Risk Factors For Systemic Complications Research Articles

Optimal Timing and Outcomes of Minimally Invasive Approach in Acute Biliary Pancreatitis.

BackgroundWe analyzed the outcomes of early biliary decompression by a minimally invasive approach in acute biliary pancreatitis (ABP).Material/MethodA retrospective study was conducted on 143 patients with ABP who underwent biliary decompression by laparoscopic or endoscopic approach between January 2015 and March 2022. Data from the observation sheets and surgical protocols were analyzed in terms of demographic characteristics, clinical and paraclinical features at admission, comorbidities, therapeutic management, and outcomes.ResultsThe mean patient age was 62.3±11.4 years. Mild ABP had a higher frequency in men (75.5%) and urban areas (70.4%). The comorbidities associated with a higher risk of severe forms were diabetes mellitus (odds ratio [OR]: 11.250), chronic bronchopneumopathy (OR: 29.297), and ischemic coronary disease (OR: 2.784). The mean hospital stay was 7.6±3.8 days and was significantly higher in severe forms (10±2.4 days, P<0.001). The time from onset to presentation was significantly higher in severe vs mild forms (5.6 vs 1.8 days, P<0.001) and was associated with systemic and local complications. Creatinine over 2 mg/dL (OR: 4.821) and leukocytes >15 000/mmc at admission (OR: 3.533) were risk factors for systemic complications, while obesity was associated with increased local complications (OR: 5.179). None of the patients with an early presentation developed severe ABP.ConclusionsEarly biliary decompression, as soon as possible after onset, either by an endoscopic or minimally invasive approach, is a safe and effective procedure in ABP. The type of procedure and optimal timing should be individualized, according to the patient’s local and general features.

Complications of glioma surgery

Background. Nowadays extensive resection remains the best treatment for gliomas. However, postoperative complications can disturb the benefits of surgery. The risk of surgical complications must be assessed against the benefits of obtaining a total resection, especially for tumors of eloquent brain. Object. The goal of this study was to review present evidence of glioma resection concerning the frequency of complications,their causes, predictive risk factors and current methods of reducing the occurrence of these events. This review strives to consolidate information about complications and preventive measures as well as to establish the utility of tools to improve neurosurgical outcome. Methods. A review of the literature concerning the main postoperative complications in patients with glial tumors was done. We performed a search using key words "cerebral neoplasm", "cerebral tumor", "glioma" and "complications". Papers that namely discussed complications rates were included. Anatomic, physiologic, clinical features were taken into consideration in patients with postoperative complications as well as current methods of investigations. Results. Documented overall complication rates ranged from 10% to 35%, with overall mortality rates of 1.0%-15%. Studies of series undergoing surgery for malignant gliomas found at least one surgical complication in 3.4% of patients with a 4.5% risk in patients for hospital-associated complications such as surgical site infection. There was a wide range of types of complications. The presence of new or worsened neurological deficit was up to 20% as the highest reported rate for treatment of eloquent arias glioma. Relatively common complications were postoperative peritumoral edema (2%-10%), CSF fistula (1%-15%), wound infection (0%-4%), surgery-related hematoma (1%-5%) and early postoperative seizure (1%-12%). The risk for cardiac complications was 0.7%, for respiratory complications - 0.5%, for deep wound infection - 0.8%,for deep venous thromboses - 0.6%, for pulmonary embolus - 3.1%, for acute renal failure -1.3%. Infratentorial tumour location, reoperations and previous radiotherapy were factors related to the incidence of regional complications. Age over 60 and severe comorbidities were risk factors for systemic complications. Conclusion. Postoperative morbidity in glial tumor surgery may be reduced by: encouraging use of standardized protocols for regional and systemic complications, intraoperative navigation that allows surgeon to maximize resection while preserving neurological function, clinical vigilance and attention to details.

Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center.

BACKGROUNDAs a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.AIMTo analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.METHODSIn total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.RESULTSAmong 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.CONCLUSIONMultiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.

Incidence and risk factors of postoperative complications after robotic gastrectomy for gastric cancer: an analysis of 817 cases based on 10-year experience in a large-scale center.

