The Impact of Functional Dependence and Related Surgical Complications on Postoperative Mortality

ABSTRACT BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.

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The impact of duration observations on precision of results GNSS measurements

Geodesy and Cartography ◽

10.22389/0016-7126-2017-921-3-7-13 ◽

2017 ◽

Vol 921 (3) ◽

pp. 7-13 ◽

Cited By ~ 1

Author(s):

S.V. Grishko

Keyword(s):

Measurement Accuracy ◽

Functional Dependence ◽

Observation Time ◽

Satellite Networks ◽

Satellite Measurements ◽

Proposed Model ◽

Actual Error ◽

Gnss Measurements ◽

The Impact ◽

Qualitative Characteristics

This paper shows that the accuracy of relative satellite measurements depend not only on the length of the baseline, as it is regulated by the rating formula of accuracy of GNSS equipment, but also on the duration of observations. As a result of the strict adjustment much redundant satellite networks with different duration of observations obtained covariance matrix of baselines, the most realistic reflecting the actual error of satellite observations. Research of forms of communication of these errors from length of the baseline and duration of its measurement is executed. A significant influence of solar activity on accuracy of satellite measurements, in general, leads to unequal similar series of measurements made at different periods, for example, in the production of monitoring activities. The model of approximation of the functional dependence of accuracy of the baseline from its length and duration of observations having good qualitative characteristics is offered. Based on the proposed model, we analyzed the dynamics of changes in measurement accuracy with an increase in observation time.

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The impact of the workability of an automated technological system on the effective implementation of the production program when processing tools in glow discharge plasma generators

Quality Innovation Education ◽

10.31145/1999-513x-2021-5-58-65 ◽

2021 ◽

pp. 58-65

Author(s):

V.A. Logvin ◽

◽

S.A. Sheptunov ◽

Keyword(s):

Glow Discharge ◽

Discharge Plasma ◽

Functional Dependence ◽

Plasma Generator ◽

Glow Discharge Plasma ◽

Optimal Time ◽

Time Interval ◽

Production Program ◽

The Impact ◽

Plasma Generators

The conditions for the hardening of tools in accordance with the author’s technological routes in the optimal time interval are considered using the functional dependence of the serviceability of plasma generators. This dependence takes into account the workability of the technical devices involved in processing the laying batch of tools in the speci ed time interval. The probability of performing the production process in the estimated time is represented by the product of the trouble-free operation of each glow discharge plasma generator involved in the nishing processing of tools that require a different type of plasma exposure in a certain sequence and duration.

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The Impact of Hospital Volume and Charlson Score on Postoperative Mortality of Proctectomy for Rectal Cancer

Annals of Surgery ◽

10.1097/sla.0000000000002898 ◽

2018 ◽

Vol 268 (5) ◽

pp. 854-860 ◽

Cited By ~ 20

Author(s):

Mehdi El Amrani ◽

Guillaume Clement ◽

Xavier Lenne ◽

Moshe Rogosnitzky ◽

Didier Theis ◽

...

Keyword(s):

Rectal Cancer ◽

Hospital Volume ◽

Postoperative Mortality ◽

Charlson Score ◽

The Impact

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Impact of Lymphadenectomy on the Oncologic Outcome of Patients with Adrenocortical Carcinoma—A Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers14020291 ◽

2022 ◽

Vol 14 (2) ◽

pp. 291

Author(s):

Anne Hendricks ◽

Sophie Müller ◽

Martin Fassnacht ◽

Christoph-Thomas Germer ◽

Verena A. Wiegering ◽

...

Keyword(s):

Systematic Review ◽

Adrenocortical Carcinoma ◽

Survival Benefit ◽

Meta Analysis ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Oncologic Outcome ◽

Stage I ◽

Tumor Stages ◽

The Impact

(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III).

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Abstract 18519: Withdrawal of Antiplatelet Therapy Results in Worse Short-term Prognosis in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽

10.1161/circ.130.suppl_2.18519 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jesús álvarez-García ◽

Miquel Vives-Borrás ◽

Joan I Llao ◽

Andreu Ferrero-Gregori ◽

Marc Bausili ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Cardiovascular Events ◽

Primary Outcome ◽

Outcome Measure ◽

Postoperative Mortality ◽

Primary Outcome Measure ◽

Noncardiac Surgery ◽

Concomitant Treatment ◽

Short Term ◽

The Impact

Background: The decision whether to discontinue antiplatelet therapy in patients undergoing major noncardiac surgery can be clinically challenging. There is insufficient clinical evidence to establish comprehensive guidelines and most of recommendations are based on expert consensus. Objective: To evaluate the effectof withdrawal of antiplatelet therapy on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery. Age, gender, risk factors, previous chronic heart or lung disease, renal function, anemia and concomitant treatment were used in a binary logistic regression to determine the impact of withdrawal of antiplatelet therapy on prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: Five percent of patients presented the composite primary outcome measure of 30-day postoperative mortality or cardiovascular events. Antiplatelet therapy was withdrawn in 11.4% of patients (table). Discontinuation of antiplatelet therapy was associated with a significant increase in the primary outcome measure (OR 2.27; CI95%: 1.16-4.46). Conclusions: In a contemporary cohort of patients undergoing noncardiac surgery, withdrawal of antiplatelet therapy was associated with a worse short-term prognosis. There is an urgent need for further research in this field.

