Risk Of Overall Postoperative Complications Research Articles

Geriatric nutritional risk index predicts postoperative prognosis in older patients with hip fracture: A meta-analysis.

Hip fracture is common in elderly individuals and is accompanied by a relatively high mortality rate. However, it is currently difficult to accurately predict postoperative prognosis for older patients with hip fractures. The aim of this meta-analysis was to further determine the prognostic value of the geriatric nutritional risk index (GNRI) for patients who underwent hip fracture surgery. The Medline, EMBASE, Web of Science, and CNKI databases were searched up to September 19, 2023, for available studies. The primary and secondary outcomes were the mortality and complication rates, respectively. Hazard ratios (HRs) and relative risks with corresponding 95% confidence intervals (CIs) were separately combined to assess the associations between the GNRI and mortality and complication rates. All the statistical analyses were performed with STATA 15.0 and SPSS 22.0 software. A total of 9 studies with 3959 patients were included. The pooled results demonstrated that a lower GNRI was significantly related to an increased risk of postoperative mortality (HR = 0.82, 95% CI = 0.72-0.92, P = .001). In addition, the GNRI predicted the risk of overall postoperative complications (52% vs 35.5%, P = .04) and pneumonia (33.3% vs 13.6%, P = .010). The GNRI might serve as a novel prognostic indicator for older patients with hip fractures, and a lower GNRI indicates an increased risk of postoperative mortality and complication rates.

Early and Long-Term Results of Simultaneous and Staged Revascularization of Coronary and Carotid Arteries.

Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up-6 years). The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048-4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment.

Outcomes of coronary artery bypass grafting (CABG) in patients with OSA-COPD overlap syndrome versus COPD alone: an analysis of US Nationwide Inpatient Sample.

Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are associated with unfavorable outcomes following coronary artery bypass grafting (CABG). The purpose of this study was to compare in-hospital outcomes of patients with COPD alone versus OSA-COPD overlap after CABG. Data of adults ≥ 18 years old with COPD who received elective CABG between 2005 and 2018 were extracted from the US Nationwide Inpatient Sample (NIS). Patients were divided into two groups: with OSA-COPD overlap and COPD alone. Propensity score matching (PSM) was employed to balance the between-group characteristics. Logistic and linear regression analyses determined the associations between study variables and inpatient outcomes. After PSM, data of 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed. After adjustment, OSA-COPD overlap was associated with a significantly increased risk of overall postoperative complications (adjusted odd ratio [aOR] = 1.12, 95% confidence interval [CI]: 95% CI: 1.01-1.24), respiratory failure/prolonged mechanical ventilation (aOR = 1.27, 95%CI: 1.14-1.41), and non-routine discharge (aOR = 1.16, 95%CI: 1.03-1.29), and AKI (aOR = 1.14, 95% CI: 1.00-1.29). Patients with OSA-COPD overlap had a lower risk of in-hospital mortality (adjusted odd ratio [aOR] = 0.53, 95% CI: 0.35-0.81) than those with COPD only. Pneumonia or postoperative atrial fibrillation (AF) risks were not significantly different between the 2 groups. Stratified analyses revealed that, compared to COPD alone, OSA-COPD overlap was associated with increased respiratory failure/prolonged mechanical ventilation risks among patients ≥ 60 years, and both obese and non-obese subgroups. In addition, OSA-COPD overlap was associated with increased risk of AKI among the older and obese subgroups. In US adults who undergo CABG, compared to COPD alone, those with OSA-COPD are at higher risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation, but a lower in-hospital mortality. No increased risk of AF was noted.

