) curves and incorporated into multivariate logistic regression. Finally, independent risk factors for postoperative complications were determined by univariate and multivariate logistic regression analyses. A total of 240 patients with bronchiectasis were included, including 101 males and 139 females, with an average age of 49.83 ± 13.23 years. Postoperative complications occurred in 59 patients (24.6%). The incidence of complications, postoperative hospital stay and drainage tube indwelling time were significantly higher in the high CONUT group than in the low CONUT group. After adjusting for sex, BMI, smoking history, lung function, extent of resection, intraoperative blood loss, surgical approach and operation time, multivariate analysis showed that the CONUT score remained an independent risk factor for postoperative complications after bronchiectasis. The preoperative CONUT score is an independent predictor of postoperative complications in patients with localized bronchiectasis.

Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency.

In recent years, the use of aspiration prevention surgery (APS) for the treatment of severe dysphagia has been on the rise. However, relevant clinical studies have included small samples, and the frequency of, and risk factors for postoperative complications have not been clarified. We investigated the clinical features of patients undergoing APS and whether oral-intake status and suction frequency could be reduced. A case series. Single-institution academic center. We retrospectively evaluated medical charts generated from 2010 to 2021. The clinical characteristics of patients undergoing APS, changes in the oral-intake status (Functional Oral Intake Scale, FOIS), suction frequency before and after surgery, risk factors for postoperative complications, and factors contributing to improvements in postoperative oral-intake status were retrieved. We included the data of 100 patients (median age: 65 years, 72 men). Amyotrophic lateral sclerosis was the most common primary disease (28%), and glottis closure was the most common APS (69%). Postoperatively, 78% of patients showed improvements in the FOIS score, and suction frequency decreased in 85% of cases. Postoperative complications were observed in 10 patients (10%), wound infection in 6, and bleeding in 4; all improved. Higher preoperative FOIS scores were significantly associated with postoperative complications (p = 0.02). APS contributed to improving the FOIS score and helped reduce the suction frequency in most cases. APS can be performed safely with proper perioperative management, even in patients with poor preoperative general conditions and nutritional status.

Frailty combined with nutritional risk score in predicting postoperative complications of elderly patients with gastrointestinal malignancies

ObjectiveExploring the predictive power of frailty combined with nutritional risk on postoperative complications in elderly gastrointestinal malignancies patients. MethodsElderly patients who underwent gastrointestinal cancer surgery at Gastrointestinal Surgery Department of the Affiliated Hospital of Binzhou Medical University from August 2021 to June 2022 were selected as the research subjects. The patients' frailty and nutritional status were assessed using the Fried Frailty Scale and the NRS2002 Nutritional Risk Scale within 24 h of admission. Observing and recording the diagnosis and treatment of postoperative complications during the hospitalization. Results202 patients were enrolled, including 119 patients (58.91%) with nutritional risk and 89 patients (44.06%) with frailty. Frailty was an independent risk factor for postoperative complications [OR = 5.904, 95%CI (3.103, 11.233)]. The AUC value of frailty assessment was 0.780, which was greater than the AUC value of NRS2002 score of 0.705 (P < 0.01). The AUC value of frailty assessment combined with NRS-2002 score was 0.844, which was significantly higher than that alone (P < 0.01). ConclusionsThe ability of frailty to predict postoperative complications is better than the NRS-2002 score. Frailty combined with nutritional risk assessment can increase the predictive power of postoperative complications in elderly gastrointestinal malignancies patients.

