Risk factors associated with 30-day postoperative complications following contemporary vulvectomies with inguinofemoral lymphadenectomies for gynecologic cancers

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

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Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters

Hand ◽

10.1177/15589447211006836 ◽

2021 ◽

pp. 155894472110068

Author(s):

Joanne Y. Zhang ◽

Aneesh V. Samineni ◽

David C. Sing ◽

Alyssa Rothman ◽

Andrew B. Stein

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Patient Characteristics ◽

Distal Radioulnar Joint ◽

Older Age ◽

Radioulnar Joint ◽

Factors Associated ◽

Shaft Fractures ◽

Male Sex ◽

Preoperative Patient

Background: The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). Methods: Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. Results: We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures ( P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). Conclusions: The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.

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Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000339 ◽

2015 ◽

Vol 25 (2) ◽

pp. 193-202 ◽

Cited By ~ 10

Author(s):

Mariam AlHilli ◽

Carrie Langstraat ◽

Christine Tran ◽

Janice Martin ◽

Amy Weaver ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Postoperative Complications ◽

Epithelial Ovarian Cancer ◽

Odds Ratio ◽

Residual Disease ◽

Factors Associated ◽

Primary Surgery ◽

American Society ◽

American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

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Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

10.21203/rs.3.rs-1008430/v1 ◽

2021 ◽

Author(s):

Xining Zhao ◽

Jie Liu ◽

Ying Wang ◽

Yuying Yang ◽

Yan Pan ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Postoperative Complications ◽

Geriatric Patients ◽

Cox Regression ◽

Significant Risk ◽

Related Factors ◽

Factors Associated ◽

Delayed Discharge ◽

Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

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A comparison of robotic mesh repair techniques for primary uncomplicated midline ventral hernias and analysis of risk factors associated with postoperative complications

Hernia ◽

10.1007/s10029-020-02199-2 ◽

2020 ◽

Author(s):

O. Y. Kudsi ◽

K. Chang ◽

N. Bou-Ayash ◽

F. Gokcal

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Mesh Repair ◽

Factors Associated ◽

Ventral Hernias ◽

Repair Techniques

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Risk factors associated with early postoperative complications following laparoscopic total gastrectomy: Experience from the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) group.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15544 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15544-e15544

Author(s):

Jingdong Liu ◽

Haojie Li ◽

Gang Zhao ◽

Zekuan Xu ◽

Guoxin Li ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Postoperative Complications ◽

Total Gastrectomy ◽

Multivariable Analysis ◽

Laparoscopic Total Gastrectomy ◽

Morbidity And Mortality ◽

Reconstruction Method ◽

Factors Associated ◽

Early Postoperative Complications

e15544 Background: The incidence rate of proximal gastric cancer has been rising steadily, and laparoscopic total gastrectomy (LTG) has been widely adopted. However, the safety of LTG still lacks solid evidence to prove. The aim of this study was to evaluate morbidity and mortality of LTG, and determine the risk factors associated with early postoperative complications. Methods: A retrospective multicenter study was carried out in China, and medical records of 109 gastric cancer patients receiving LTG during September 2014 and June 2016 were retrieved from the database. Patient characteristics, surgical outcomes, and postoperative morbidities and mortalities were analyzed. Results: Morbidity and mortality rates were 22.0% and 0% respectively. Pulmonary infection (13.8%, n = 15) was the most common complication. Most complications were grade II (15.5%, n = 17) according to the Clavien-Dindo classification. Multivariable analysis identified comorbidity, type of reconstruction method (TLTG) were independent risk factors of early postoperative complications. Comorbidity was the only independent risk factor of complications graded more than II. Diabetes mellitus was found correlated with surgical complication in subgroup analysis. Conclusions: LTG is safe and technically feasible in treating gastric cancer. Careful selection of patients without comorbidity and applying laparoscopy-assisted total gastrectomy instead of totally laparoscopic total gastrectomy may decrease postoperative complications.

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