Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study

2021 ◽  
Author(s):  
Lei Xu ◽  
Xian‐kai Chen ◽  
Hou‐nai Xie ◽  
Ya‐Fan Yang ◽  
Rui‐xiang Zhang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Enhanced Recovery ◽  
Mediastinal Pleura

Impact of the introduction of an enhanced recovery pathway in esophageal cancer surgery: a cohort study and propensity score matching analysis

2021 ◽  
Author(s):  
J Moons ◽  
L Depypere ◽  
T Lerut ◽  
T van Achterberg ◽  
W Coosemans ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Enhanced Recovery ◽  
Infectious Complications ◽  
Propensity Score Matching Analysis ◽  
Postoperative Blood Transfusion ◽  
The Impact

Summary Enhanced recovery pathways (ERP) have the potential to improve clinical outcomes. Aim of this study was to determine the impact of ERP on perioperative results as compared with traditional care (TC) after esophagectomy. In this study, two cohorts were compared. Cohort 1 represented 296 patients to whom TC was provided. Cohort 2 consisted of 200 unselected ERP patients. Primary endpoints were postoperative complications. Secondary endpoints were the length of stay and 30-day readmission rates. To confirm the possible impact of ERP, a propensity matched analysis (1:1) was conducted. A significant decrease in complications was found in ERP patients, especially for pneumonia and respiratory failure requiring reintubation (39% in TC and 14% in ERP; P<0.0001 and 17% vs. 12%; P<0.0001, respectively) and postoperative blood transfusion (26.7%–11%; P<0.0001). Furthermore, median length of stay was also significantly shorter: 13 days (interquartile range [IQR] 10–23) in TC compared with 10 days (IQR 8–14) in ERP patients (P<0.0001). The 30-day readmission rate (5.4% in TC and 9% in ERP; P=0.121) and in-hospital mortality rate (4.4% in TC and 2.5% in ERP; P=0.270) were not significantly affected. A propensity score matching confirmed a significant impact on pneumonia (P=0.0001), anastomotic leak (P=0.047), several infectious complications (P=0.01–0.034), blood transfusion (P=0.001), Comprehensive Complications Index (P=0.01), and length of stay (P=0.0001). We conclude that ERP for esophagectomy is associated with significantly fewer postoperative complications and blood transfusions, which results in a significant decrease of length of stay without affecting readmission and mortality rates.

Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study

2021 ◽  
Author(s):  
Zhen Yang ◽  
Hengjun Gao ◽  
Jun Lu ◽  
Zheyu Niu ◽  
Huaqiang Zhu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Disease Free Survival ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Estimated Blood Loss ◽  
Disease Free

Abstract Objective There are limited data from retrospective studies on whether therapeutic outcomes after regular pancreatectomy are superior to those after enucleation in patients with small, peripheral and well-differentiated non-functional pancreatic neuroendocrine tumors. This study aimed to compare the short- and long-term outcomes of regular pancreatectomy and enucleation in patients with non-functional pancreatic neuroendocrine tumors. Methods Between January 2007 and July 2020, 227 patients with non-functional pancreatic neuroendocrine tumors who underwent either enucleation (n = 89) or regular pancreatectomy (n = 138) were included. Perioperative complications, disease-free survival, and overall survival probabilities were compared. Propensity score matching was performed to balance the baseline differences between the two groups. Results The median follow-up period was 60.76 months in the enucleation group and 43.29 months in the regular pancreatectomy group. In total, 34 paired patients were identified after propensity score matching. The average operative duration in the enucleation group was significantly shorter than that in the regular pancreatectomy group (147.94 ± 42.39 min versus 217.94 ± 74.60 min, P < 0.001), and the estimated blood loss was also significantly lesser (P < 0.001). The matched patients who underwent enucleation displayed a similar overall incidence of postoperative complications (P = 0.765), and a comparable length of hospital stay (11.12 ± 3.90 days versus 9.94 ± 2.62 days, P = 0.084) compared with those who underwent regular pancreatectomy. There were no statistically significant differences between the two groups in disease-free survival and overall survival after propensity score matching. Conclusion Enucleation in patients with non-functional pancreatic neuroendocrine tumors was associated with shorter operative time, lesser intraoperative bleeding, similar overall morbidity of postoperative complications, and comparable 5-year disease-free survival and overall survival when compared with regular pancreatectomy.

FA03.05: NEOADJUVANT CHEMOTHERAPY OR CHEMORADIOTHERAPY FOR ADENOCARCINOMA OF THE ESOPHAGUS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Els Visser ◽  
David Edholm ◽  
Mark Smithers ◽  
Iain Thomson ◽  
Bryan Burmeister ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Neoadjuvant Chemoradiotherapy ◽  
Treatment Modalities ◽  
The Impact

Abstract Background Multimodality treatment of patients with esophageal adenocarcinoma (EAC) improve survival, but the optimal treatment strategy remains undetermined. The aim of this study was to compare outcomes in patients undergoing neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) for EAC. Methods Patients who underwent nCT or nCRT followed by surgery for EAC were identified from a prospective database (2000–2017) and included in this study. After propensity score matching, we compared the impact of the treatments on postoperative complications, in-hospital mortality, pathological outcomes and survival rates. Results Of the 396 eligible patients, 262 patients were analysed following propensity score matching. This resulted in 131 patients in the nCT group versus 131 patients in the nCRT group. There were no significant differences between the nCT and nCRT groups for overall complications (59% vs 57%, P = 0.802) or in-hospital mortality (2% vs 0%, P = 0.156). Patients who had nCRT had more R0 resections (93% vs. 83%, P = 0.013), and a higher pathological complete response rate (15% vs. 5%, P < 0.001). The pattern of recurrence was similar (P = 0.753) and there were no differences in 5-year disease-free survival rates (nCT vs nCRT; 39% vs 39%, P = 0.879) or 5-year overall survival rates (nCT vs nCRT; 44% vs 33%, P = 0.645). Conclusion In this study no differences between nCT and nCRT were seen in postoperative complications and in-hospital mortality in patients treated for EAC. Inspite of improved complete resection and pathological response there was no difference in the overall survival between the treatment modalities. Disclosure All authors have declared no conflicts of interest.

