Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

Abstract Objective Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections. Methods Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OTs. A multivariate analysis was carried out to identify predictors of longer OTs and post-operative complications. Results A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p < 0.00001) and the length of hospital stay (6 vs. 7 days; p < 0.00001) were significantly reduced in the short OT group. Two predictors of long OT were identified on multivariate analysis: male sex (OR 1.41, p = 0.04) and neoadjuvant chemotherapy (OR 3.46, p = 0.003). A long OT was identified as an individual predictor of postoperative complications (OR 1.84, p < 0.0001). Conclusion A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.

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Evaluation of post-operative complications associated with tobacco use in thoracic surgery patients

International Surgery Journal ◽

10.18203/2349-2902.isj20213119 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2272

Author(s):

Mehmet Degirmenci ◽

Celal Kus

Keyword(s):

Postoperative Complications ◽

Thoracic Surgery ◽

Tobacco Use ◽

Intensive Therapy ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Thoracic Diseases ◽

Operative Complications ◽

Poor Outcomes ◽

Post Operative Complications

Background: Tobacco can make thoracic diseases more complicated by affecting their respiratory functions. Smoking causes many diseases that require surgical treatment and affects surgical results. The aim of the study was to determine the relationship between tobacco use and post-operative complications in thoracic surgery patients and contribute to public health.Methods: In this study, 754 patients were evaluated retrospectively. Patient characteristics and tobacco use habits of the patients were determined. Postoperative complications, admission to the intensive therapy unit, intubation, death, and length of stay in hospital were defined as surgical outcomes. These results were compared and analyzed with tobacco use.Results: The patients consisted of 536 (71.1%) men and 218 (28.9%) women. Tobacco use was more common in men (X2=223.216, p<0.001) and younger ages (X2=45.342, p<0.001). Complications occurred in 96 patients, 76 (79.2%) of whom used tobacco. Tobacco use (p<0.001, OR=3.547), ASA score (p=0.029, OR=2.004), major surgeries (p<0.001, OR=4.458), and minimally invasive surgeries (p=0.027, OR=2.323) are associated with complications. Length of hospital stay is related to the amount of tobacco (p<0.001, OR=3.706), size of surgery (p<0.001, OR=14.797), over 65 years (p<0.001, OR=2.635), and infectious diseases (p=0.039, OR=1.939).Conclusions: Tobacco use is related to poor outcomes in thoracic surgery patients, and it is a severe health problem, especially at young ages. Tobacco control programs should be supported to prevent the effects of tobacco use on thoracic diseases and postoperative complications.

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Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13165261994076 ◽

2011 ◽

Vol 93 (8) ◽

pp. 620-623 ◽

Cited By ~ 11

Author(s):

SR Markar ◽

A Karthikesalingam ◽

J Cunningham ◽

C Burd ◽

G Bond-Smith ◽

...

Keyword(s):

Multivariate Analysis ◽

Acute Appendicitis ◽

Medical Records ◽

Operative Time ◽

University Teaching ◽

Complication Rates ◽

Operative Complications ◽

Negative Appendicectomy ◽

Appendiceal Perforation ◽

Post Operative Complications

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

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An investigation of the role of irinotecan and oxaliplatin in liver toxicity during first-line neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.689 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 689-689

Author(s):

Marie Desjardin ◽

Benjamin Bonhomme ◽

Isabelle Soubeyran ◽

Jeremy Vara ◽

Marianne Fonck ◽

...

Keyword(s):

