Local Referral of High-Risk Pancreatectomy Patients to Improve Surgical Outcomes and Minimize Travel Burden

376 Background: Gasless single port retroperitoneal radical nephrectomy is minimally invasive, curative and cost effective operation which we have developed since 1998 (Eur Urol Suppl 2009; 8: 392), and covered by the Japanese universal insurance system from April, 2008. Patients necessitating dialysis are considered high risk operative candidates because of their multiple comorbidities. We compared surgical outcomes of dialysis patients with non-dialysis patients to evaluate this operation as treatment for high risk group. Methods: We reviewed 304 consecutive patients including 59 (19.4%) dialysis patients who underwent CO2 gasless single port retroperitoneal radical nephrectomy at our institute between 2000 and 2009. Complications within the first 30 days after the surgery were graded retrospectively according to the modified Clavien classification system. Patient demographics, operative outcomes, and complications were compared between dialysis and non-dialysis patients. Results: In all patients, the median patient age and body mass index were 60 years and 23.0 kg/m2. The median length of surgical incision, operative time (OT) and estimated blood loss (EBL) were 6.5 cm, 189 minutes and 214 mL, respectively. The transfusion rate was 3.3%. The intra and postoperative complication rate were 3.9% and 10.1%. Two grade 3a (ureteral obstruction, 1; diverticulitis, 1), three grade 3b (occlusion of peripheral hemodialysis shunt, 3) and two grade 4 (pulmonary embolism, 1; acute heart failure, 1) surgical complications occurred. In dialysis patients, the mean BMI was lower (20.4 vs. 23.3, p<0.0001), the mean OT was shorter (170 vs. 201 minutes, p<0.0001) and the mean EBL was lower (216 vs. 311mL, p<0.0001) than non-dialysis patients. There was no Clavien grade 3 or 4 surgical complications except dialysis access occlusion in dialysis patients. The average time to oral feeding and walking were equivalent, but possible discharge were longer in dialysis patients (4.3 vs. 3.4 days, p<0.0037). Conclusions: Our data supports the safety and feasibility of gasless single port retroperitoneal radical nephrectomy for dialysis patients. No significant financial relationships to disclose.

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R18 Surgical Outcomes of Minimally Invasive Mitral Valve Replacement in Low, Medium and High Risk Groups. A 10 Year Retrospective Cohort Study

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.03.176 ◽

2021 ◽

Vol 30 ◽

pp. S23

Author(s):

T. Surman ◽

J. Edwards ◽

M. Worthington

Keyword(s):

Cohort Study ◽

High Risk ◽

Mitral Valve ◽

Minimally Invasive ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Retrospective Cohort Study ◽

Surgical Outcomes ◽

Retrospective Cohort ◽

Risk Groups

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The African Surgical OutcomeS-2 (ASOS-2) Pilot Trial, a mixed-methods implementation study

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2019.25.1.2173 ◽

2019 ◽

pp. 14-23

Author(s):

L Du Toit ◽

H-L Kluyts ◽

V Gobin ◽

CM Sani ◽

E Zoumenou ◽

...

Keyword(s):

High Risk ◽

Data Collection ◽

Surgical Outcomes ◽

Pilot Trial ◽

Surgical Patients ◽

Implementation Study ◽

Postoperative Surveillance ◽

High Risk Patients ◽

Risk Patients ◽

Collection Strategies

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. The working hypothesis is that patients die as a result of failure to rescue following complications in the postoperative period. The African Surgical OutcomeS-2 (ASOS-2) Trial plans to test the efficacy of increased postoperative surveillance in high risk patients for decreasing perioperative morbidity and mortality. This pilot trial aimed i) to evaluate the adequacy of data produced by the data collection strategies of the ASOS-2 Trial, ii) to evaluate the fidelity of implementation of the increased postoperative surveillance intervention, and iii) to understand the acceptability, appropriateness and feasibility of the intervention and the trial processes. Methods: The ASOS-2 Pilot Trial was a mixed-methods (quantitative-qualitative) implementation study focusing on the intervention arm of the proposed ASOS-2 Trial. The intervention is increased postoperative surveillance for high-risk surgical patients. The intervention protocol was implemented at all sites for a seven-day period. A post pilot trial survey was used to collect data on the implementation outcomes. Results: 803 patients were recruited from 16 hospitals in eight African countries. The sampling and data collection strategies provided 98% complete data collection. Seventy-three percent of respondents believed that they truly provided increased postoperative surveillance to high risk patients. In reality 83/125 (66%) of high-risk patients received some form of increased postoperative surveillance. However, the individual components of the increased postoperative surveillance intervention were implemented in less than 50% of high-risk patients (excepting increasing nursing observations). The components most frequently unavailable were the ability to provide care in a higher care ward (32.1%) and assigning the patient to a bed in view of the nurses’ station (28.4%). Failure to comply with available components of the intervention ranged from 27.5% to 54.3%. The post pilot survey had a response rate of 30/40 (75%). In Likert scale questions about acceptability, appropriateness, and feasibility of the ASOS-2 intervention, 63% to 87% of respondents indicated agreement. Respondents reported barriers related to resources, trial processes, teamwork and communication as reasons for disagreement. Conclusions: The proposed ASOS-2 Trial appears to be appropriate, acceptable and feasible in Africa. This pilot trial provides support for the proposed ASOS-2 Trial. It emphasises the need for establishing trial site teams which address the needs of all stakeholders during the trial. A concerted effort must be made to help participating hospitals to increase compliance with all the components of the proposed intervention of ‘increased postoperative surveillance’ during the ASOS-2 Trial.