Postoperative complications in asthmatic patients following orthognathic surgery: A two-year follow-up study

BackgroundLack of evidence exists related to the incidence of postoperative complications in asthmatic patients following orthognathic surgery. The present study aimed to assess the incidence and risk factors of postoperative complications in asthmatic patients following orthognathic surgery. Material and methodsA retrospective cohort study was conducted which consisted of two groups of patients i.e., asthmatic and systemically healthy patients, who underwent conventional orthognathic surgical procedures (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). The recorded postoperative complications in both groups of patients included infection, relapse, altered facial sensation, temporomandibular joint disorder, respiratory complications, and hemorrhage-related events. The association between baseline variables and complications for identifying the possible risk factors was assessed using bivariate analysis and a logistic regression model. ResultsA total of 886 patients underwent orthognathic surgery over a period of 6-years. Following the eligibility criteria, 16 patients were recruited in the asthmatic group and 278 patients were systemically healthy. The most common complications in the asthmatic patients were altered sensation (37.5%) followed by TMJ disorder (25.0%) and relapse (18.8%). These patients were associated with an increased risk of relapse (P = 0.048) compared to healthy patients. Following adjustment of baseline variables, increased risk of relapse was still associated with asthma (odds ratio [OR]. = 4.704, P = 0.027). ConclusionAsthmatic patients suffer from a significantly higher risk of relapse and need to be closely monitored following orthognathic surgery to ensure a stable outcome. Asthma does not seem to have a significant impact on other postoperative complications.

Impact of sarcopenia on postoperative pulmonary complications after gastric cancer surgery: A retrospective cohort study.

Few studies have investigated the relationship between sarcopenia and postoperative pulmonary complications (PPCs) after gastric cancer surgery. This study aimed to explore the impact of sarcopenia on PPCs in patients who had undergone gastric cancer surgery. We included patients who underwent a transabdominal radical gastrectomy between June 2016 and October 2020. Patients were divided into two groups according to the median prevalence rate of lumbar triplane skeletal muscle index (L3 SMI): sarcopenia group (≤37.5% percentile in male and female group) and non-sarcopenia group (>37.5% percentile in male and female group). Baseline characteristics, intraoperative and postoperative conditions, pulmonary complications, and overall complications were compared between the two groups. The primary outcome was the incidence of PPCs. The secondary outcomes were overall postoperative complications and length of stay (LOS). Among the 143 patients included, 50 had sarcopenia and 93 had not. Compared to the non-sarcopenia group, the sarcopenia group had a higher the incidence of PPCs (22.0% vs. 8.6%, P = 0.024). The incidence of overall postoperative complications in the sarcopenia group was higher than that in the non-sarcopenia group (36.00% vs. 20.43%, P = 0.043). There was no significant difference in the LOS between the two groups. Our research indicates that sarcopenia, preoperative comorbidities, and longer duration of intraoperative oxygen saturation <95% were risk factors for PPCs. Sarcopenia is an independent risk factor for postoperative complications. Given that our results provided a correlation rather than causation, future prospective randomized trials are needed to confirm the relationship between sarcopenia and prognosis.

Advantage of laparoscopic surgery in patients with generalized obesity operated for colorectal malignancy: A retrospective cohort study.

Because of the progression of minimally invasive surgery skills and obesity in colorectal surgery, we aimed to evaluate the short-term outcomes of colorectal cancer resections in patients with generalized obesity at a single teaching hospital with mature surgical techniques and training programs. A total of 537 patients were diagnosed with CRC and had a body mass index ≥30 kg/m2 between January 2009 and December 2019 at a single institution. 265 patients underwent open surgery and 272 patients underwent laparoscopic surgery. Data were analysed to explore the independent risk factors for postoperative complications. The laparoscopic group had less blood loss (73 ± 128 vs. 148 ± 290 ml, p < 0.001) and a shorter postoperative hospital stay (10.8 ± 17.1 vs. 11.7 ± 6.8 days, p < 0.001) than the open group. The number of harvested lymph nodes did not significantly differ between the two groups (30.9 ± 18.3 vs. 30.2 ± 15.3, p = 0.981). Although anastomotic leakage was significantly higher in the laparoscopic group (1.5% vs. 4.8%, p = 0.030), there were also similar overall postoperative morbidity and mortality rates between the open and laparoscopic groups for CRC patients with generalized obesity who underwent surgery. Laparoscopic surgery can reduce blood loss, decrease the length of hospital stay, obtain a similar number of harvested lymph nodes, and achieve an acceptable conversion rate for CRC patients with generalized obesity. We suggest that laparoscopic surgery could become a standard method for CRC treatment in patients with generalized obesity.

