Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Abstract Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32–12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74–7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53–5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33–10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48–12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2–24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27–25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17–14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03–3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.

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Risk factors for wound-related reoperations in patients with metastatic spine tumor

Journal of Neurosurgery Spine ◽

10.3171/2017.10.spine1765 ◽

2018 ◽

Vol 28 (6) ◽

pp. 663-668 ◽

Cited By ~ 8

Author(s):

Hannah M. Carl ◽

A. Karim Ahmed ◽

Nancy Abu-Bonsrah ◽

Rafael De la Garza Ramos ◽

Eric W. Sankey ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Tumor Resection ◽

Multivariate Model ◽

Wound Complications ◽

Karnofsky Performance Scale ◽

Thromboembolic Events ◽

Spine Tumor ◽

Wound Breakdown ◽

Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

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Which Factors Increase the Risk of Re-Operation after Meniscus Surgery in the Skeletally Immature?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00064 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0006

Author(s):

Neeraj M. Patel ◽

Surya Mundluru ◽

Nicholas Beck ◽

Theodore J. Ganley

Keyword(s):

Risk Factors ◽

Cruciate Ligament ◽

Statistical Significance ◽

Univariate Analysis ◽

Multivariate Model ◽

Skeletally Immature ◽

Initial Surgery ◽

Repeat Operation ◽

Operation Rate ◽

Meniscus Surgery

Objectives: The purpose of this study is to determine which factors heighten the risk for subsequent operations in skeletally immature patients undergoing meniscus surgery. Methods: A retrospective institutional database of 1,063 meniscus surgeries performed between 2000 and 2015 was reviewed. All procedures were performed in skeletally immature patients. Demographic and intra-operative information was recorded, as were concurrent injuries or operations and subsequent surgeries. Univariate analysis consisted of chi-square and independent-samples t-tests. Multivariate logistic regression was then performed to control for confounding factors. Results: The mean age at initial surgery was 13.4 years (standard deviation, SD, 2.2 years) and the average follow-up duration was 47 months (SD 54 months). Overall, 314 patients (29.5%) required repeat surgical intervention. 36% of all females required subsequent surgery compared to 26% of males (p<0.01). Discoid menisci underwent repeat operation more frequently than non-discoid menisci (35% vs. 27%, p=0.01). After accounting for confounders in a multivariate model, females had 2.2 times the odds of repeat surgery than males (95% CI 1.4-3.3, p<0.01) and each year of increasing age resulted in 1.3 times higher odds (95% CI 1.1 -1.4, p<0.01). The odds of subsequent surgeries were 4.2 times higher in those with flap tears (95% CI 1.8-9.7, p<0.01) and 2.9 times higher for discoid menisci (95% CI 1.4-6.0, p<0.01). Concomitant anterior cruciate ligament rupture or tibial spine fracture decreased the risk of needing additional surgeries in univariate analysis, but lost statistical significance in the multivariate model. Conclusion: Even when accounting for other factors in a multivariate model, female sex, increasing age, flap tears, and discoid meniscus were risk factors for subsequent procedures after meniscus surgery in skeletally immature patients. The re-operation rate in this population may be higher than previously reported. This study describes, for the first time, risk factors for repeat operations in skeletally immature patients undergoing meniscus surgery. These results can be used to counsel and monitor patients accordingly.

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Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-02031-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojia Chen ◽

Fan Wang ◽

Jing Liu ◽

Wenhui Tao ◽

Zhang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Bile Duct ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Univariate Analysis ◽

Balloon Dilation ◽

Endoscopic Papillary Balloon Dilation ◽

Endoscopic Retrograde ◽

Therapeutic Success ◽

Surgically Altered Anatomy

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

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Milyen hatása van a COVID–19-járványnak a gyermekkori akut appendicitisekre?

Orvosi Hetilap ◽

10.1556/650.2021.32189 ◽

2021 ◽

Vol 162 (16) ◽

pp. 608-610

Author(s):

Balázs Fadgyas ◽

Gábor István Garai ◽

Zoltán Ringwald

Keyword(s):