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Placenta Accreta Spectrum: Correlation of MRI Parameters With Pathologic and Surgical Outcomes of High-Risk Pregnancies

American Journal of Roentgenology ◽

10.2214/ajr.19.21705 ◽

2020 ◽

Vol 214 (6) ◽

pp. 1417-1423

Author(s):

Haley R. Clark ◽

Timothy W. Ng ◽

Ambereen Khan ◽

Sarah Happe ◽

Jodi Dashe ◽

...

Keyword(s):

High Risk ◽

Surgical Outcomes ◽

Placenta Accreta ◽

Placenta Accreta Spectrum ◽

Spectrum Correlation

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Perioperative Optimization Of Senior Health (POSH): A Multidisciplinary Approach To Improve Post-Surgical Outcomes In An Older, High-Risk Population

Journal of Surgical Research ◽

10.1016/j.jss.2013.11.586 ◽

2014 ◽

Vol 186 (2) ◽

pp. 609 ◽

Cited By ~ 6

Author(s):

M.E. Lidsky ◽

P.J. Speicher ◽

S. McDonald ◽

C.M. Poer ◽

M. Yanamadala ◽

...

Keyword(s):

High Risk ◽

Surgical Outcomes ◽

Multidisciplinary Approach ◽

High Risk Population ◽

Risk Population ◽

Senior Health

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The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

BMC Surgery ◽

10.1186/s12893-022-01466-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Woubet Tefera Kassahun ◽

Matthias Mehdorn ◽

Jonas Babel

Keyword(s):

High Risk ◽

Surgical Outcomes ◽

Unit Length ◽

Normal Weight ◽

Overweight And Obesity ◽

World Health ◽

Emergency Laparotomy ◽

Morbidly Obese ◽

Abdominal Emergencies ◽

The Impact

Abstract Background Obesity has been shown to increase the rates of morbidity and occasionally mortality in patients undergoing nonbariatric elective surgery. However, little is known about the impact of obesity on outcomes after surgery for high-risk abdominal emergencies. Methods A single-center retrospective evaluation of outcomes in high-risk abdominal emergency patients categorized by body mass index (BMI) was conducted. Patient demographics, comorbidities, and operative details were analyzed. Patients with normal weight (BMI 18.5–24.9) served as comparators. Multivariable linear and logistic regression analyses were performed to assess the impact of obesity on surgical outcomes. Results In total, 886 patients with BMI < 18.5 (underweight; n = 50), 18.5–24.9 (normal weight; n = 306), 25–29.9 (overweight; n = 336) and ≥ 30 (obese; n = 194) based on the World Health Organization (WHO) weight classification criteria met the inclusion criteria. Compared to normal-weight patients, patients with overweight and obesity were older and more likely to be male. The rates of comorbidity (100% vs 91.2%, p = < 0.0001), morbidity (77.8% vs 65.6%, p = 0.003), and in-hospital mortality (44.8% vs 30.4%, p = 0.001) were all higher in patients with obesity than in normal-weight patients. Patients with obesity had an increased intensive care unit length of stay (ICU LOS) (13 days vs 9 days, p = 0.019) and hospital LOS (21.4 days vs 18.1 days, p = 0.081) and prolonged ventilation (39.1% vs 19.6%, p = 0.003). As BMI deviated from the normal range, the morbidity and mortality rates increased incrementally, with the highest morbidity (87.9%) and mortality (54.5%) rates observed in morbidly obese patients (BMI ≥ 40). Conclusions Patients with obesity were the most likely to have coexisting conditions, experience postoperative complications, and die during the first admission following EL for high-risk abdominal emergencies.

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