Risk factor analysis and construction of prediction models for short-term postoperative complications in patients undergoing gastrointestinal tract surgery.

To identify risk factors associated with short-term postoperative complications in patients with gastrointestinal cancer and develop and validate prediction models to predict the probability of complications. A total of 335 patients enrolled in the primary cohort of this study were divided into training and validation sets in a chronological order. Using univariate and multivariate logistic regression analyses, the risk factors for postoperative complications were determined, and nomogram prediction models were constructed. The performance of the nomogram was assessed with respect to the receiver operator characteristic and calibration curves. Patients with complications had a stronger postoperative stress response and a longer duration of daily fluid intake/output ratio >1 after surgery. Logistic analysis revealed that body mass index (BMI), body temperature on POD4 (T.POD4), neutrophil percentage on POD4 (N.POD4), fasting blood glucose on POD4 (FBG.POD4), and the presence of fluid intake/output ratio <1 within POD4 were risk factors for POD7 complications, and that BMI, T.POD7, N.POD7, FBG.POD4, FBG.POD7, and the duration of daily fluid intake/output ratio >1 were risk factors for POD30 complications. The areas under the curve of Nomogram-A for POD7 complications were 0.867 and 0.833 and those of Nomogram-B for POD30 complications were 0.920 and 0.918 in the primary and validation cohorts, respectively. The calibration curves showed good consistency in both cohorts. This study presented two nomogram models to predict short-term postoperative complications in patients with gastrointestinal cancer. The results could help clinicians identify patients at high risk of complications within POD7 or POD30.

Comparison of Laparoscopic and Open Gastrectomy for Patients With Gastric Cancer Treated With Neoadjuvant Chemotherapy: A Multicenter Retrospective Study Based on the Korean Gastric Cancer Association Nationwide Survey.

Despite scientific evidence regarding laparoscopic gastrectomy (LG) for advanced gastric cancer treatment, its application in patients receiving neoadjuvant chemotherapy remains uncertain. We used the 2019 Korean Gastric Cancer Association nationwide survey database to extract data from 489 patients with primary gastric cancer who received neoadjuvant chemotherapy. After propensity score matching analysis, we compared the surgical outcomes of 97 patients who underwent LG and 97 patients who underwent open gastrectomy (OG). We investigated the risk factors for postoperative complications using multivariate analysis. The operative time was significantly shorter in the OG group. Patients in the LG group had significantly less blood loss than those in the OG group. Hospital stay and overall postoperative complications were similar between the two groups. The incidence of Clavien-Dindo grade ≥3 complications in the LG group was comparable with that in the OG group (1.03% vs. 4.12%, P=0.215). No statistically significant difference was observed in the number of harvested lymph nodes between the two groups (38.60 vs. 35.79, P=0.182). Multivariate analysis identified body mass index (odds ratio [OR], 1.824; 95% confidence interval [CI], 1.029-3.234; P=0.040) and extent of resection (OR, 3.154; 95% CI, 1.084-9.174; P=0.035) as independent risk factors for overall postoperative complications. Using a large nationwide multicenter survey database, we demonstrated that LG and OG had comparable short-term outcomes in patients with gastric cancer who received neoadjuvant chemotherapy.

Outcomes and prognostic factors of surgically treated extramammary Paget's disease of the vulva.