In this study, we investigated the incidence and risk factors for postoperative complications after robotic gastrectomy (RG) in patients with gastric cancer. A total of 817 patients who underwent RG for gastric cancer between March 2010 and August 2019 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo classification, and possible risk factors were evaluated. Among 817 patients who underwent RG, overall, severe, local and systemic complication rates were 13.8, 4.2, 7.0 and 6.9%, respectively. Multivariable analysis revealed that an age of 70years or older (P < 0.001) and multiorgan resection (P = 0.031) were independent risk factors for the occurrence of overall complications. Multivariable analysis showed that an age of 70years or older (P = 0.005) and surgeons' experience ≤ 25 cases(P = 0.004) were independent risk factors for severe complications. Regarding local complications, an age of 70years or older (P < 0.001), multiorgan resection (P = 0.010) and surgeons' experience ≤ 25 cases (P = 0.005) were identified as independent risk factors. An age of 70years or older (P < 0.001), a BMI of 25 or higher (P = 0.045) and the presence of comorbidity (P = 0.029) were identified as independent risk factors for systemic complications. The present study demonstrated that RG is a safe and feasible procedure for the treatment of gastric cancer, and it has an acceptable postoperative morbidity. Elderly patients and insufficient surgeon experience were two major risk factors for the occurrence of complications following RG. We suggest that surgeons choose patients in good condition during their RG learning phase to reduce learning-associated morbidity.

Abstract 17241: The Impact of Overweight and Obesity on End-Organ Function in Fontan Patients

Introduction: Patients with Fontan circulation often develop multiorgan dysfunction. Obesity is a risk factor for systemic complications in the general population, but the impact of obesity in Fontan circulation is unclear. This study investigates the impact of increased BMI on end-organ function in Fontan survivors. Methods: Single center data from patients 13 years and older with Fontan circulation were retrospectively collected from June 2018 to May 2020. Weight at clinic visit was categorized as normal or overweight/obese by WHO BMI-for-age classifications. End-organ function between normal and overweight patients was assessed. The relationship between overweight and measures of end-organ function were modeled via multivariable regression analyses controlling for age, sex, race, heterotaxy, time since Fontan, ventricular function, and atrioventricular valve (AVV) regurgitation. Results: Among 75 patients (median age 18 [15, 26] years), 24 (32%) were overweight or obese. Age, race, duration since Fontan, oxygen saturation, and dominant ventricle did not differ between groups. There were significantly more overweight females (p= 0.02). Overweight patients had significantly lower GFR (p= 0.01), lower predicted peak VO2 (p= 0.02), and higher systemic vascular resistance (SVR) (p= 0.02) than normal weight patients. Duration since Fontan (β= 0.38, p = 0.02) and overweight (β= -0.35, p = 0.03) were independently associated with GFR. Female sex (β= -0.42, p &lt; 0.01) and overweight were independently associated with lower predicted peak VO2. Overweight was independently associated with presence of high SVR (OR = 7.5, p= 0.03). Other tested variables for hepatic (MELD-XI score, liver stiffness), cardiovascular (cardiac index, Fontan pressure, ventricular and AVV function), pulmonary, bone, and hematologic function did not significantly differ between groups. Conclusions: Overweight/obese BMI is common in aging Fontan patients and is significantly associated with worse renal function, exercise capacity, and elevated SVR. These findings suggest a possible relationship between weight, vascular changes, and renal perfusion. Further studies are needed to investigate this mechanism and the impact on Fontan patient outcome.

Risk factors related to perioperative systemic complications and mortality in elderly patients with osteoporotic vertebral fractures\u2014analysis of a large national inpatient database

BackgroundThe surgical treatment of osteoporotic vertebral fractures (OVF) is generally associated with a high risk of complications due to an aging population with osteoporosis; however, the detailed risk factors for systemic complications and mortality have not been clarified. We evaluated the risk factors for systemic complications and mortality in surgically treated OVF patients using a large national inpatient database.MethodsPatients over 65 years old who were diagnosed with OVF and received either anterior fusion (AF) or posterior fusion (PF), from 2012 to 2016, were extracted from the diagnosis procedure combination (DPC) database. In each of the perioperative systemic complications (+) or (−) group, and the in-hospital death (+) or (−) group, we surveyed the various risk factors related to perioperative systemic complications and in-hospital death.ResultsThe significant factors associated with systemic complications were older age (OR 1.38, 95% CI 1.09–1.74), a lower activity of daily living score upon admission (OR 1.52, 95%CI 1.19–1.94), atrial fibrillation (OR 2.14, 95%CI 1.25–3.65), renal failure (OR 2.29, 95%CI 1.25–4.20), and surgical procedure (AF, OR 1.73, 95%CI 1.35–2.22). The significant explanatory variables for in-hospital death were revealed to be male sex (OR 3.26, 95%CI 1.20–8.87), a lower body mass index (OR 3.97, 95%CI 1.23–12.86), unscheduled admission (OR 3.52, 95%CI 1.17–10.63), atrial fibrillation (OR 8.31, 95%CI 2.25–30.70), renal failure (OR 7.15, 95%CI 1.32-38.77), and schizophrenia (OR 8.23, 95%CI 1.66–42.02).ConclusionsAtrial fibrillation and renal failure as preoperative comorbidities were common factors between perioperative systemic complications and mortality in elderly patients for OVF.