Prognostic Nutritional Index and the Risk of Postoperative Complications After Spine Surgery: A Meta-Analysis

BackgroundA low prognostic nutritional index (PNI) may reflect malnutrition, which has been associated with poor prognosis in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to investigate the association between preoperative PNI and risk of postoperative complications in adult patients after spine surgery. MethodsAn extensive search was conducted on PubMed, Embase, and Web of Science to identify relevant cohort studies. Random-effects models were employed to combine the findings, taking into account the potential influence of heterogeneity. ResultsTen cohort studies involving 3249 patients receiving spine surgeries were included. Pooled results showed that a low preoperative PNI was associated with an increased risk of overall postoperative complications in these patients (odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.42 to 2.34, p < 0.001; I2 = 49%). Specifically, a preoperative malnutrition as evidenced by a low PNI was associated with a higher incidence of postoperative delirium (OR: 2.36, 95% CI: 1.52 to 3.66, p < 0.001; I2 = 38%) and surgical site infection (OR: 1.41, 95% CI: 1.15 to 1.73, p = 0.001; I2 = 0%). Sensitivity analyses by excluding one study at a time did not significantly change the results (p all < 0.05). ConclusionA preoperative low PNI may be a risk factor of increased incidence of overall postoperative complications, postoperative delirium, and surgical site infection in adult patients after spine surgeries.

The Impact of Helicobacter pylori on Laparoscopic Sleeve Gastrectomy Postoperative Complications: a Systematic Review and Meta-analysis.

We aimed to assess the impact of Helicobacter pylori infection on postoperative outcomes following laparoscopic sleeve gastrectomy (LSG). We searched Cochrane, Scopus, and PubMed databases, reviewed 1026 studies, and thoroughly analyzed 42 of them. Our final analysis included 13 studies comprising 6199 patients. We found that H. pylori infection was correlated with higher rates of risk of overall postoperative complications (OR 1.56; 95% CI 1.13, 2.16; P= 0.007) and staple line leak (OR 1.89; 95% CI 1.05, 3.41; P= 0.03). There were no significant differences in hospital length of stay or postoperative bleeding rates. Despite observed correlations between H. pylori positivity in gastric specimen and postoperative complications in LSG, definitive causation remains elusive, emphasizing the need for prospective randomized studies evaluating the effect of preoperative H. pylori screening and eradication.

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates.

Evidence about the importance of sarcopenia in patients operated on for gastrointestinal cancers and that it may have both early and long-term impacts is expanding. In our study, we aimed to evaluate the impact of sarcopenia on the outcomes of the patients we operated on for left colon and rectum cancer. We retrospectively evaluated the electronic records of 38 patients operated on for left colon and rectal cancer between 2010 and 2020, and demographic variables, clinical stages, laboratory tests, body mass index (BMI), psoas muscle index (PMI), pathological stages, and Dindo Clavien complication scores were interpreted. We also assigned our patients into two groups according to their preoperative PMI values. We compared the first group of 12 patients with preoperative sarcopenia with the second group of 26 patients without preoperative sarcopenia. Of the 38 patients who underwent curative surgery for left colon and rectal cancer, 20 were female and 18 were male. The median age of the group was 59.9 years. The most common tumour localization was in the rectosigmoid region in 17 patients, and the tumour in 6 patients was in the left colon. Therapy had been initiated with neoadjuvant treatment in 19 patients. At the preoperative evaluation, sarcopenia was present in 12 patients. Thirty-four patients underwent robot-assisted surgery. Postoperative pathologies were reported as stage 3 in 15 patients. Complications were reported in 17 patients, and nine were minor (Dindo-Clavien score < 3), but in eight patients, they were moderate to severe (Dindo-Clavien score ≥ 3). When the first group, 12 patients with preoperative sarcopenia, and the second group, 26 patients without preoperative sarcopenia, were compared, the patients with sarcopenia were found to be older (p=0.001), and male patients were in the majority (p=0.017). The postoperative follow-up of 12 patients with preoperative sarcopenia revealed that 7 (58.8%) had complications. Complications were observed in 10 (38.4%) patients in the second group. When the two groups were compared, the risk of developing complications was significantly higher in the sarcopenia group (p=0.016). Only one patient in the first group had moderate to severe complications, but seven patients without sarcopenia had moderate to severe complications. Our study revealed that many patients we have operated on for left colon and rectal cancer have preoperative sarcopenia for which we should care. The sarcopenia rate was higher in males and elderly patients, and the risk of overall postoperative complications increased significantly in patients with preoperative sarcopenia. In consequence, the results of our study provide evidence that preoperative sarcopenia status is an important parameter to determine the risk status of the patient, and patients with preoperative sarcopenia should be monitored more closely. Thus, we may be able to diagnose and intervene early in the complications.

