Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data

Abstract Background The ACS-NSQIP surgical risk calculator (SRC) is an open-access online tool that estimates the chance for adverse postoperative outcomes. The risk is estimated based on 21 patient-related variables and customized for specific surgical procedures. The purpose of this monocentric retrospective study is to validate its predictive value in an Italian emergency setting. Methods From January to December 2018, 317 patients underwent surgical procedures for acute cholecystitis (n = 103), appendicitis (n = 83), gastrointestinal perforation (n = 45), and intestinal obstruction (n = 86). Patients’ personal risk was obtained and divided by the average risk to calculate a personal risk ratio (RR). Areas under the ROC curves (AUC) and Brier score were measured to assess both the discrimination and calibration of the predictive model. Results The AUC was 0.772 (95%CI 0.722–0.817, p < 0.0001; Brier 0.161) for serious complications, 0.887 (95%CI 0.847–0.919, p < 0.0001; Brier 0.072) for death, and 0.887 (95%CI 0.847–0.919, p < 0.0001; Brier 0.106) for discharge to nursing or rehab facility. Pneumonia, cardiac complications, and surgical site infection presented an AUC of 0.794 (95%CI 0.746–0.838, p < 0.001; Brier 0.103), 0.836 (95%CI 0.790–0.875, p < 0.0001; Brier 0.081), and 0.729 (95%CI 0.676–0.777, p < 0.0001; Brier 0.131), respectively. A RR > 1.24, RR > 1.52, and RR > 2.63 predicted the onset of serious complications (sensitivity = 60.47%, specificity = 64.07%; NPV = 81%), death (sensitivity = 82.76%, specificity = 62.85%; NPV = 97%), and discharge to nursing or rehab facility (sensitivity = 80.00%, specificity = 69.12%; NPV = 95%), respectively. Conclusions The calculator appears to be accurate in predicting adverse postoperative outcomes in our emergency setting. A RR cutoff provides a much more practical method to forecast the onset of a specific type of complication in a single patient.

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The Influence of age on Postoperative Morbidity and Mortality After Pancreatoduodenectomy. An Analysis of 6293 Cases from the Acs-Nsqip

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.101 ◽

2012 ◽

Vol 172 (2) ◽

pp. 192

Author(s):

V. Advani ◽

C.R. Gonczy ◽

S.J. Markwell ◽

S. Ahad ◽

I. Hassan

Keyword(s):

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Acs Nsqip

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Post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine rupture at the gynecology and obstetrics service of the Ignace Deen National Hospital in Guinea

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204782 ◽

2020 ◽

Vol 9 (11) ◽

pp. 4367

Author(s):

Ibrahima S. Balde ◽

Ousmane Balde ◽

Ibrahima Stylla ◽

Alhassane II Sow ◽

Massa Keita ◽

...

Keyword(s):

Surgical Procedures ◽

Uterine Rupture ◽

Maternal Morbidity ◽

Caesarean Delivery ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Significance Level ◽

Gynecology And Obstetrics ◽

Maternal Morbidity And Mortality ◽

One Year

Background: The aim of the work was to study post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine failure, to describe the main causes and to analyze the risk factors.Methods: It was a descriptive, comparative and analytical study lasting 2 years with data collection in 2 phases, one of which was a retrospective study lasting one year from July 2018 to June 2019 and the other a prospective study also lasting one year, from July 2019 to June 2020. It concerned all pregnant women who had been caesarized or had had a laparotomy for uterine rupture with complications and those who had not developed any complications. The parameters studied were types of complications, risk factors and maternal mortality. The Chi-square test was used to compare the two populations with a significance level p=0.05.Results: During the study period, 6141 hospitalizations were recorded among which 5682 surgical procedures were performed, i.e. 92.52% of hospitalizations. Caesarean delivery accounted for 90.55% of surgical procedures and laparotomy for uterine rupture for 1.10%. The overall maternal post-operative morbidity rate was 7.60%. Post-operative anemia was by far the most common complication (75.76%) followed by infection (23.46%). The maternal death rate was 0.92% with a ratio of 409.97 maternal deaths per 100,000 live births and more than 2/3 of these deaths were due to caesarean delivery. Anemia and septic shock were the main causes of death. Factors related to this post-operative maternal morbidity were: age greater than or equal to 40 years, multi-parity, illiteracy, emergency obstetric evacuation, low socio-economic level, poor quality of prenatal follow-up and rupture of membranes before admission.Conclusion: In the emergency context concerning majority of our cesarean deliveries and the totality of uterine ruptures predispose the mother to high significant morbidity and mortality.

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