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Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽

10.1182/blood.v120.21.2088.2088 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2088-2088 ◽

Cited By ~ 1

Author(s):

Khaled M Musallam ◽

John B Porter ◽

Assaad Soweid ◽

Jamal J Hoballah ◽

Pierre M Sfeir ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Postoperative Mortality ◽

Major Surgery ◽

Vascular Events ◽

Improvement Program ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein ◽

The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

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Low preoperative platelets to predict postoperative liver dysfunction in patients with metastatic colorectal cancer undergoing liver resection.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.634 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 634-634

Author(s):

Patrick Starlinger ◽

Beata Herberger ◽

Dietmar Tamandl ◽

Stefan Stremitzer ◽

Christine Brostjan ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

High Risk ◽

Postoperative Complications ◽

Metastatic Colorectal Cancer ◽

Liver Dysfunction ◽

Postoperative Mortality ◽

Platelet Counts ◽

The Impact ◽

Selection Of

634 Background: Despite improving median survival of metastatic colorectal cancer (mCRC) patients, chemotherapy (CTx) compromises liver function. Therefore, selection of patients who are of high risk to develop liver dysfunction (LD) after surgery is important. As platelets are of major importance in liver regeneration, we investigated the impact of preoperative platelet counts on the incidence of postoperative LD and its correlation to postoperative morbidity and mortality. Methods: Patients treated with liver resection for mCRC between January 2000 and December 2010 were eligible. LD was defined as bilirubin > 5 mg/dL or prothrombin time <50% within the first postoperative week. The association of preoperative platelets < 150 x 103/ml with LD, 90 days mortality and surgical complications was analyzed. Results: 518 patients with metastatic CRC cancer underwent liver resection, of whom 68% had received neoadjuvant CTx. 21% of all patients developed LD. Postoperative complications occurred in 13.5%. 10 patients died within 90 days after liver resection (1.9%). The incidence of LD and complications was significantly higher in patients with preoperative platelets < 150 x 103/ml (P=0.010, P=0.047). 90 days mortality was nearly 3 times higher in patients with reduced preoperative platelets (9.8% vs. 3.7%). Neoadjuvant CTx was associated with an increased rate of platelets < 150 x 103/ml (with CTx 25%, without CTx 17%; P=0.051), LD (with CTx 23%, without CTx 15%; P=0.029) and postoperative mortality (with CTx 5.3%, without CTx 2.5%). Conclusions: Patients with platelets < 150 x 103/ml have an increased incidence of postoperative LD, major complications and 90 days mortality. Using this simple routine parameter, it might be possible to select patients that could be better served with alternative treatments such as radiofrequency ablation. Furthermore, reduced platelet counts and the incidence of LD were more frequent in patients after neoadjuvant CTx resulting in an increased 90 days mortality. This suggests that patients after extensive CTx accompanied by low platelets are of high risk to suffer from postoperative complications and surgical treatment should be reconsidered.

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Neoadjuvant therapy for localized gastrointestinal stromal tumors (GISTs): A propensity score weighted analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23516 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23516-e23516

Author(s):

Kathryn E. Marqueen ◽

Erin Moshier ◽

Michael Buckstein ◽

Celina Ang

Keyword(s):

Overall Survival ◽

Logistic Regression ◽

Propensity Score ◽

Survival Benefit ◽

Postoperative Mortality ◽

Phase Iii ◽

R0 Resection ◽

Treatment Groups ◽

Significant Difference ◽

The Impact

e23516 Background: Retrospective and single-arm prospective studies have reported clinical benefit associated with receipt of neoadjuvant imatinib for GISTs. In the absence of randomized phase III data, the impact of neoadjuvant systemic therapy (NAT) on survival, in comparison to upfront resection, remains unknown. Methods: We identified N = 14,402 patients with complete clinical, demographic, treatment and pathologic data within the National Cancer Database (2004-2016) who underwent resection of localized GIST of the stomach, esophagus, small bowel, and colorectum, with or without ≥3 months of NAT. Inverse probability of treatment weighting (IPTW) was used to adjust for covariable imbalance among treatment groups, with the propensity score estimated by logistic regression. The effect of NAT on overall survival was estimated with a weighted time-dependent Cox proportional hazards model. A weighted logistic regression was used to estimate the effect of NAT on 90-day postoperative mortality and R0 resection. Results: 759 (5.3%) patients received NAT followed by resection, compared to 13,643 (94.7%) who underwent upfront resection. Median length of NAT was 6.3 months. 53% of NAT patients were male vs. 49% of UR patients, 68% vs. 66% had primary gastric GIST, and 73% vs 49% were high risk. Patients receiving NAT had larger tumors (p < 0.001) and higher mitotic index (p = 0.003). There was a significant survival benefit associated with receipt of NAT (table). 90-day postoperative mortality rate was 3/759 (0.4%) among NAT patients vs. 307/13,643 (2.3%) UR patients. Receipt of NAT was significantly associated with lower odds of 90-day postoperative mortality (table). Of the 13,562 patients with information on margin status, the R0 resection rate was 635/716 (88.7%) for the neoadjuvant group vs. 11,823/12,846 (92%), with no significant difference between treatment groups (table). Conclusions: After adjustment for imbalance in prognostic and demographic factors, this analysis demonstrates that receipt of NAT for localized GIST is associated with a modest overall survival benefit. Although NAT patients had higher risk features, NAT was associated with a lower risk of 90-day postoperative mortality, with no difference in likelihood of achieving an R0 resection. [Table: see text]

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Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review

Vascular ◽

10.2310/6670.2008.00053 ◽

2008 ◽

Vol 16 (6) ◽

pp. 340-345 ◽

Cited By ~ 17

Author(s):

Umar Sadat ◽

David G. Cooper ◽

Jonathan H. Gillard ◽

Stewart R. Walsh ◽

Paul D. Hayes

Keyword(s):

Hospital Stay ◽

General Anesthesia ◽

Endovascular Aneurysm Repair ◽

Postoperative Mortality ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Icu Stay ◽

Locoregional Anesthesia ◽

Aneurysm Repair ◽

The Impact

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.

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