Transanal specimen extraction after left-sided laparoscopic colectomy: a systematic review and meta-analysis

To compare the short-term results after left-sided laparoscopic colectomy with transanal and transabdominal specimen extraction. We selected 998 appropriate manuscripts and subsequently excluded 995 ones due to exclusion criteria. Thus, the meta-analysis was based on 3 randomized trials in accordance with PRISMA recommendations. A total of 353 patients were enrolled in meta-analysis including 169 resections with transanal specimen extraction and 184 surgeries with transabdominal extraction. Overall risk of postoperative complications (OR=0.60; 95% CI 0.31-1.14; p=0.12) including anastomotic leakage (OR=1.83; 95% CI 0.43-7.89; p=0.42) was similar in both groups. At the same time, severity of pain syndrome (mean difference = -2.35; 95% CI -2.51-2.19), time to the first flatus discharge (mean difference = -0.92; 95% CI -0.99-0.85) and postoperative hospital stay (mean difference = -1.5; 95% CI -2.03-0.98) were significantly lower in the group of transanal extraction (p<0.00001). Transanal specimen extraction in left-sided laparoscopic colectomy does not increase overall risk of postoperative complications. In addition, the NOSE technique has some advantages in short-term results compared to procedures with transabdominal specimen extraction.

Establishment of a risk assessment system for complications of hepatectomy based on preoperative variables

To reduce the incidence of postoperative complications, it is important to predict them and intervene before surgery if necessary. However, there is no ideal system to evaluate the overall risk of postoperative complications of liver surgery on the basis of preoperative variables. Therefore, this study aimed to design and validate a risk assessment system to predict postoperative complications of hepatectomy on the basis of preoperative variables. Binomial logistic regression was used to derive the “hepatectomy overall risk formula” (HORF) for predicting postoperative complications on the basis of preoperative variables. Multivariate analysis revealed that Child-Pugh grade B–C (odds ratio [OR] = 1.984, p = 0.002), medical diseases requiring drug treatment (OR = 1.883, p = 0.003), major hepatectomy (OR = 1.947, p < 0.001), adjacent organ invasion (OR = 3.616, p = 0.023), and preoperative hospital stay > 7 days (OR = 1.565, p = 0.004) were independent risk factors for postoperative complications of hepatectomy. The area under the curve for the HORF was 0.736. The optimal cut-off value for predicting complications was 0.32 (32%). The area under the curve for the HORF in the validation dataset was 0.727. The HORF can accurately predict postoperative complications of hepatectomy on the basis of preoperative variables, and thus enables the determination of the necessity for intervention before surgery.

Artificial intelligence-based body composition predicts postoperative complications and mortality in advanced heart failure patients receiving long-term mechanical circulatory support