Extramammary Paget's disease (EMPD) of the vulva is a rare disease which predominantly presents in postmenopausal Caucasian women. As yet, no studies on Asian female patients with EMPD have been performed. This study aimed to identify the clinical features of patients with vulvar EMPD in Korea, and to evaluate the risk factors of recurrence and postoperative complications in surgically treated EMPD. We retrospectively reviewed 47 patients with vulvar EMPD who underwent wide local excision or radical vulvectomy. The clinical data and surgical and oncological outcomes following surgery were extracted from medical records and analyzed. Univariate and multivariate analyses for predicting recurrence and postoperative complications were performed. 21.3% of patients had complications after surgery, and wound dehiscence was the most common. 14.9% of patients experienced recurrence, and the median interval to recurrence from initial treatment was 69 (range 33-169) months. Vulvar lesions larger than 40 mm was the independent risk factor of postoperative complications (odds ratio [OR]=7.259; 95% confidence interval [CI]=1.545-34.100; p=0.012). Surgical margin status was not associated with recurrence in surgically treated vulvar EMPD patients (OR=0.83; 95% CI=0.16-4.19; p=1.000). Positive surgical margin is a frequent finding in the patients with vulvar EMPD, but disease recurrence is not related with surgical margin status. Since EMPD is a slow growing tumor, a surveillance period longer than 5 years is required.

Predictors of postoperative complications in patients with ventral hernia

To evaluate potential predictors of 1-month postoperative complications after primary ventral hernia repair using database of the 1st Clinic of the Samarkand State Medical University. A cohort study included 348 patients who underwent ventral hernia surgery in the 1st Clinic of the Samarkand State Medical University between January 1, 2014 and January 1, 2021. We performed logistic regression analysis to identify risk factors of postoperative complications. More than one complication within 1-month after surgery developed in 87 (25%) patients. Those factors associated with complications in univariate analysis (p<0.05) and clinically important factors were included in multivariate analysis. In multivariate analysis, age, body mass index, hypertension, hernia size, hospital-stay and surgery time were independent risk factors. Age, BMI, hypertension, anamnesis and size of hernia, as well as surgery time correlated with postoperative complications. Therefore, these factors should be used in preoperative risk assessment.

Fatores de risco para complicações pós-operatórias da hidradenite supurativa: artigo de revisão

INTRODUCTION: Hidradenitis Suppurativa is a chronic inflamatory and relapsing disease. High levels of recurrence can persist even after wide local excision. OBJECTIVE: Identify the main risk factors for postoperative complications of Hidradentis Suppurativa. METHODS: We included journal articles with data from Google, Pubmed, Lilacs, and Scielo, in Portuguese and English, from 2000 to 2021. RESULTS: The main risk factors that influence postoperative outcomes are related to surgical technique, disease severity, comorbidities, and adjuvant clinical therapy.

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Introduction: Sarcopenia and visceral obesity have been identified as risk factors for postoperative complications following hepatobiliary and colon surgery. However, the correlation between body composition parameters and morbidity following pancreatectomy remains unclear. This study aimed to assess the predictive value of body composition parameters measured from preoperative CT images for postoperative complications following pancreaticoduodenectomy (PD). Methods: A retrospective study of patients who underwent PD between January 2018 and January 2021 was performed. Areas of subcutaneous adipose tissue, visceral adipose tissue, total abdominal muscle area, and mean muscle radio-attenuation were measured from preoperative CT images. Postoperative complications were categorized according to the Clavien-Dindo classification, and comprehensive complication index (CCI) scores were calculated. Logistic regression analysis was performed to identify factors associated with clinically relevant postoperative pancreatic fistula (CR-POPF) and high CCI score (≥26.2). Results: From the data collected on 129 study patients, sarcopenia, visceral obesity, and myosteatosis were detected in 47 (36.4%), 38 (29.4%), and 50 (38.7%) patients, respectively. CR-POPF developed in 51 (39.5%) patients, the overall median CCI score was 30.8 (22.6–36.2), and high CCI scores were identified in 70 (54.3%) patients. Multivariate analysis indicated sarcopenia and visceral obesity were independent risk variables for CR-POPF. Preoperative sarcopenia, visceral obesity, age, preoperative biliary drainage, and a positive culture of postoperative drainage were predictors of high CCI scores. Conclusion: Sarcopenia and visceral obesity were significant predictors of CR-POPF and high CCI score. Preoperative body composition assessment by CT images may help identify high-risk patients who undergo PD.

