scholarly journals Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

2020 ◽  
Vol 405 (7) ◽  
pp. 977-988
Author(s):  
Oliver Beetz ◽  
Clara A. Weigle ◽  
Sebastian Cammann ◽  
Florian W. R. Vondran ◽  
Kai Timrott ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Postoperative Complications ◽  
Intrahepatic Cholangiocarcinoma ◽  
Postoperative Morbidity ◽  
Severity Index ◽  
The Body ◽  
Morbidity And Mortality ◽  
Independent Risk Factors ◽  
Risk Factors For Survival

Abstract Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

scholarly journals Sigmoid volvulus: outcomes of treatment and predictors of morbidity and mortality

2022 ◽  
Author(s):  
David Moro-Valdezate ◽  
José Martín-Arévalo ◽  
Vicente Pla-Martí ◽  
Stephanie García-Botello ◽  
Ana Izquierdo-Moreno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Postoperative Morbidity ◽  
Elective Surgery ◽  
Mortality Rates ◽  
Sigmoid Volvulus ◽  
Morbidity And Mortality ◽  
Asa Score

Abstract Purpose To analyze the treatment outcomes for sigmoid volvulus (SV) and identify risk factors of complications and mortality. Methods Observational study of all consecutive adult patients diagnosed with SV who were admitted from January 2000 to December 2020 in a tertiary university institution for conservative management, urgent or elective surgery. Primary outcomes were 30-day postoperative morbidity, mortality and 2-year overall survival (OS), including analysis of risk factors for postoperative morbidity or mortality and prognostic factors for 2-year OS. Results A total of 92 patients were included. Conservative management was performed in 43 cases (46.7%), 27 patients (29.4%) underwent emergent surgery and 22 (23.9%) were scheduled for elective surgery. Successful decompression was achieved in 87.8% of cases, but the recurrence rate was 47.2%. Mortality rates following episodes were higher for conservative treatment than for urgent or elective surgery (37.2%, 22.2%, 9.1%, respectively; p = 0.044). ASA score > III was an independent risk factor for complications (OR = 5.570, 95% CI = 1.740–17.829, p < 0.001) and mortality (OR = 6.139, 95% CI = 2.629–14.335, p < 0.001) in the 30 days after admission. Patients who underwent elective surgery showed higher 2-year OS than those with conservative treatment (p = 0.011). Elective surgery (HR = 2.604, 95% CI = 1.185–5.714, p = 0.017) and ASA score > III (HR = 0.351, 95% CI = 0.192–0.641, p = 0.001) were independent prognostic factors for 2-year OS. Conclusion Successful endoscopic decompression can be achieved in most SV patients, but with the drawbacks of high recurrence, morbidity and mortality rates. Concurrent severe comorbidities and conservative treatment were independent prognostic factors for morbidity and survival in SV.

Morbidity and mortality after colorectal cancer surgery in patients with cirrhosis: A critical review of the literature.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 608-608
Author(s):  
Tarek Boussaha ◽  
Jean François Cadranel ◽  
Allaoua Smail ◽  
Hortensia Lison ◽  
Armand Garioud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Independent Risk Factors

608 Background: Cirrhotic patients with localized colorectal cancer are potential candidates for tumor resection. The aim of this review was to evaluate the morbi-mortality after colorectal surgery. Methods: Comprehensive search was conducted using PUBMED, EMBASE, and the COCHRANE Library. Prospective and retrospective studies were selected. The study population included cirrhotic patients who underwent colorectal resection for non-metastatic colorectal cancer and patients with benign and other malignant disease. The postoperative morbi-mortality and independent risk factors were analysed. Results: Eight studies were identified. Among these, four studies compared the risk of colorectal surgery in patients with and without liver cirrhosis. The number of patients varied from 41 to 6,120. The severity of cirrhosis in most of the studies was classified with the Child-Pugh score. Class B and C were observed in 20% to 60% of the patients. Sepsis represented the main postoperative complication and occurred in 48% to 77% of patients. Mortality varied according to the Child-Pugh score, ranging from 11% to 41%, and was significantly higher for patients with cirrhosis in Child-Pugh Class C. Urgent surgical procedure had a negative impact on prognosis. The average length of hospital stay ranged from 9 to 18 days. Cirrhosis was associated with a 2-3 time and a 4-10 time increased risk of postoperative mortality in the absence and presence of portal hypertension, respectively compared with non-cirrhotic patients. The independent risk factors for postoperative morbidity and mortality were encephalopathy, ascites, low haemoglobin, prolonged prothrombin time, elevated bilirubin, hypoalbuminemia, postoperative infection, total colectomy, elective or non-elective surgery, the presence of co-morbidities and MELD score ≥ 15. Conclusions: Colorectal cancer surgery is associated with an increased risk of postoperative morbidity and mortality in cirrhosis patients. Studies evaluating exclusively the operative risk for colorectal cancer surgery in this patient’s population are rare. Prospective controlled trials to optimize the perioperative management of those patients are needed.

scholarly journals Therapeutic Effects of Microsurgical Clipping at Different Time Points on Intracranial Aneurysm and Prognostic Factors