Statistical Analysis ◽

Acute Appendicitis ◽

Antibiotic Treatment ◽

Laparoscopic Appendectomy ◽

Perforated Appendicitis ◽

Complicated Appendicitis ◽

Histological Findings ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test

Összefoglaló. Bevezetés: A COVID–19-pandémia miatt a gyermekkori appendicitisek kezelésében számos változás történt (laparoszkópia helyett nyílt műtét, antibiotikumkezelés). Világszerte emelkedett a szövődményes appendicitisek aránya. Célkitűzés: Munkánk során a COVID–19-járványnak a gyermekkori akut appendicitisekre kifejtett hatását szerettük volna vizsgálni: lett-e több perforált eset? Módszerek: A 2012 és 2020 között akut vakbélgyulladás miatt operált gyermekeket vizsgáltuk, külön, havi bontásban a 2020-as eseteket. A szövettani diagnózis alapján perforált és nem perforált appendicitis csoportokat alkottunk. A 2020-ban operált betegek COVID–19-statusát is rögzítettük. Statisztikai analízisre a khi2-próbát (’chi2 test for trend’) és a Fisher-féle egzakt tesztet alkalmaztuk. Eredmények: A vizsgált időszakban 1343 appendectomia történt, többségében nem perforált akut appendicitis miatt (1166/1343). 2015-től kezdődően a perforált esetek aránya szignifikáns emelkedést mutat (p = 0,0002). Az igazoltan COVID–19-pozitív betegek között magasabb volt a perforáltak aránya (5/8), mint az igazoltan negatív betegek között (15/92) (p = 0,0075). Megbeszélés: A nemzetközi trendeknek megfelelően 2020-ban osztályunkon is magasabb volt a perforált appendicitisek aránya, mint a korábbi években. Ez az emelkedés 2015-től tart, a pandémiával nem mutat szoros összefüggést. A perforált appendicitisek COVID–19-pozitív betegek között észlelt magas arányának okát nem ismerjük. Következtetés: További vizsgálat indokolt annak feltárására, hogy mi okozza a perforált appendicitisek COVID–19-pozitív betegek között észlelt magas, illetve 2015 óta emelkedő rátáját. Orv Hetil. 2021; 162(16): 608–610. Summary. Introduction: As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. Objective: Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? Methods: Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher’s exact test were used for statistical analysis. Results: In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). Discussion: In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. Conclusion: The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608–610.

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Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Annals of Coloproctology ◽

10.3393/ac.2019.06.25 ◽

2020 ◽

Vol 36 (1) ◽

pp. 30-34

Author(s):

Tae Gyeong Lee ◽

Soomin Nam ◽

Hyung Soon Lee ◽

Jin Ho Lee ◽

Young Ki Hong ◽

...

Keyword(s):

Risk Factors ◽

Acute Appendicitis ◽

Surgical Site Infection ◽

Postoperative Complication ◽

Laparoscopic Appendectomy ◽

Operative Time ◽

Multiple Logistic Regression Analysis ◽

Operation Time ◽

Site Infection ◽

Uncomplicated Acute Appendicitis

Purpose: To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis.Methods: Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic.Results: A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis.Conclusion: There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

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Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

World Journal of Pediatric Surgery ◽

10.1136/wjps-2019-000084 ◽

2020 ◽

Vol 3 (1) ◽

pp. e000084

Author(s):

Elbert Johann Mets ◽

Ryan Patrick McLynn ◽

Jonathan Newman Grauer

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Adverse Events ◽

General Surgery ◽

Elective Surgery ◽

Cohort Analysis ◽

Adverse Outcomes ◽

Trauma Patients ◽

Improvement Project ◽

Increased Risk

BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

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Risk factors for adverse outcomes in solid tumor interhospital transfer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.191 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 191-191

Author(s):

Christopher Wee ◽

Leticia Varella ◽

Lisa A. Rybicki ◽

James Stevenson

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Solid Tumor ◽

Adverse Outcomes ◽

House Staff ◽

Risk Scores ◽

Admission Time ◽

Interhospital Transfer ◽

Oncology Service ◽

Hospital Transfer

191 Background: We previously reported that inter-hospital transfer patients to our institution’s oncology service experienced higher mortality and increased length of stay (LOS) compared to other origins of admission. We sought to identify risk factors for adverse outcomes in this hospital transfer population. Methods: We reviewed all inter-hospital transfers from Jan-June 2016 to the Cleveland Clinic’s solid tumor oncology service. Patient characteristics, including age, albumin, and case severity indices (mortality and severity risk scores and AP-DRG), as well as encounter characteristics, including admitting provider (house staff or hospitalist), admission time (8AM-5PM or evening), admission day (weekday or weekend), and time between transfer acceptance and admission were recorded. Adverse events examined included activation of adult medical emergency team (AMET), ICU transfer, LOS, in-hospital mortality, and 30-day readmission. Associations of patient and encounter characteristics with adverse events were assessed using Wilcoxon and Fisher’s exact tests. Results: Fifty-three transfer admissions were identified. Patients had a median age of 67 years and 58.5% were male. House staff admitted the majority of patients (81.1%) and most occurred after hours (62.3%). Age, admission time and day, and type of admitting physician were not associated with adverse events. There was a significant association between higher AP-DRG and mortality/severity risk scores with ICU transfers, AMET activations, and mortality. Patients who experienced any adverse events on average had a lower mean albumin than those who did not (2.3 vs 3.0 g/dL p=0.006). LOS and readmission were not significantly associated with any patient or encounter characteristics. Conclusions: Burden of disease as measured by mortality/severity risk and AP-DRG as well as lower albumin levels are associated with adverse events in solid tumor inter-hospital transfer patients, while encounter characteristics do not predict for poorer outcomes. This population should be targeted for improvements in communication and handoffs at the time of transfer, as well as early involvement of palliative care providers.