Abstract Background Obesity is an independent cardiovascular risk factor and is associated with higher postoperative infection rates in patients after cardiac surgery. However, in heart failure, obesity has been described as beneficial in terms of survival (“obesity paradox”); whereas sarcopenia is associated with poor prognosis. An increasing number of advanced heart failure patients requires surgical treatment in terms of left ventricular assist device (LVAD) implantation. The postoperative in-hospital survival has improved in recent years but is still relatively high (11.1%). The impact of body composition on outcome in this population remains unclear. Purpose The aim of this investigation was to examine the preoperative computed tomography (CT) body composition based on artificial intelligence (AI) analysis as a predictor of the postoperative outcome in advanced heart failure patients, who underwent LVAD implantation. Methods Preoperative CT scans of 137 patients who received LVAD implantations between 2015 and 2020 were retrospectively analyzed using an AI-powered automated software tool based on a convolutional neural network, U-net, developed for image segmentation (Visage version 7.1., Visage Imaging GmbH, Berlin, Germany; Figure 1). Assessment of body composition included visceral and subcutaneous adipose tissue areas (VAT, SAT), psoas and total abdominal muscle areas (PMA, TAMA) and sarcopenia (defined as lumbal skeletal muscle index ≤38.5 cm2/m2 in women and ≤54.4 cm2/m2 in men). The body composition parameters were correlated with postoperative major complication rates and survival. Results The mean age of patients was 58.21±11.9 years; 122 (89.1%) were male. Most patients had severe heart failure requiring inotropes (INTERMACS profile I-III, 71.9%) secondary to coronary artery diseases or dilated cardiomyopathy (96.4%). 44 (32.1%) patients were obese (BMI ≥30 kg/m2), 96 (70.1%) were sarcopene and 19 (13.9%) were sarcopene obese. Adipose tissue was associated with a significantly higher risk of overall postoperative complications (SAT 158.22 cm2 [63.09, 256.78 cm2] vs. 124.04 cm2 [42.86, 187.68 cm2], p=0.049) and in-hospital mortality (VAT 168.11 cm2 [134.19, 285.27 cm2] vs. 135.42 cm2 [49.44, 227.91 cm2], p=0.033; SAT 227.28 cm2 [139.38, 304.35 cm2] vs. 173.81 cm2 [97.65, 254.16 cm2], p=0.009). Sarcopenia did not influence the postoperative outcome and survival within 1 year post LVAD implantation. Conclusions Preoperative AI-based CT body composition identifies patients with poor prognosis after LVAD implantation. Adipose tissue areas predict in-hospital mortality, thus, obesity as a perioperative risk factor outweighs the protective effect known in heart failure patients when undergoing LVAD implantation. Funding Acknowledgement Type of funding sources: None.

A clinical study of inferior mesenteric artery typing in laparoscopic radical resections with left colonic artery preservation of rectal cancer

ObjectivesAn investigation of the effects of different types of the inferior mesenteric artery (IMA) on laparoscopic left colic artery (LCA) radical resection of rectal cancer was conducted.MethodsClinical data were collected from 92 patients who underwent laparoscopic radical resection of rectal cancer with preservation of the LCA at Nantong University’s Second Affiliated Hospital. All patients underwent full-abdominal dual-energy CT enhancement examination before surgery and 3D post-processing reconstruction of the IMA. Two radiologists with >3 years of experience in abdominal radiology jointly conducted the examination. A total of three types of IMA were identified among the patients: IMA type I (the LCA arising independently from the IMA), type II (LCA and sigmoid colon artery [SA] branching from a common trunk from IMA), and type III (LCA, SA, and superior rectal artery [SRA] branching from the IMA at the same point). The baseline data, pathological results, and intra-operative and post-operative indicators of the groups were analyzed.ResultsThe proportions of type I, type II, and type III IMA were 58.70% (54/92), 18.48% (17/92), and 22.82% (21/92), respectively. IMA typing was consistent with the preoperative CT evaluation results. The intra-operative blood loss of type III IMA patients [median (interquartile spacing), M (P25, P75): 52.00 (39.50, 68.50) ml] was higher than that of type I and II IMA patients [35.00 (24.00, 42.00) and 32.00 (25.50, 39.50) ml, respectively] (P<0.05). The incidence of anastomotic fistula in type III IMA patients (4 cases, 19.05%) was higher than that in non-type III IMA patients (1 case, 1.41%) (X2=6.679, P=0.010). The incidence of postoperative complications among the three types of IMA was not significantly different (P>0.05).ConclusionsAmong rectal cancer patients undergoing laparoscopic LCA preservation, type III IMA patients had more intraoperative bleeding and a higher incidence of postoperative anastomotic fistula. However, this did not increase the risk of overall postoperative complications.

The impact of frailty on adverse outcomes after transcatheter aortic valve replacement in older adults: A retrospective cohort study.

BackgroundTranscatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement for patients who are at increased surgical risk. Consequently, frailty is common in patients undergoing TAVR.ObjectivesThis study aims to investigate the impact of frailty on outcomes following TAVR.MethodsA retrospective cohort study was conducted, including all TAVR candidates who visited the geriatric outpatient clinic for preoperative screening. Frailty status was assessed according to the Groningen Frailty Indicator. The primary outcome of the study was defined as the occurrence of postoperative complications, and this was evaluated according to the Clavien–Dindo classification. An additional analysis was performed to assess the impact of frailty on 1‐year all‐cause mortality and complications within 30 days of TAVR according to the Valve Academic Research Consortium (VARC‐2) criteria. The VARC‐2 criteria provide harmonized endpoint definitions for TAVR studies.ResultsIn total, 431 patients with a mean age of 80.8 ± 6.2 years were included, of whom 56% were female. Frailty was present in 36% of the participants. Frailty was associated with a higher risk of the composite outcome of complications [adjusted odds ratio (OR): 1.55 (95% confidence interval, CI: 1.03–2.34)], 30‐day mortality [adjusted OR: 4.84 (95% CI: 1.62–14.49)], 3‐month mortality [adjusted OR: 2.52 (95% CI: 1.00–6.28)] and 1‐year mortality [adjusted OR: 2.96 (95% CI: 1.46–6.00)].ConclusionsFrailty is common in TAVR patients and is associated with an increased overall risk of postoperative complications, particularly mortality. Increased optimization of screening and treatment of frailty in the guidelines for valvular heart diseases is recommended.

Poster 179: Fracture Morphology, Surgical Technique, and Obesity as Predictors of Major Postoperative Complications in Midshaft Clavicle Fractures

Objectives:Optimal management of midshaft clavicle fractures remains controversial. This study assessed demographic factors, injury patterns, and surgical technique as potential predictors of complications following open reduction internal fixation (ORIF) of midshaft clavicle fractures. We hypothesize that smoking, diabetes, obesity, and fracture pattern would be risks factors for surgical complications.Methods:Consecutive patients who presented to a single tertiary institution who underwent ORIF of midshaft clavicle fractures were identified retrospectively from 2007-2019. Patients who were lost to follow-up or had a follow-up period of 12 weeks or less, were excluded from analyses. Of the 354 eligible patients, 223 (63%) completed at least 12 weeks of follow-up.Demographics, injury data, surgery characteristics, and postoperative complications were recorded. Postoperative complications were obtained via chart review and separated into major (reoperation) and minor (no reoperation) complications based on reoperation status. Chi-squared statistics, Fisher’s Exact test, and multivariate logistic regression were utilized with significance level set to p<0.05.Results:223 patients (average 39.3 + 15.2 yo) were identified with average follow-up of 9.2 months Table 1. Overall complication incidence was 21.5% (95% [CI], 16.3% to 27.5%), minor complication incidence was 15.2% (95% [CI], 10.8% to 20.6%), major complication incidence was 6.3% (95% [CI], 3.5% to 10.3%), and incidence of non-union was 1.8% (95% [CI], 0.5% to 4.5%). Major complications requiring reoperation revealed 4 cases of non-union (28.6%), 4 instances of symptomatic hardware (28.6%), 3 incidents of deep infections (21.4%), 1 instance of acromioclavicular joint dislocation (7.1%), and 1 incident of broken hardware (7.1%).Smoking status, obesity, and fracture morphology were significant prognostic factors for overall complication risk while diabetes was not. Results from a multivariate analysis demonstrated a 2.4- and 3.2-times greater risk of overall post-operative complications among smokers and obese patients, respectively (p=0.013 and p=0.004, respectively). After adjusting for BMI and smoking status, the risk of post-operative complications among patients with a transverse fracture was 2.26 times greater compared to a patient with an oblique fracture (p = 0.035).Regarding major complications, obese patients were 3.5-times more likely to require reoperative intervention. Moreover, after adjusting for obesity status, transverse and z-type fractures had an 8.9- and 22.7-times greater risk for reoperation, relative to patients with oblique fractures respectively (p=0.04 and p=0.006, respectively. Finally, there were no reported major complications among patients with dual plating, and nonunion occurred exclusively among patients with transverse fractures. Conclusions:Fracture pattern, obesity, and smoking status were significant predictors of postoperative complications. However, only fracture morphology, BMI, and surgical technique were significant predictors of reoperative risk. Transverse and z-type fractures may require increased vigilance, especially among obese patients, with potential consideration for dual plating in these circumstances.Table 1.Baseline Characteristics