An age-stratified follow-up of complications and clinical benefit of posterior lumbar intervertebral fusion procedure in middle-aged and older patients

To compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment. The clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient's pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications. There were significant differences in the number of surgical fusion segments and osteoporosis between groups ( P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups ( P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups ( P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups ( P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups ( P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups ( P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up. The risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients' quality of life.

Analysis of the related factors of complications after laparoscopic D2 radical operation in the treatment of advanced gastric cancer

Objective To analyze the related factors of postoperative complications after laparoscopic assisted D2 radical resection for advanced gastric cancer. Methods From August 2015 to July 2017, 80 patients with advanced gastric cancer admitted to the First Hospital of Jiaxing were selected.All the patients were treated with laparoscopic-assisted D2 radical resection, and the risk factors related to postoperative complications were analyzed by logistic regression analysis model. Results There were 33 cases (41.25%) with postoperative system complications, 19 cases (23.75%) with complications of level Ⅱ and above; 15 cases (18.75%) with postoperative local complications, among them 12 cases (15.00%) appeared level Ⅱ and above local complications.The number of concomitant diseases and age were related risk factors for systemic complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=1.982, 95%CI: 2.183-34.405, OR=6.587, 95%CI: 1.738-23.495, all P<0.05). The preoperative neoadjuvant chemotherapy, reconstruction method and age were the risk factors for local complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=8.273, 95%CI: 4.982-35.394, OR=12.304, 95%CI: 2.384-88.921, OR=6.365, 95%CI: 2.183-21.384, all P<0.05). Conclusion Treatment of advanced gastric cancer patients with laparoscopic D2 radical mastectomy, attention should be paid to control the patients' age, preoperative neoadjuvant chemotherapy, reconstruction mode, associated disease and other related risk factors.In order to ensure the safety of patients and to avoid postoperative complications. Key words: Stomach neoplasms; Postoperative complications; Laparoscopy; Factor analysis, statistical; Antineoplastic combined chemotherapy protocols; Age factors

Chronic preoperative opioid use is a risk factor for increased complications, resource use, and costs after cervical fusion

As health-care transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and postoperative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. The objective of this study was to answer the following questions from a large cohort of patients who underwent primary cervical fusion for degenerative pathology: (1) What is the patient profile associated with preoperative COT? (2) Is preoperative COT a risk factor for 90-day systemic complications, emergency department (ED) visits, readmission, and 1-year adverse events? (3) What are the risk factors and 1-year adverse events related to long-term postoperative opioid use? (4) How much did payers reimburse for management of complications and adverse events? This is a retrospective review of Humana commercial insurance data (2007-Q3 2015). The patient sample included 29,101 patients undergoing primary cervical fusion for degenerative pathology. Patients and procedures of interest were included using International Classification of Diseases (ICD) coding. Patients with opioid prescriptions for >6 months before surgery were considered as having preoperative COT. Patients with continued opioid use until 1-year after surgery were considered as long-term users. Descriptive analysis of patient cohorts has been done. Multiple-variable logistic regression analyses adjusting for approach, number of levels of surgery, discharge disposition, and comorbidities were done to answer first three study questions. Reimbursement data from insurers have been reported to answer our fourth study question. Of the entire cohort, 6,643 (22.8%) had preoperative COT. Preoperative COT was associated with a higher risk of 90-day wound complications (odds ratio [OR] 1.39, 95% confidence interval [CI]: 1.16-1.66), all-cause 90-day ED visits (adjusted OR 1.22, 95% CI: 1.13-1.32), and pain-related ED visits (adjusted OR 1.39, 95% CI: 1.24-1.55). Patients who had preoperative COT were more likely to receive epidural or facet joint injections within 1 year after surgery (adjusted OR 1.68, 95% CI: 1.47-1.92). These patients were also more likely to undergo a repeat cervical fusion within a year than patients who did not have preoperative COT (adjusted OR 1.21, 95% CI: 1.01-1.43). Preoperative COT had a higher likelihood of long-term use after surgery (adjusted OR 4.72, 95% CI: 4.41-5.06). Long-term opioid use after surgery was associated with a higher risk of new-onsetconstipation (adjusted OR 1.34, 95% CI: 1.22-1.48). The risk of complications and adverse events was not found to be significant in patients with <3 months of preoperative opioid use or those who stopped opioids for at least 6 weeks before surgery. The cost of additional resource use for medications, ED visits, constipation, injections, and revision fusion ranged from $623 to $27,360 per patient. Preoperative opioid use among patients who underwent cervical fusion increases complication rates, postoperative opioid usage, health-care resource use, and costs. These risks may be reduced by restricting the duration of preoperative opioid use or weaning off before surgery. Better understanding and management of pain in the preoperative period with judicious use of opioids is critical to enhance outcomes after cervical fusion surgery.