Postoperative Complications ◽

Neoadjuvant Chemotherapy ◽

Liver Toxicity ◽

Operative Outcomes ◽

Increased Risk ◽

Operative Complications ◽

Preoperative Ct ◽

Grade 3 ◽

The Impact ◽

Post Operative Complications

689 Background: Neoadjuvant chemotherapy (CT) have been associated with an increased risk of surgery for colorectal liver metastases (CRLM). Irinotecan (IRI) is claimed to induce CT-associated steatohepatitis (CASH) and oxaliplatin (OX) to induce sinusoidal obstruction (SOS). Imputability is sometimes difficult to establish and the impact on postoperative complications is unclear. The objective of this study is to investigate the impact of IRI and OX on induced liver toxicity, and to study the effects of toxicity on surgical outcomes. Methods: Patients (Pts) who received only one line of CT before resection of CRLM were retrospectively included. CASH and SOS were described according to Kleiner and Rubbia-Brandt classifications respectively. Associations were sought between CASH or SOS and various patient and treatment factors, and between patient and treatment factors and the occurrence of post-operative complications grade 3 or over. Results: Among 379 pts operated on for CRLM from 2003 to 2013, 223 were eligible for inclusion; 57 were excluded as there was no healthy hepatic parenchyma to be analyzed. Median age was 64 y [34-88], BMI ≥25 kg/m² for 52%, 8% had diabetes, and 28% had a dyslipidemia. CRLM were synchronous in 76.5%. 65 (39.2%) received Folfox, 95 (57.2%) Folfiri and 6 (3.6%) Folfirinox. Bevacizumab, cetuximab and panitumumab were given in 71 (42.8%), 30 (17.5%), 4 (2.4%) respectively. Extra-hepatic resections were performed in 78 pts (47%). 90-day mortality was 1.8% and 31 pts encountered complications more severe than 3A. Histological hepatoxicity was established for 82 pts (49%) including 33 (19.9%) with grade 2 or 3 SOS and 22 (13%) with CASH. No significant associations were identified between SOS and OX, nor CASH and IRI. BMI ≥ 25 kg/m² was correlated with an increased risk of CASH. Only septic extra-hepatic surgeries were correlated with the prediction of postoperative complications. Conclusions: In this selected series, preoperative CT was not associated to liver toxicity. The presence of histological lesions did not worsen post-operative outcomes. BMI and extra-hepatic surgery were the only co-factors correlated with CASH and post-operative complications respectively.

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Impact of Radiation Dose on Postoperative Complications in Esophageal and Gastroesophageal Junction Cancers

Frontiers in Oncology ◽

10.3389/fonc.2021.614640 ◽

2021 ◽

Vol 11 ◽

Author(s):

Noah Kastelowitz ◽

Megan D. Marsh ◽

Martin McCarter ◽

Robert A. Meguid ◽

Narine Wandrey Bhardwaj ◽

...

Keyword(s):

Postoperative Complications ◽

Gastroesophageal Junction ◽

Neoadjuvant Chemoradiation ◽

Complication Rates ◽

Trimodality Therapy ◽

Significant Difference ◽

Operative Complications ◽

The Cross ◽

The Impact ◽

Post Operative Complications

Introduction: The impact of radiation prescription dose on postoperative complications during standard of care trimodality therapy for operable stage II-III esophageal and gastroesophageal junction cancers has not been established.Methods: We retrospectively reviewed 82 patients with esophageal or gastroesophageal junction cancers treated between 2004 and 2016 with neoadjuvant chemoradiation followed by resection at a single institution. Post-operative complications within 30 days were reviewed and scored using the Comprehensive Complication Index (CCI). Results were compared between patients treated with <50 Gy and ≥ 50 Gy, as well as to published CROSS study neoadjuvant chemoradiation group data (41.4 Gy).Results: Twenty-nine patients were treated with <50 Gy (range 39.6–46.8 Gy) and 53 patients were treated with ≥ 50 Gy (range 50.0–52.5 Gy) delivered using IMRT/VMAT (41%), 3D-CRT (46%), or tomotherapy IMRT (12%). Complication rates and CCI scores between our <50 Gy and ≥ 50 Gy groups were not significantly different. Assuming a normal distribution of the CROSS data, there was no significant difference in CCI scores between the CROSS study neoadjuvant chemoradiation, <50 Gy, or ≥ 50 Gy groups. Rates of pulmonary complications were greater in the CROSS group (50%) than our <50 Gy (38%) or ≥ 50 Gy (30%) groups.Conclusions: In selected esophageal and gastroesophageal junction cancer patients, radiation doses ≥ 50 Gy do not appear to increase 30 day post-operative complication rates. These findings suggest that the use of definitive doses of radiotherapy (50–50.4 Gy) in the neoadjuvant setting may not increase post-operative complications.

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P-OGC74 Effect of pre-operative anaemia on short-term outcomes following oesophagectomy: a 10-year retrospective cohort study

British Journal of Surgery ◽

10.1093/bjs/znab430.202 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Siobhan Chien ◽

Khurram Khan ◽

Lewis Gall ◽

Liam Deboys ◽

Carol Craig ◽

...

Keyword(s):