Anterior cervical discectomy fusion versus posterior decompression and fusion in octogenarians with cervical myelopathy: Clinical outcomes and complications with a 3-year follow-up

IntroductionCervical stenosis and concurrent Cervical Spondylotic Myelopathy (CSM) are prevalent in the elderly. Treatment options include Anterior Cervical Discectomy Fusion (ACDF) and Posterior Decompression and Fusion (PDF). Research questionThis study aims to compare clinical outcomes and complications between ACDF and PDF in patients aged 80 and above. Material and methodsData from electronic medical records between 2005 and 2021 at a single institution were analyzed. Logistic and linear regression analyses were performed to explore risk factors and the relationship between comorbidities and neurological conditions. Results21 patients with ACDF and 26 with PDF were studied over 16 years. PDF patients had more operated levels, higher blood loss, and longer hospital stays, but mortality rates and mJOA improvements were similar in both groups. The presence of comorbidities was a unique risk factor for postoperative complications. Discussion and conclusionACDF and PDF led to neurological improvements in elderly CSM patients. However, the decision of surgical procedure should carefully consider the potential for postoperative complications, particularly in patients with comorbidities.

Organ dysfunction as a risk factor of postoperative complications of surgical treatment for colon tumors

Цель – оценить влияние шкал органной дисфункции SAPS 2, SOFA, ASA на результаты хирургического лечения пациентов с опухолевой толстокишечной непроходимостью. Материалы и методы. Проведен когортный ретроспективный анализ хирургического лечения колоректального рака осложненного острой обтурационной толстокишечной непроходимостью у 108 пациентов. Критерием включения явились: пациенты с острой обтурационной кишечной непроходимостью в стадии суб- и декомпенсации. Критериями исключения из исследования были: больные с иными или сочетанными осложнениями колоректального рака, опухоли прямой кишки. Изучалась взаимосвязь результатов прогностических бальных шкал ASA и SAPS 2 на риск послеоперационных осложнений и госпитальную летальность в течение 30 суток после операции. Статистическую обработку материалов выполняли на базе программного обеспечения StatTech v. 2.5.9 (разработчик - ООО "Статтех", Россия). Статистически значимый уровень считался р≤0,05. Результаты. Установлено, что система оценки SAPS II была точной в прогнозировании развития послеоперационных осложнений и исхода лечения у пациентов, перенесших хирургического лечения. SAPS II может рассматривается как более перспективное в плане стратификации пациентов для оптимизации лечения больных. Ключевые слова: колоректальный рак, шкала SAPS 2, опухолевая толстокишечная непроходимость, органная дисфункция, коморбидность

Influence factors of debilitating and nutritional risk on complications of primary hip replacement

To analyze relationship of debilitating and nutritional risk on complications of primary hip replacement, and risk factors of influence of complications of primary hip replacement. Totally 100 patients who underwent hip replacement from January 2019 to January 2021 were retrospectively analyzed, including 36 males and 64 females, aged from 18 to 85 years old with an average of (73.82±4.04) years old. Postoperative frailty status was evaluated by modified frailty index, and nutritional status was evaluated by clinical biochemical indexes and NRS2002 nutritional risk assessment scale. One hundred patients were divided into frailty group and non-frailty group according to modified frailty index, 100 patients were divided into normal nutrition group and nutritional risk group according to nutritional status, and relationship between frailty, nutritional risk and complications after primary hip replacement was analyzed. There were significant differences in age, body mass index (BMI), complications and ASA grade between frailty group and non-frailty group(P<0.05). There were statistically significant differences in age, BMI, complications and ASA grade between normal nutrition group and nutritional risk group (P<0.05). Thirty-five patients occurred at least one postoperative complications, and the incidence of pulmonary infection was the highest, accounting for 34.29% (12/35). The second was urinary infection, accounting for 22.86%(8/35). Univariate Logistic regression analysis showed that age, BMI, ASA grade, complications, frailty and nutritional risk were the risk factors for postoperative complications. Multivariate Logistic regression analysis showed that complications, frailty and nutritional risk were independent factors affecting postoperative complications. Patients with comorbidities, frailty and nutritional risk could increase the incidence of complications. Timely assessment and identification of these patients in time, and formulation of targeted intervention measures have great clinical significance.