Safety of body contouring surgery in an aging patient population

The fastest-growing age group undergoing cosmetic procedures are those over age 60, i.e. the aging patient group. While advanced age is a known predictor for increased surgical complications, the effects of age on complications in specific plastic procedures have yet to be thoroughly investigated. To determine the relationship between increased age and risk of surgical complications following body contouring procedures, specifically: abdominoplasty, brachioplasty, mastopexy, bilateral reduction, and thigh lift. A retrospective analysis of all patients undergoing body contouring procedures of the categories mentioned above between 2000–2018 at a tertiary university medical center. Patients were divided into two age groups: those below and those above, age 60. Data analysis included: demographics, underlying medical conditions, procedure type, and occurrence of postoperative complications (according to the Clavien-Dindo classification system). 803 body contouring procedures were identified, with 12% performed on the aging population. Aging patients had more underlying medical conditions than the younger ones. While the distribution of procedure type was similar in both groups, mastopexy was more common in aging patients. Of the 107 procedures identified as having complications, 37 were classified as grade I, 38 as grade II, and 32 as grade III. As a categorical variable, no relationship was found between the age of the patients and an increased risk of postoperative complications (age cut-off as 60). However, as a continuous variable, increased age did increase the overall risk of postoperative complications, although no optimal age as a cut-off point was identified. In multivariant analysis, diabetes mellitus with abdominoplasty was identified as a risk factor for postoperative complications. Conclusions: When undergoing body contouring procedures, we found that patients over the age of 60 are not at increased risk for postoperative complications than those under that age. Although age as a continuous variable was found to increase the overall postoperative complications, no optimal age could be defined as a cut-off point.

Association between vedolizumab and postoperative complications in IBD: a systematic review and meta-analysis.

The effect of preoperative vedolizumab (VDZ) therapy on postoperative complications in inflammatory bowel disease (IBD) patients is still controversial. This meta-analysis aims to review postoperative complications of IBD patients who preoperatively received VDZ. A meta-analysis of the available literature was performed. Studies of IBD patients who received VDZ and non-VDZ therapy (including anti-TNF-α agents, non-biological therapy, other biological agents, ustekinumab, and placebo) before surgery were included. Primary outcomes included overall complications, infectious complications, and non-infectious complications. Twelve studies with 1925 IBD patients were enrolled, among which 709 patients received VDZ treatment. The results show that, compared with non-VDZ treatment, there is no significant difference in the incidence of overall complications (OR = 1.25, p = 0.43) for adult IBD patients treated with VDZ preoperatively, the incidence of infectious complications (OR = 0.49, p = 0.001) decreases, but the risks of all surgical site infection (SSI) (Crohn's disease (CD): OR = 2.97, p < 0.001), superficial surgical site infection (sSSI) (OR = 2.24, p = 0.02), and ileus (OR = 2.16, p < 0.001) increase. The risk of mucocutaneous separation (MCS) (OR = 4.69, p = 0.03) with VDZ is also higher than non-VDZ. Two studies involved pediatric patients and showed no difference in ileus (OR = 0.55, p = 0.55). Overall, compared with non-VDZ treatment, preoperative use of VDZ is relatively safer in adult IBD patients, which does not increase the risk of overall postoperative complications and reduces the occurrence of infectious complications. But, it increases the risk of all SSI and sSSI in infectious complications and the incidence of ileus and MCS in non-infectious complications. Due to lack of sufficient data, the safety of VDZ in pediatric patients is uncertain and requires further study.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

A systemic review and metaanalysis of postoperative outcomes in urgent and elective bowel resection in patients with Crohn's disease.