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P0150APREECLAMPSIA ABOUT 252 PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0150a ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Boubchir Akli ◽

Brahim Kichou ◽

MADIOU ALI

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Pregnant Women ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Death ◽

Gestational Hypertension ◽

Adverse Outcomes ◽

Previous Pregnancy ◽

Fetal Complications

Abstract Background and Aims The main objective was to estimate the prevalence of pre-eclampsia (PE) in pregnant women in Tizi-ouzou (Algeria). Secondary objectives were to estimate the frequency of PE risk factors, and the incidence of maternal and fetal complications. Methods Our study was observational, prospective and descriptive, including all pregnant women at the prenatal appointment in the 2 maternity units of Tizi-ouzou, between January 2012 and June 2013. PE was diagnosed if gestational hypertension was associated with proteinuria > 300mg/24h, after 20 weeks of gestation. Results We had 252 cases of PE on 3225 pregnant women. The prevalence of PE was 7.8% (CI 95%: 6.9%–8.7%). The most frequent PE risk factors were nulliparity (56%), age >40 years (27%), obesity (26%) and PE in any previous pregnancy (21%). The incidence of maternal adverse events was 28.7% (CI 95%: 23.1%–34.3%), including 5 deaths. The rates of prematurity, small for gestational age infant and fetal death were 58.2%, 49.7% and 6.7%, respectively. Conclusion The prevalence of PE in pregnant women in Tizi-ouzou is around 8%. The incidence of maternal and fetal adverse outcomes remains high. Only earlier diagnosis and closer monitoring could improve the prognosis of our patients, since the treatment of PE remains currently childbirth.

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Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?

10.20944/preprints201809.0590.v1 ◽

2018 ◽

Author(s):

Atsushi Kohga ◽

Kiyoshige Yajima ◽

Takuya Okumura ◽

Kimihiro Yamashita ◽

Jun Isogaki ◽

...

Keyword(s):

Acute Appendicitis ◽

Independent Predictor ◽

Univariate Analysis ◽

Operation Time ◽

Complicated Appendicitis ◽

Intraabdominal Abscess ◽

Ct Findings ◽

Free Air ◽

Preoperative Ct ◽

Ct Finding

Background: To investigate the preoperative clinical and radiological factors that predict the development of a postoperative intraabdominal abscess (IAA) in patients with acute appendicitis who were treated by laparoscopic appendectomy (LA). Methods: Two hundred sixteen patients with pathologically proven acute appendicitis underwent LA between January 2013 and March 2018 in our department. Of these, 147 patients were diagnosed with complicated appendicitis (CA) (CA group), while the other 69 patients were diagnosed with simple appendicitis (SA) (SA group). We compared the perioperative clinical and radiographic factors between the two groups and investigated the predictive factors of postoperative IAA. Results: Sixteen patients developed postoperative IAA in the CA group, while no patients did in the SA group. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p <0.001), operation time more than 120 minutes (p = 0.023) and placement of a drainage tube (p <0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427). Conclusions: IAA was developed predominantly in the patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.

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Retrospective cohort study on the risk factors of admission due to serious adverse events during S-1 (tegaful, gimeracil, oteracil potassium) containing chemotherapy for gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.141 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 141-141

Author(s):

Yasuyuki Kawamoto ◽

Satoshi Yuki ◽

Yoshimitsu Kobayashi ◽

Koji Oba ◽

Hideyuki Hayashi ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Adverse Events ◽

Odds Ratio ◽

Univariate Analysis ◽

Multivariate Logistic Regression Model ◽

First Line ◽

Serious Adverse Events ◽

Exact Test ◽

Line Chemotherapy

141 Background: S-1 (tegaful, gimeracil, oteracil potassium) containing regimens are widely used as first line chemotherapy for metastatic or unresectable gastric cancer in Japan. Because patients often need admission due to serious adverse events (SAE) during chemotherapy, it is important to predict admission. We retrospectively investigated the risk factors of admission due to SAE during first line chemotherapy which contained S-1. Methods: We retrospectively analyzed the patients who began to receive S-1 containing chemotherapy for the first line chemotherapy at our institution from January 2005 to December 2010 by medical records. Association between baseline characteristics and admission due to SAE were evaluated by Fisher’s exact test, t-test or Mann-Whitney test. Age, sex, S-1 dose (mg/m2) and other factors which significantly associated in the univariate analysis were evaluated in the multivariate logistic regression model. Results: One hundred nine patients were assessed. Admission due to SAE were observed in 24 patients (34 times), and tended to occur before 2nd cycle had ended. Multivariate analysis suggested that hypoalbuminemia was a risk factor of admission due to all SAE (Odds ratio 0.15, 95% C.I. 0.05 - 0.44, P = 0.0005). It is suggested that S-1 dose was a risk for admission due to FU-induced colitis (Odds ratio 1.30, 95% C.I. 1.12 - 1.50, P=0.0004). Conclusions: Hypoalbuminemia might constitute a marker of admission due to SAE. FU-induced colitis occurred in S-1 dose-related fashion, and the patients had lost their weight before appropriate course. It is suggested that clinicians should pay attention to patients’ weight loss during chemotherapy, notably time of initiation of chemotherapy.

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