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®.

BackgroundEndotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.MethodsPatient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.ResultsDuring the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time.ConclusionOur study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.

Hepatitis A immunity and region-of-origin in a Swiss prison.

Purpose - The environmental and demographic characteristics of closed institutions, particularly prisons, precipitate morbidity during hepatitis A virus (HAV) outbreaks. Given the high prevalence of chronic liver disease and other risk factors in the prison setting, the purpose of this paper is to examine HAV-immunity and its associated factors in this population. Design/methodology/approach - The cross-sectional study was conducted in 2009: a serology screening for HAV IgG was carried out among 116 inmates in Switzerland's largest pre-trial prison. Other participant characteristics were collected through a structured face-to-face questionnaire with a physician. Findings - In terms of significant demographics, Africa (53.5 percent) and the Balkans/Eastern Europe (36.2 percent) were the main regions of origin; a minority of inmates were from Western Europe (6.9 percent), Latin America (2.6 percent) or Asia (0.9 percent). The authors identified hepatitis A antibody-negative serology (lack of immunity) in five out of 116 prisoners (4.3 percent, 95 percent CI 1.4-9.7). Among participants of European origin alone, five out of 50 inmates were hepatitis A antibody-negative (10 percent, 95 percent CI 3.3-21.8), whereas the 66 inmates from other all continents were hepatitis A antibody-positive (immune) (p=0.026). Originality/value - In this prison population composed of mostly African migrants, hepatitis A immunity was high. This reaffirms that region of origin is highly associated with childhood immunity against HAV. HAV vaccination should take into account a patient's area of origin and his/her risk factors for systemic complications, if ever infected. This targeted strategy would offer herd immunity, and seek out the most vulnerable individuals who are potentially at risk of new exposure in this precarious setting.

Morbid obesity increases the risk for systemic complications in patients with femoral shaft fractures.

To determine whether morbidity and mortality were increased in morbidly obese patients who had reamed intramedullary nailing of closed femoral shaft fractures compared with similar patients of normal weight. Retrospective case-control study. Level I trauma center. All patients with closed femoral shaft fractures treated with reamed intramedullary nailing over a 5-year period were identified. Normal-weight patients (BMI < 25) were compared with overweight (25 ≤ BMI < 30), obese (30 ≤ BMI < 40), and morbidly obese patients (BMI ≥ 40). Reamed intramedullary nailing. Occurrence of postoperative complications. Of 507 patients with 526 femoral shaft fractures (AO/OTA-32), 184 (36.3%) were of normal weight, 170 (33.5%) were overweight, 114 (22.5%) were obese, and 39 (7.7%) were morbidly obese. There were no significant differences in complications when comparing normal-weight patients with overweight and obese patients. Systemic complications occurred in 23% of morbidly obese and 9% of normal-weight patients [odds ratio (OR) = 3.15, P = 0.013]. Morbid obesity increased odds of adult respiratory distress syndrome (OR = 35.38, P = 0.019) and sepsis (OR = 6.49, P = 0.0015). Overall, morbidly obese patients with a femoral fracture had a mortality rate of 10%, but a subset of polytraumatized patients (Injury Severity Score > 17) had a mortality rate of 20%. Morbid obesity significantly increased the odds of mortality (OR = 46.77, P = 0.01). Body mass index was found to be an independent predictor of adult respiratory distress syndrome, sepsis, and death. Morbid obesity is a significant risk factor for systemic complications in patients with closed femoral shaft fractures, especially in polytraumatized patients. Patients and their families need to be counseled regarding the high risk of morbidity and mortality. Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.

Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?

IntroductionLong bone fractures are assumed to be an independent risk factor for systemic complications and death after trauma. Multiple studies have identified an increased risk for mortality and morbidity in patients with bilateral femoral fractures. Data about bilateral tibial shaft fractures is rare. The aim of our study was to analyze if patients with bilateral tibial shaft fractures are at higher risk for systemic complications. MethodsWe performed a retrospective analysis of the TraumaRegister DGU® from 1993 to 2008. Inclusion criteria were unilateral or bilateral tibial shaft fractures and an age ≥16. Additionally to the overall collective we analyzed different subgroups (divided into different injury severities and treatment periods). Results1899 patients with unilateral and 175 patients with bilateral tibial shaft fractures were included. Age, gender and mean ISS (25.8 vs. 26.2, p=0.51) in the two groups were comparable. Regarding the entire study population, patients with bilateral tibial shaft fractures showed no significant higher incidence of respiratory organ failure (29.5% vs. 23.1%, p=0.076) or mortality (20.0% vs. 16.3%, p=0.203). However, subgroup analysis showed a significant higher rate of pulmonary organ failure for bilateral tibial shaft fractures as compared to unilateral tibial shaft fractures in the group ISS<25 (20.7% vs. 11.7%, p=0.023). Multivariate regression analysis identified the additional tibial shaft fracture as an independent risk factor for pulmonary organ failure (OR=1.56) but not for mortality. DiscussionThe additional tibial shaft fracture is an independent risk factor for pulmonary organ failure but not for multiple organ failure or mortality. The impact of the additional tibial shaft fracture is especially pronounced in less severely injured patients (ISS<25). These findings are comparable to results of bilateral femoral fracture studies and we therefore suggest to treat patients with bilateral tibial shaft fractures with the same caution as those with bilateral femoral fractures.

Risk Factors Associated with Complication Following Gastrectomy for Gastric Cancer: Retrospective Analysis of Prospectively Collected Data Based on the Clavien–Dindo System

BackgroundMost studies about complication after gastric cancer surgery have been performed without consideration of the severity of each complication. The purposes of this study were to prospectively analyze all postgastrectomy complications according to severity using Clavien–Dindo classification and to identify risk factors related to postoperative complications. MethodsComplication data were collected prospectively through weekly conferences with all gastric adenocarcinoma patients who underwent gastrectomy between March 2011 and February 2012 at Seoul National University Hospital. Complications were categorized according to the Clavien–Dindo classification. ResultsOut of the 881 patients who underwent gastrectomy, there were 254 events in 197 patients (22.4 %). The numbers of grade I, II, IIIa, IIIb, IVa, and V complications according to the Clavien–Dindo classification were 71 (8.1 %), 58 (6.6 %), 108 (12.3 %), 8 (0.9 %), 5 (0.6 %), and 4 (0.5 %), respectively. Extended gastrectomy (odds ratio [OR], 3.92; 95 % confidence interval [CI], 1.96–7.82, p < 0.001), total gastrectomy (OR, 1.97; 95 % CI, 1.24–3.14, p = 0.004), and age of 60 years or more (OR, 1.66; 95 % CI, 1.15–2.38, p = 0.007) were found to be significant independent risk factors for overall complications of gastrectomy. These three factors were also risk factors for the complications of grade IIIa or over and local and systemic complications. In addition, ASA 3 or 4 and moderate or severe malnutrition as well as those three factors were risk factors for systemic complications. ConclusionAge and the extent of gastrectomy were revealed as the prognostic factors for overall complications and the complications of grade IIIa or over according to the Clavien–Dindo classification following gastrectomy for gastric cancer.

Factors influencing surgical complications of intra-axial brain tumours.

