Imaging in Adult Scoliosis: Preoperative Assessment and Postoperative Complications

Abstract Aim To investigate the impact of malnutrition on postoperative complications in esophageal cancer patients. Background and Methods Malnutrition is common in esophageal cancer patients due to the debilitating nature of their disease. Several methods of nutritional assessment have emerged as significant prognostic factors for short-and long-term outcomes in patients operated for esophageal cancer. The study sample consisted of 85 patients with esophageal (n=11) and gastroesophageal junction (n=74) cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and March 2019. Out of them, 65 patients underwent esophagectomy, while 20 patients underwent total gastrectomy. The assessment of nutritional status included the Geriatric Nutritional Risk Index (GNRI), the Patient Generated Subjective Global Assessment (PG-SGA) and sarcopenia. GNRI was based on preoperative values of patients’ serum albumin and body weight. The preoperative assessment of sarcopenia was based on Skeletal Muscle Index (SMI) derived from analysis of CT scans using SliceOmatic® Software version 4.3 (Tomovision, Montreal, Canada). Postoperative complications were graded according to Clavien-Dindo classification. Minor complications included categories I-II, whereas major complications included categories III-V. Results Thirty nine patients (47.6%) developed postoperative complications. More specifically, 21 patients (24.7%) developed minor complications and 18 patients (21.2%) developed major complications, while anastomotic leakage occurred in 10 patients (11.8%). Eighty patients (94.1%) had a high-risk GNRI (<92), while 5 patients (5.9%) had a low-risk GNRI (≥92). Forty four patients (51.8%) were diagnosed with sarcopenia. The mean PG-SGA score was 8.82 ± 5.57. Patients with a high-risk GNRI demonstrated significantly higher rate of overall complications compared to low-risk GNRI patients (100% vs 44.2%, p<0.05 respectively). Moreover, the rate of anastomotic leakage was significantly higher in the sarcopenia group than in the non-sarcopenia group (29% vs 3.4%, p<0.05). Nonetheless, PG-SGA was not significantly associated with postoperative outcomes. Conclusion Higher-risk scores on the GNRI are associated with an increased risk for developing postoperative complications, while sarcopenia is associated with higher risk for anastomotic leakage among esophageal cancer patients. Preoperative assessment of GNRI and sarcopenia should be performed in all patients in order to detect patients who are at greater risk of postoperative morbidity.

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Eyelid Malposition after Blepharoplasty: An Ounce of Prevention

Seminars in Plastic Surgery ◽

10.1055/s-0041-1727281 ◽

2021 ◽

Vol 35 (02) ◽

pp. 072-077

Author(s):

Katherine J. Williams ◽

Richard C. Allen

Keyword(s):

Postoperative Complications ◽

Preoperative Assessment ◽

Lower Eyelid ◽

Eyelid Malposition ◽

Video Library

AbstractUpper and lower eyelid blepharoplasty are common procedures performed to provide a more youthful and rejuvenated appearance. However, this seemingly straightforward procedure may result in lid malpositions, frustrating the patient and surgeon alike, which ultimately require further treatment. We review preoperative assessment pearls to avoid these lid malpositions, as well as options for treating any postoperative complications related to lid position. Many of the techniques discussed in this article, in addition to many other oculoplastic procedures, are available to view in Dr. Richard C. Allen's operative video library at: http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/.

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Postoperative complications after kidney and pancreas transplantation: can they be predicted by simple preoperative assessment?

Clinical Nutrition ◽

10.1016/0261-5614(90)90321-i ◽

1990 ◽

Vol 9 ◽

pp. 58

Author(s):

K. Filip ◽

M. Anděl ◽

V. Bartoš ◽

J. Malý ◽

P. Pavel ◽

...

Keyword(s):

Postoperative Complications ◽

Pancreas Transplantation ◽

Preoperative Assessment

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Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-020-71140-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yingke He ◽

Lydia Weiling Li ◽

Ying Hao ◽

Eileen Yilin Sim ◽

Kai Lee Ng ◽

...

Keyword(s):

Postoperative Complications ◽

Observational Study ◽

Abdominal Surgery ◽

Elderly Patients ◽

Prospective Observational Study ◽

Postoperative Morbidity ◽

Preoperative Assessment ◽

Major Abdominal Surgery ◽

Assessment Clinic ◽

Point Increase

Abstract Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

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Predicting Hospital Outcomes Using the Reported Edmonton Frail Scale-Thai Version

Innovation in Aging ◽

10.1093/geroni/igaa057.963 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 300-301

Author(s):

Inthira Roopsawang ◽

Hilaire Thompson ◽

Oleg Zaslavsky ◽

Basia Belza ◽

Suparb Aree-Ue

Keyword(s):