Influence of Operative Time in the Results of Elective Endovascular Repair of Abdominal Aortic Aneurysms

A prolonged operative time (OT) is a well-recognized risk factor of postoperative complications after many open surgical procedures, although little is known about its impact in less-invasive endovascular procedures. We aimed to define the characteristics related to a prolonged OT in the endovascular treatment of aorto-iliac aneurysms (EVAR) and to evaluate the influence of OT on postoperative outcomes. Retrospective analysis of 284 consecutive patients (mean age 75years, 95% male) who underwent an elective EVAR between 2000 and 2019. Operative characteristics related to OT and the impact of OT in postoperative results was studied using multiple lineal and logistic regression analyses, respectively. The mean surgical time was 200min. OT was associated (regression model) with the implantation of straight endografts (-38min, P=0.007), femoral artery surgery (+80min, P<0.001), hypogastric preservation procedures (+70min, P<0.001), associated peripheral arterial disease (+22min, P=0.013), general anesthesia (+34min, P<0.001), and aneurysm diameter (+9min/cm, P=0.002). During the postoperative period (<30days or at discharge), 21% presented a complication and 2.8% died. OT was independently associated with a higher incidence of postoperative complications (odds ratio [OR] for each additional 30' of surgery=1.34, P<0.001), such as immediate (OR=1.48, P=0.003) and 6-month mortality (OR=1.28, P=0.025). A prolonged OT is an independent risk factor for complications and mortality after EVAR. Surgeons must take this factor into consideration when defining the best therapeutic strategy for abdominal aortic aneurysms.

The Neutrophil-to-Lymphocyte Ratio and Preoperative Pulmonary Function Test Results as Predictors of In-Hospital Postoperative Complications after Hip Fracture Surgery in Older Adults.

Purpose: This study retrospectively evaluated the usefulness of the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and pulmonary function test (PFT) results as objective predictors of in-hospital postoperative complications after hip fracture surgery in older adults. Methods: The patients aged >65 years who underwent hip fracture surgery under general anaesthesia were enrolled. In-hospital postoperative complications with preoperative NLR, PNI and PFT results were evaluated. The NLR was calculated as the preoperative neutrophil count/lymphocyte count in peripheral blood. The PNI was calculated as the serum albumin (g/dL) × 10 + total lymphocyte count × 0.005 (/mm3). Results: One hundred ninety nine patients were analysed. The most common postoperative complications were respiratory complications. Compared with patients who did not have postoperative complications, patients with postoperative complications had a significantly higher NLR (8.01 ± 4.70 vs. 5.12 ± 4.34, p < 0.001), whereas they had a significantly lower PNI (38.33 ± 6.80 vs. 42.67 ± 6.47, p < 0.001), preoperative functional vital capacity (FVC; 2.04 ± 0.76 vs. 2.45 ± 0.71 L, p < 0.001), and forced expiratory volume at 1 s (FEV1; 1.43 ± 0.53 vs. 1.78 ± 0.58 L, p < 0.001). Multiple logistic regression analysis identified NLR (odds ratio [OR], 1.142; 95% confidence interval [CI], 1.060−1.230; p < 0.001) and FEV1 (OR, 0.340; 95% CI, 0.191−0.603; p < 0.001) as risk factors for postoperative complications after hip fracture surgery. Conclusion: Preoperative NLR and FEV1 are objective predictors of in-hospital postoperative complications after hip fracture surgery in older patients.