The study examined whether urgency of surgical intervention affects postoperative outcomes in patients with Crohn's disease (CD) undergoing bowel resection. The review was conducted according to a predefined, published study protocol in Prospero which is an international database of prospectively registered systematic reviews in health. The study reported according to PRIMSMA guidelines. We searched Embase and Pubmed for articles reporting postoperative outcome after urgent and elective surgery in patients with CD undergoing bowel resection. Primary outcome variable was 30-day overall postoperative complications while secondary outcome variables were intraabdominal septic complications (IASCs), mortality, reoperation, and readmission. Assessment of bias was performed using Newcastle-Ottawa score. Two authors independently extracted data on each study, patients, and outcome measures. The search identified 22 studies in which 955 patients underwent urgent surgeries while 6518 patients underwent elective surgeries. Based on the quality assessment, 19 studies were classified as having high risk of bias, one study as having a medium risk of bias and 2 studies as having low risk of bias (≥8 stars). Random-effect metaanalysis showed urgent surgery was associated with ~ 40% increase in overall complications compared to elective surgery (RR = 1.43, 95% CI [1.09; 1.87], p= 0.010). IASCs also increased in patients who had urgent surgery (RR = 1.44, 95% CI [1.08; 1.92], p= 0.013). No significant difference was shown in mortality and readmission rates. Urgent bowel resection in patients with CD is associated with higher risk of overall postoperative complications and IASCs.

Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients.

Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.

Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients.

Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively. This was a retrospective review using the National Inpatient Sample, a national database incorporating inpatient hospitalization information. ICD-9 codes were used to identify patients who underwent primary and revision THA or TKA. Patients were separated based on the diagnosis of OS. Primary outcomes assessed included patient mortality, postoperative complications, length of stay, and cost during index hospitalization. From 2001 to 2014, a total of 12,541,169 patients underwent primary and revision THA or TKA. Of those, 3,182 patients (0.03%) developed OS postoperatively. There was an increased incidence of OS in revision THA and TKA compared with primary THA and TKA. Fluid and electrolyte disorders were associated with the largest increased adjusted risk of OS. Patients with OS had an increased adjusted risk of overall postoperative complications and being discharged to skilled nursing facility. Patients with OS had an increased average length of stay and hospitalization cost compared with patients without OS. Given our findings, the risk factors for the development of OS, including revision surgery, should be identified and minimized during the perioperative period to prevent the development of this morbid and potentially life-threatening complication. III (Retrospective cohort study).

Partial Versus Radical Nephrectomy in Patients with Renal Cell Carcinoma: A Systematic Review and Meta-analysis.

Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC. PubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets. A total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38-0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58-0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17-1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28-2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35-58.30, P < 0.001) as compared to RN. These findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications.

Total Joint Arthroplasty in Patients With Cerebral Palsy.

Cerebral palsy (CP) is a neurodevelopmental condition with a wide range of presentations that usually lead to muscle imbalance culminating with precocious knee and hip arthrosis, often leading to total hip (THA) and knee arthroplasty (TKA). This study sought to determine the following: (1) the inherent differences of in-hospital characteristics and comorbidities between CP and non-CP patients undergoing total joint arthroplasty (TJA) and (2) do patients with CP have an increased risk of perioperative complications after TJA? The Nationwide Inpatient Sample database from 2005 to 2014 was queried in this retrospective cohort study to compare patient demographics and comorbidities, hospital characteristics, perioperative complications, and length of stay in patients with CP undergoing TJA compared with their non-CP counterparts. Statistical analyses were performed using the Rao-Scott chi-square test and analysis of variance. All analyses took into account the sampling procedure and weighting. A total of 2,062 and 2,193 patients with CP underwent THA and TKA, respectively, during the study period. Both CP groups were younger (P < 0.0001), were more likely to have Medicaid insurance (P < 0.0001), and had longer lengths of hospital stay (P < 0.0001) compared with their non-CP counterparts. Non-CP patients had significantly higher rates of obesity, coronary artery disease, diabetes, and peripheral vascular disease (P < 0.05). However, patients with CP undergoing THA had a lower Charlson Comorbidity Index (P = 0.0002), whereas those undergoing TKA had similar comorbidity profile as the non-CP group (P = 0.097). Both THA and TKA CP patients had a higher risk of overall postoperative complications (P < 0.05) and surgical complications (P < 0.05), in particular acute postoperative anemia (P < 0.05). Despite being younger with fewer comorbidities, patients with CP are at an increased risk of immediate perioperative complications after TJA compared with the general osteoarthritis population. Given that these patients have satisfactory long-term outcomes after TJA, these procedures can be performed successfully for patients with CP with careful medical management and surgical planning. Level III, retrospective cohort study.