Extensive surgical resection remains nowadays the best treatment available for most intra-axial brain tumours. However, postoperative sequelae can outweigh the potential benefits of surgery. The goal of this study has been to review the results of this treatment in our Department in order to quantify morbidity and mortality and determine predictive risk factors for each patient. We report a retrospective study of 200 patients submitted to a craniotomy for intra-axial brain tumours including gliomas and metastases. Postoperative major complications are analysed and related to different variables. An exhaustive review of the literature concerning the main controversial points about primary and metastatic brain tumours surgery is done. The overall major complication rate was 27.5%, with neurological complications being the most frequently encountered. We did not find a statistically significant relation between them and the grade of eloquence of the tumoural area. Infratentorial tumour location, previous radiotherapy and reoperations were factors strongly related to the incidence of regional complications. Age over 60 and severe concomitant disease were risk factors for systemic complications. The results from published series concerning surgical complications after craniotomies for brain tumours are not comparable because of the lack of homogeneity between them. The knowledge of the complications rate in each particular neurosurgical department turns out essentially to provide the patient with tailored information about risks before surgery.

Morbidity and mortality in elderly trauma patients.

Despite an increasing incidence, relatively few studies have examined the factors that predict morbidity and mortality in older patients and several reports have found standard predictors such as the Injury Severity Score to be less useful in this patient population. Similarly, the effect of skeletal injury has not been examined with regard to complications and mortality. The purpose of this study was to review a large multicenter experience with elderly trauma patients to isolate factors that might predict morbidity and mortality. The potential effect of skeletal long-bone injury was of particular interest. The charts of all patients older than 60 years who were admitted to one of four Level I trauma centers after sustaining blunt trauma were reviewed. Mechanisms of injury included in the study were motor vehicle crash, pedestrian struck, fall from a height, and crush injury. Slip-and-fall injuries were excluded. A total of 326 patients met inclusion criteria. Variables studied included age, sex, mechanism of injury, Injury Severity Score (ISS), Revised Trauma Score, Glasgow Coma Scale (GCS) score, blood transfusion, fluid resuscitation, surgery performed (laparotomy, long-bone fracture stabilization, both), and timing of surgery. Outcome variables measured included incidence of adult respiratory distress syndrome, pneumonia, sepsis, myocardial infarction, deep venous thromboembolism, gastrointestinal complications, and death. chi2, logistic regression, t test, and nonparametric analyses were done as appropriate for the type of variable. The average age of the patients was 72.2+/-8 years. Overall, 59 patients (18.1%) died, of whom 52 of 59 survived at least 24 hours. Statistical significance for continuous variables (p < 0.05) using univariate analysis was reached for the following factors for the patients who died: higher ISS (33.1 vs. 16.4), lower GCS score (11.5 vs. 13.9), greater transfusion requirement (10.9 vs. 2.9 U), and more fluid infused (12.4 vs. 4.9 L). Logistic regression analysis was performed to determine the factors that predicted mortality. They included (odds ratios and p values in parentheses) transfusion (1.11, p = 0.01), ISS (1.04, p = 0.008), GCS score (0.87, p = 0.007), and fluid requirement (1.06, p = 0.06). Regarding surgery, orthopedic surgery alone had an odds ratio of 0.53, indicating that orthopedic patients was less likely to die than patients who did not undergo any surgery. Patients who underwent only a general surgical procedure were 2.5 times more likely to die (p = 0.03) and patients who underwent both general and orthopedic procedures were 1.5 times more likely to die (p = 0.32) than patients who did not require surgery. Early (< or =24 hours) versus late (>24 hours) surgery for bony stabilization did not have a statistical effect on mortality (11% early vs. 18% late). Two patients in need of bony stabilization, however, died before these procedures were performed. With regard to complications, regression analysis revealed that ISS predicted adult respiratory distress syndrome, pneumonia, sepsis, and gastrointestinal complications; fluid transfusion predicted myocardial infusion; and need for surgery and transfusion requirements predicted sepsis. These complications, in turn, were significant risk factors for mortality. This large series of elderly patients demonstrates that mortality correlates closely with ISS and is influenced by blood and fluid requirements and by GCS score. The institution-specific mortality was the same when adjusted for ISS. The need for orthopedic surgery and the timing of the surgery was not a risk factor for systemic complications or mortality in this series. Mortality is predicted by ISS and by complications in older patients. Seventy-seven percent of the orthopedic injuries were stabilized early, but the timing of surgery did not have any statistical effect on the incidence of complications or mortality. (ABSTRACT TRUNCA