2021 ◽  
Author(s):  
Ge Huang ◽  
Yang Sun ◽  
Jinhong Li ◽  
Zhengyuan Xie ◽  
Xiaoguang Tong
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Postoperative Complications ◽  
Poor Prognosis ◽  
Therapeutic Effects ◽  
Time Points ◽  
Microsurgical Clipping ◽  
History Of ◽  
Prognosis Group ◽  
Independent Risk Factors

Abstract Background Microsurgical clipping is effective for treating early rupture hemorrhage in intracranial aneurysm (IA) patients. We aimed to evaluate the therapeutic effects of microsurgical clipping at different time points on IA and to explore prognostic factors. Methods A total of 102 eligible patients were divided into good prognosis group (n = 87) and poor prognosis group (n = 15) according to Glasgow Outcome Scale (GOS) scores at discharge. The effects of microsurgical clipping at different time points (within 24 h, 48 h and 72 h) were compared. The incidence rates of postoperative complications in patients with different Hunt–Hess grades were compared. Prognostic factors were determined by multivariate logistic regression analysis. The nomogram prediction model was established based on independent risk factors and validated. Results The good recovery and success rates of complete aneurysm clipping were significantly higher in patients undergoing surgery within 24 h after rupture. The incidence rate of complications was significantly higher in patients with Hunt–Hess grade IV. Good and poor prognosis groups had significantly different age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and National Institute of Health Stroke Scale (NIHSS) score, as independent risk factors for prognosis. The nomogram model predicted that poor prognosis rate was 14.71%. Conclusion Timing (within 24 h after rupture) microsurgical clipping benefits the prognosis of IA patients. Age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and NIHSS score are independent risk factors for poor prognosis.

scholarly journals A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

2021 ◽  
Author(s):  
Koichi Tomita ◽  
Itsuki Koganezawa ◽  
Masashi Nakagawa ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Risk Score ◽  
Surgical Procedure ◽  
Evaluation Method ◽  
Preoperative Risk ◽  
Preoperative Serum ◽  
Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

scholarly journals The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

2021 ◽  
Author(s):  
M. Runkel ◽  
T. D. Diallo ◽  
S. A. Lang ◽  
F. Bamberg ◽  
M. Benndorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Visceral Obesity ◽  
The Body ◽  
Postoperative Outcomes ◽  
Sarcopenic Obesity ◽  
Colorectal Metastases ◽  
Complication Rates ◽  
The Impact ◽  
Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

scholarly journals Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

2019 ◽  
Vol 103 (11-12) ◽  
pp. 578-584
Author(s):  
Fatih Ciftci ◽  
Fazilet Erözgen
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Postoperative Period ◽  
Perforated Peptic Ulcer ◽  
Apache Ii ◽  
Morbidity And Mortality ◽  
Apache Ii Score ◽  
Peptic Ulcers ◽  
Presentation Time ◽  
Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

scholarly journals Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Gland Surgery ◽  
2017 ◽  
Vol 6 (4) ◽  
pp. 355-367 ◽  
Author(s):  
Andri Thorarinsson ◽  
Victoria Fröjd ◽  
Lars Kölby ◽  
Mattias Lidén ◽  
Anna Elander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Independent Risk Factors

Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia

Hernia ◽  
2012 ◽  
Vol 16 (4) ◽  
pp. 405-410 ◽  
Author(s):  
B. Romain ◽  
R. Chemaly ◽  
N. Meyer ◽  
C. Brigand ◽  
J. P. Steinmetz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Groin Hernia ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality

scholarly journals Prognosis and Complications of Attempted Suicidal Hanging

2019 ◽  
Vol 9 (4) ◽  
pp. 191-198
Author(s):  
Azadeh Memarian ◽  
Kamran Aghakhani ◽  
Babak Soltani ◽  
Siamak Soltani
Keyword(s):  
Risk Factors ◽  
Substance Abuse ◽  
Prognostic Factors ◽  
Respiratory Distress ◽  
Cause Of Death ◽  
Cerebral Edema ◽  
Medical Center ◽  
The Body ◽  
Loss Of Consciousness ◽  
Duration Of Hospitalization

Background: Hanging is a form of strangulation, in which the body is suspended through the neck and the weight of the body acts as a constricting force. This study assessed various factors on the outcome of hanging and identification of prognostic factors related to the outcomes.Methods: Ninety-nine hanging victims from 1995 to 2015 in Iran were evaluated; then, variables such as the cause of death, distribution of mortality, duration of hospitalization, substance abuse consumption, respiratory distress, and cerebral edema were studied in these people. Finally, the data were analyzed.Results: Major cases of suicide by hanging were men. In connection with prognosis, about 12% of the deaths occurred in men and about 21% were represented in women. More importantly, in the matter of suspension, the model was largely incomplete to complete. Also, the outcomes of pulmonary stress and cerebral edema were recognized in association with the type of hanging and mortality prognosis.Conclusion: Only two risk factors, including loss of consciousness at the time of entry into the medical center, as well as the complete suspension, would be predictive operations of death and unsuccessful revival.

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