A risk assessment score for postoperative VTE among patients undergoing minimally invasive surgery for gynecologic cancer

Major changes are taking place at a great pace in modern medicine, and surgical oncologists are at the forefront when new skills are to be tested and implemented. Perhaps the most significant change we are facing relates to the aging of our population, with most solid tumors presenting at age 70 years (± 5 years). The demographics and epidemiological details are covered in the appropriate sections of this special issue, but it is important to realize how such a shift influences our day-to-day practice. These principally are occurring in improved anesthetic care, minimally invasive surgery, nonoperative therapies, risk assessment, and quality-of-life estimates.

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Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2017.12.023 ◽

2018 ◽

Vol 25 (5) ◽

pp. 848-854 ◽

Cited By ~ 4

Author(s):

Floriana Mascilini ◽

Lorena Quagliozzi ◽

Francesca Moro ◽

Maria Cristina Moruzzi ◽

Valerio Gallotta ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Gynecologic Cancer ◽

Intraoperative Ultrasound ◽

Recurrent Gynecologic Cancer

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Robotic Surgery in Gynecologic Oncology

Obstetrics and Gynecology International ◽

10.1155/2011/139867 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Robert DeBernardo ◽

David Starks ◽

Nichole Barker ◽

Amy Armstrong ◽

Charles A. Kunos

Keyword(s):

Minimally Invasive Surgery ◽

Robotic Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Gynecologic Oncology ◽

Gynecologic Cancer ◽

Morbidly Obese ◽

Surgical Removal ◽

Surgical Morbidity ◽

Cancer Management

Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management.

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Surgical Site Infection in Women Undergoing Surgery for Gynecologic Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000126 ◽

2014 ◽

Vol 24 (4) ◽

pp. 779-786 ◽

Cited By ~ 32

Author(s):

Haider Mahdi ◽

Anar Gojayev ◽

Megan Buechel ◽

Jason Knight ◽

Janice SanMarco ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Transfusion ◽

Minimally Invasive ◽

Surgical Site Infection ◽

Hospital Stay ◽

Invasive Surgery ◽

Gynecologic Cancer ◽

Site Infection ◽

Increased Risk ◽

Perioperative Blood Transfusion

ObjectivesThe objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome.Materials and MethodsPatients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors.ResultsOf 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P < 0.001). Among laparotomy group, independent predictors of SSI included endometrial cancer diagnosis, obesity, ascites, preoperative anemia, American Society of Anesthesiologists class greater than or equal to 3, MSCS greater than or equal to 3, and perioperative blood transfusion. Among laparoscopic cases, independent predictors of SSI included only preoperative leukocytosis and overweight. For patients with deep or organ space SSI, significant predictors included hypoalbuminemia, preoperative weight loss, respiratory comorbidities, MSCS greater than 4, and perioperative blood transfusion for laparotomy and only preoperative leukocytosis for minimally invasive surgery. Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI.ConclusionsSeven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

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Risk factors of pulmonary complications after minimally invasive surgery for elderly patients with vertebral compression fractures

10.21203/rs.2.15338/v1 ◽

2019 ◽

Author(s):

Hua-Xing Zhang ◽

Yong Shen ◽

Jia Chen ◽

Long Zhang ◽

Wei Lin

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Minimally Invasive Surgery ◽

Cardiovascular Diseases ◽

Minimally Invasive ◽

Elderly Patients ◽

Invasive Surgery ◽

Pulmonary Complications ◽

Assessment Scale ◽

Vertebral Compression Fractures

Abstract Purpose: To determine the risk factors for pulmonary complications after minimally invasive surgery in elderly patients with vertebral compression fractures (VCFs). Methods: We retrospectively analyzed 233 elderly patients (age ≥ 65 years) with VCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) surgery at Hebei General Hospital from January 2011 to December 2016 . Risk factors and the effects of the model were determined by univariate logistic regression analyses and the receiver operating characteristic (ROC) curve, respectively. A risk assessment scale was established based on the risk factors and physiological and surgical scores for mortality and morbidity. The risk assessment scale prospectively evaluated risk factors of pulmonary complications after minimally invasive surgery for elderly patients with VCFs from January to June 2017. Results: A total of 27 patients diagnosed with pulmonary complications (11.59%) among 233 detected patients. There were statistically significant differences in age, body mass index (BMI), smoking, cardiovascular diseases and old fractures between patients with and without pulmonary complications (P<0.05). Logistic regression analysis showed that smoking, cardiovascular diseases and old fractures were risk factors of pulmonary complications after PVP or PKP for elderly patients with VCFs (P<0.05) and area under the curve was 0.738 (95% confidence intervals (CI): 0.648-0.828). We assessed 53 elderly patients with VCFs, 5 of whom occurred pulmonary complications after PVP or PKP. Areas under the curve of preoperative and total risk assessment values were all 0.925. Conclusions: Significant risk factors of pulmonary complications were BMI, cardiovascular diseases and old fractures for patients aged 65 years or elderly with VCFs after minimally invasive surgery. The risk assessment scale established by us gaining high accuracy.

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