Cohort Study ◽

Blood Transfusion ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

Short Term ◽

Operative Complications ◽

The Impact ◽

Post Operative Complications

Abstract Background Pre-operative anaemia is associated with increased length of hospital stay, requirement for allogenic blood transfusion, post-operative complications and mortality. Oesophagectomy is a complex procedure associated with significant physiological insult, thus pre-operative patient optimisation is imperative to improve clinical outcomes. This study aimed to determine the impact of pre-operative anaemia on short-term outcomes following oesophagectomy for benign and malignant disease. Methods A retrospective cohort study of all oesophagectomies performed in a single tertiary referral centre between 1 January 2010 and 31 December 2019 was performed. Patients were identified from a prospectively collected database and individual patient electronic records were interrogated. Patients were dichotomised into two groups, based on the most recent pre-operative haemoglobin. Patients with pre-operative anaemia (haemoglobin <130mg/L in males and <120mg/L in females) were compared to those without pre-operative anaemia. Patients with missing data were excluded from the study. Patients were followed up for a median of 32 months (IQR 18-66). Results Of 352 patients eligible for inclusion, 173 (49.1%) patients were anaemic immediately pre-operatively. Patients with pre-operative anaemia were older (66 vs. 64 years, p = 0.031), with a lower anaerobic threshold (11.7 vs. 12.3ml/min/kg, p = 0.011), and were significantly more likely to have undergone neoadjuvant chemotherapy (91.3% vs. 78.8%, p < 0.001). Patient comorbidities and disease-related characteristics were similar between the two groups. Patients with pre-operative anaemia were significantly more likely to require post-operative blood transfusion (34.7% vs. 16.8%; p < 0.001). However, pre-operative anaemia was not associated with increased post-operative complications, intensive care admission, length of hospital stay, or 30- and 90-day mortality rates following oesophagectomy. Conclusions Patients with anaemia immediately prior to undergoing an oesophagectomy were significantly more likely to require post-operative blood transfusion. However, pre-operative anaemia was not associated with an increased rate of post-operative morbidity or mortality. In addition, pre-operative iron transfusion is becoming increasingly utilised to minimise the incidence of pre-operative anaemia: this was not analysed in this study.

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Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633130 ◽

1994 ◽

Vol 07 (03) ◽

pp. 110-113 ◽

Cited By ~ 6

Author(s):

D. L. Holmberg ◽

M. B. Hurtig ◽

H. R. Sukhiani

Keyword(s):

Postoperative Complications ◽

Pelvic Osteotomy ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Canal Width ◽

Operative Complications ◽

Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

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The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

World Journal of Surgery ◽

10.1007/s00268-021-06073-9 ◽

2021 ◽

Author(s):

M. Runkel ◽

T. D. Diallo ◽

S. A. Lang ◽

F. Bamberg ◽

M. Benndorf ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Visceral Obesity ◽

The Body ◽

Postoperative Outcomes ◽

Sarcopenic Obesity ◽

Colorectal Metastases ◽

Complication Rates ◽

The Impact ◽

Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

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Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4562 ◽

2021 ◽

Vol 28 (05) ◽

pp. 652-655

Author(s):

Robina Ali ◽

Riffat Ehsan ◽

Ghazala Niaz ◽

Fatima Abid

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Uterovaginal Prolapse ◽

Prolapse Recurrence ◽

Gynecology And Obstetrics ◽

Duration Of Surgery ◽

Operative Complications ◽

Operative Recovery ◽

Post Operative Complications

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material & Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were <30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was <150ml while in 4(12.5%) it was estimated to be >150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

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Postoperative Complications after Phacoemulsification and Implantation of Foldable Acrylic Intraocular Lenses in Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4206 ◽

2021 ◽

Author(s):

Babita Das ◽

Apra Shahi ◽

Vishnu Pratap Chandrapuria ◽

Shobha Jawre ◽

Madhu Swamy ◽

...

Keyword(s):

Postoperative Complications ◽

Cataract Surgery ◽

Postoperative Complication ◽

Corneal Opacity ◽

Intraocular Lenses ◽

Major Postoperative Complication ◽

Ophthalmic Pathology ◽

Cataractous Lens ◽

Operative Complications ◽

Post Operative Complications

Background: Despite significant advances in canine cataract surgery over the years, many post-operative complications persist and reduces the success rate of phacoemulsification procedure. The aim of current study was to evaluate post-operative complications encountered till 90 days after bimanual phacoemulsification with implantation of different acrylic Intraocular Lenses.Methods: The study was conducted on 24 canine eyes. All the clinical cases were subjected to detailed ocular, ultrasonography and neuro-ophthalmic tests for ascertaining cataract and associated neuro-ophthalmic pathology. Dogs were divided in four groups with 6 eyes in each group and subjected to phacoemulsification procedure for removal of cataractous lens and implanted with square edge or round edge hydrophilic or hydrophobicintra ocular lenses.Result: Statistically non-significant (p£0.05) variations were found for all the post- operative complications among the groups. Within the groups initially higher values were recorded and on subsequent days a declining trend of varying degrees were observed. The corneal opacity was a major postoperative complication leading to failure to achieve vision with other coinciding neuro-ophthalmic conditions.

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Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

Surgical Innovation ◽

10.1177/1553350618812322 ◽

2018 ◽

Vol 26 (2) ◽

pp. 201-208

Author(s):

Mohamed El Shobary ◽

Ayman El Nakeeb ◽

Ahmad Sultan ◽

Mahmoud Abd El Wahab Ali ◽

Mohamed El Dosoky ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Surgical Outcomes ◽

Operative Time ◽

Postoperative Pancreatic Fistula ◽

Tube Removal ◽

Matched Study ◽

The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

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