Older Adults ◽

Postoperative Complications ◽

Characteristic Curve ◽

Surgical Care ◽

Preoperative Assessment ◽

Care Quality ◽

Adverse Outcomes ◽

Hospital Outcomes ◽

Discharge Disposition ◽

Physical Status Classification

Abstract Backgrounds Frailty is a common geriatric condition leading to poor surgical outcomes. Having a valid frailty measure has the potential to improve surgical care quality. Objectives To test the ability of the Reported Edmonton Frailty Scale-Thai version (REFS-Thai) in predicting hospital outcomes compared with the American Society of Anesthesiologists physical status classification (ASA) and the Elixhauser Comorbidity Measure (EMC) in older Thai orthopedic patients. Methods A prospective study was conducted on hospitalized older adults scheduled for elective orthopedic surgery. Multiple Firth logistic regression modeled the effect of frailty on postoperative complications, postoperative delirium (POD), and discharge disposition, while the length of stay (LOS) was examined by Poisson regression. The area under the receiver operating characteristic curve (AUC) and mean squared errors (MSE) were used to compare the predictive ability of the instruments. Results Two hundred participants with mean age of 72 (range 60-94 years) were mostly female, 23% were frail. Adjusting for other variables, frailty was significantly associated with postoperative complications (OR = 2.38, p = 0.049), POD (OR = 3.52, p = 0.034), and prolonged LOS (relative risk [RR] = 1.42, p = 0.043). The REFS-Thai alone shows good performance in predicting postoperative complications (AUC = 0.81, 95% CI = 0.74-0.88) and POD (AUC = 0.81, 95% CI = 0.72-0.90). The combination of REFS-Thai with ASA and EMC demonstrates an improved predictability. Conclusion The REFS-Thai was useful in predicting adverse outcomes in surgical orthopaedic older adults. Integrating the REFS-Thai for preoperative assessment may be useful for enhancing care quality.

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Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

10.21203/rs.3.rs-32419/v1 ◽

2020 ◽

Author(s):

XIAOBO YANG ◽

Chenying Xu ◽

Jiumei Cao ◽

Li Xie ◽

Qingqing Qiu ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Postoperative Complications ◽

Geriatric Patients ◽

Clinical Decision Making ◽

Meta Analysis ◽

Postoperative Mortality ◽

Preoperative Assessment ◽

Postoperative Outcomes ◽

Increased Risk

Abstract Background Surgery remains the mainstay of colorectal cancer (CRC) and substantially reduces cancer-related morbidity and mortality. Preoperative assessment for frailty in geriatric patients is critically important in risk stratification and clinical decision-making. In this systematic review and meta-analysis, we aimed to quantitatively summarise the effect of frailty on postoperative outcomes in geriatric patients receiving surgery for CRC. Methods A systematic literature search was conducted in MEDLINE, Cochrane and EMBASE from inception to 30 April 2020. Fully published articles reporting risk estimate(s) of frailty on postoperative complication(s), readmission and/ or mortality in patients aged ≥65 years who received surgery for CRC were eligible for qualitative and quantitative analyses. Results Across 10 articles of 9 unique studies (n = 69332) that were eventually included in the systematic review and meta-analysis, overall prevalence of frailty was 23.0% (95% CI: 11–43%, I 2 = 100%). Odds ratios (ORs) on overall and severe postoperative complications were respectively increased by 2.36- (95% CI: 1.66–3.35, P <0.01; I 2 = 12%) and 2.35-fold (95% CI: 1.30–4.27, P <0.01; I 2 = 72%) in frail patients compared to non-frail counterparts. On pooled analysis, frailty was significantly associated with an increased risk of postoperative readmission (OR:1.91; 95% CI: 1.35–2.70, P <0.01; I 2 = 6%). Whilst a significantly higher risk of frailty on mortality during 12 months after CRC surgery was observed (OR: 5.52; 95% CI:4.40–6.92, P <0.01; I 2 = 89%), the summary OR on 30-day/ inpatient mortality crossed the null line (OR: 1.65; 95% CI: 0.56–4.93, P = 0.37; I 2 = 55%). Funnel plot and Duval-Tweedie’s trim and fill test did not reveal significant publication bias. Conclusions In the studies reviewed, frailty appeared to be associated with increased risks for postoperative complications, readmission and mortality during 12 months in patients aged ≥65 years who received surgery for CRC. Nevertheless, no significant association between frailty and 30-day/ inpatient postoperative mortality was observed.

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Surgical Management of Patients With 22q11.2 Deletion Syndrome

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0004 ◽

2019 ◽

Vol 4 (5) ◽

pp. 857-869

Author(s):

Oksana A. Jackson ◽

Alison E. Kaye

Keyword(s):

Surgical Management ◽

Preoperative Evaluation ◽

Preoperative Assessment ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

22Q11.2 Deletion ◽

Surgical Decision ◽

Obstructive Sleep ◽

Spine Abnormalities ◽

Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

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