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

2020 ◽  
Author(s):  
Efstathios Karamanos ◽  
Amita R. Shah ◽  
Julie N. Kim ◽  
Howard T. Wang
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Propensity Score ◽  
Breast Reconstruction ◽  
Propensity Score Matching ◽  
Free Flap ◽  
Improvement Program ◽  
National Quality ◽  
The Impact ◽  
Perioperative Blood Transfusion

Abstract Background Microvascular thrombosis has been associated with cytokine release and inflammatory syndromes which can occur as a result of blood transfusions. This phenomenon could potentially lead to complications in breast free flap reconstruction. The aim of this study was to evaluate the impact of perioperative blood transfusion in free flap breast reconstruction using large population analysis. Methods The American College of Surgeons National Quality Improvement Program database was queried for delayed free flap breast reconstructions performed in 2016. The study population was divided based on perioperative blood transfusion within 24 hours of the start of the operation. Propensity score matching analysis was used to ensure homogeneity between the two study groups. Primary outcome was unplanned return to the operating room (OR) within 30 days. Secondary outcomes were readmission and complications. Results A total of 1,256 patients were identified. Out of those, 91 patients received a perioperative blood transfusion. All the patients received only one unit of PRBC within the first 24 hours. Those patients were matched with similar patients who did not receive a transfusion on a ratio of 1:3 (273 patients). Patients who received a transfusion had a significantly higher incidence of reoperation (42 vs. 10%, p < 0.001). Patients who received a transfusion were more likely to return to the OR after 48 hours from the initial operation (13 vs. 5%, p = 0.001). All returns to the OR were due to flap-related complications. Perioperative blood transfusion increased the incidence of wound dehiscence (9 vs. 2%, p = 0.041) but had no protective effect on the development of other postoperative complications. Conclusion Perioperative blood transfusion in free flap breast reconstruction is associated with an increased probability of flap-related complications and subsequent return to the OR without decreasing the probability of developing other systemic postoperative complications.

Utility of Regional Anesthesia in Extremity Reconstruction

2019 ◽  
Vol 36 (01) ◽  
pp. 053-058
Author(s):  
Joseph S. Weisberger ◽  
Nicholas C. Oleck ◽  
Haripriya S. Ayyala ◽  
Margaret M. Dalena ◽  
Edward S. Lee
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
General Anesthesia ◽  
Propensity Score Matching ◽  
Regional Anesthesia ◽  
Operative Time ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Significant Difference ◽  
Extremity Reconstruction

Background Regional anesthesia (RA) may help to circumvent the well-documented risks associated with general anesthesia, increase patient comfort and satisfaction, and mitigate costs. This study aims to investigate the utility of RA in extremity reconstruction. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cases of extremity reconstruction including muscle, myocutaneous, or fasciocutaneous flaps from 2005 to 2016. Two groups were created based on anesthesia technique, regional/epidural and general. Postoperative complications included reoperation, readmission, and wound complications. Propensity score matching was utilized to control for variation in sample size, significant comorbidities, and demographics in the analysis of complications. Results A total of 2,874 cases were identified with general anesthesia utilized in 2,820 cases and RA in the remaining 54. After propensity score matching, 53 cases were identified in each group. In both unmatched and matched cohorts, there was no statistically significant difference in the rates of reoperation, readmission, or wound complication rates. In the matched cohort, mean operative time in the RA cohort was significantly shorter, 157.64 (±112.36) minutes compared with 293.06 minutes (±201.35 minutes) in the general anesthesia group (p < 0.001). While no statistically significant difference was detected in mean length of stay (LOS) between the two groups, the RA group experienced a clinically significant shorter LOS of 5.77 days (±5.87 days) compared with 7.02 (±5.61) days in the general anesthesia group (p = 0.269). Conclusion RA may be a safe, reasonable alternative to general anesthesia in extremity reconstruction without increase in postoperative complications. Additionally, RA use is associated with a significant reduction in operative time, potentially leading to shorter and safer procedures without compromising outcomes.

Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

2021 ◽  
Author(s):  
Qiang Zhang ◽  
Zhou-yang Lian ◽  
Jian-Qun Cai ◽  
Yang Bai ◽  
Zhen Wang
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Operation Time ◽  
Intraepithelial Neoplasia ◽  
R0 Resection ◽  
En Bloc ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Traction Group

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

scholarly journals Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

2021 ◽  
Author(s):  
Chun-Qing Li ◽  
Chen Zhang ◽  
Fan Yu ◽  
Hao Kong ◽  
Chun-Mei Deng
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Digestive Tract ◽  
Older Patients ◽  
Infectious Complications ◽  
Increased Risk ◽  
Life Threatening ◽  
Digestive Tract Surgery ◽  
Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

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