High-risk patients and postoperative complications following video-assisted thoracic surgery lobectomy: a case-matched comparison with lower-risk counterparts

Abstract Background Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. Methods We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. Results Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient’s propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61–1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. Conclusions The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.

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High risk patients in major thoracic surgery

Critical Care ◽

10.1186/cc617 ◽

1999 ◽

Vol 3 (Suppl 1) ◽

pp. P244

Author(s):

G Della Rocca ◽

F Ruberto ◽

F Pugliese ◽

L Pompei ◽

C Coccia ◽

...

Keyword(s):

High Risk ◽

Thoracic Surgery ◽

High Risk Patients ◽

Risk Patients

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Beating Heart Video-Assisted Mitral Valve Surgery: A Useful Technique for High-Risk Patients

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2009.00816.x ◽

2009 ◽

Vol 24 (3) ◽

pp. 312-314 ◽

Cited By ~ 5

Author(s):

Saqib Masroor ◽

Garland Dance ◽

Stephen J. Angeli

Keyword(s):

High Risk ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Beating Heart ◽

Valve Surgery ◽

High Risk Patients ◽

Video Assisted ◽

Risk Patients

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Bilateral Pulmonary Artery Banding before Norwood Procedure: Survival of High-Risk Patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1676617 ◽

2019 ◽

Vol 68 (01) ◽

pp. 030-037 ◽

Cited By ~ 2

Author(s):

Antonia Schulz ◽

Nicodème Sinzobahamvya ◽

Mi-Young Cho ◽

Wolfgang Böttcher ◽

Oliver Miera ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Pulmonary Artery ◽

Lower Risk ◽

Pulmonary Artery Banding ◽

Norwood Procedure ◽

High Risk Patients ◽

Significant Difference ◽

Bilateral Pulmonary Artery Banding ◽

Risk Patients

Background This study reports midterm results of high-risk patients with hypoplastic left ventricle treated with initial bilateral pulmonary artery banding (PAB) before secondary Norwood procedure (NP). Methods Retrospective study of 17 patients admitted between July 2012 and February 2017 who underwent this treatment strategy because diagnosis or clinical status was associated with high risk for NP. Survival was compared with that of patients who underwent primary NP. Results Mean Aristotle comprehensive complexity score for NP would have been 19.7 ± 2.6. Risk factors included obstructed pulmonary venous return (n = 9), body weight < 2.5 kg (n = 7), total anomalous pulmonary venous connection (n = 3), and necrotizing enterocolitis (n = 1). Ten patients had a score ≥ 19.5. Early survival after PAB was 82.4% (14/17). NP was performed in 14 patients after improvement of clinical condition at a median age of 56 days and a weight ≥2,500 g. There was no 30-day mortality, but one interstage death. One patient died later after Glenn operation. One-year survival after primary PAB followed by NP was 70.6 ± 11.1%. During the same period, 35 patients with overall lower risk factors underwent primary NP; early postoperative survival and 1-year survival were 88.6 ± 5.4% and 68.6 ± 7.8%, respectively. There was no significant difference in survival between the two groups (p = 0.83) despite higher risk in the secondary Norwood group (p <0.0001). Conclusions PAB before NP in high-risk patients constituted salvage management. Primary PAB provided enough time for stabilization and control of most risk factors. It allowed midterm survival equivalent to the survival after primary NP in lower risk neonates.

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DOES PREOPERATIVE INTERVENTION PROGRAM IMPROVE POSTOPERATIVE OUTCOME IN HIGH-RISK PATIENTS UNDERGOING THORACIC SURGERY?

CHEST Journal ◽

10.1378/chest.128.4_meetingabstracts.337s-b ◽

2005 ◽

Vol 128 (4) ◽

pp. 337S

Author(s):

Wai Ming M. Yung ◽

Y.W. T. Mok ◽

S.O. Ling ◽

Y.N. Poon ◽

K.C. Wong ◽

...

Keyword(s):

High Risk ◽

Thoracic Surgery ◽

Intervention Program ◽

Postoperative Outcome ◽

High Risk Patients ◽

Risk Patients

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Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery

JAMA ◽

10.1001/jama.2019.20833 ◽

2020 ◽

Vol 323 (3) ◽

pp. 225 ◽

Cited By ~ 25

Author(s):

Emmanuel Futier ◽

Matthias Garot ◽

Thomas Godet ◽

Matthieu Biais ◽

Daniel Verzilli ◽

...

Keyword(s):

High Risk ◽

Postoperative Complications ◽

Abdominal Surgery ◽

Replacement Therapy ◽

Hydroxyethyl Starch ◽

Major Abdominal Surgery ◽

Volume Replacement ◽

High Risk Patients ◽

Volume Replacement Therapy ◽

Risk Patients

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Prophylaxis for patients at Risk to Eliminate Post-operative Atrial Fibrillation (PREP-AF trial): a protocol for a feasibility randomized controlled study

Trials ◽

10.1186/s13063-021-05318-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Heather A. Smith ◽

Salmaan Kanji ◽

Diem T. T. Tran ◽

Calum Redpath ◽

Dean Ferguson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adverse Event ◽

High Risk ◽

Thoracic Surgery ◽

Prediction Model ◽

Feasibility Trial ◽

Controlled Study ◽

High Risk Patients ◽

Randomized Controlled ◽

Risk Patients

Abstract Background Postoperative atrial fibrillation (POAF) is a frequent adverse event after thoracic surgery with associated morbidity, mortality, and healthcare costs. It has been shown to be preventable with prophylactic amiodarone, which is only recommended in high-risk individuals due to the potential associated side effects. Risk factors for POAF have been identified and incorporated into a prediction model to identify high-risk patients. Further evaluation in the form of a multicenter clinical trial is required to assess the effectiveness of prophylaxis specifically in this high-risk population. The feasibility of such a trial first needs to be assessed. Methods The PREP-AF trial is a double-blind randomized controlled feasibility trial. Individuals undergoing major thoracic surgery who are identified to be high-risk by the POAF prediction model will be randomized 1:1 to receive a short course of amiodarone vs. placebo in the immediate postoperative period. The primary outcome is feasibility, which will be measured by the number of eligible patients identified, consented, and randomized; intervention adherence; and measurement of future outcomes of a full trial. Discussion This study will determine the feasibility of a randomized controlled trial to assess the effectiveness of prophylactic amiodarone, in high-risk patients undergoing major thoracic surgery. This will inform the development of a multi-center trial to establish if prophylactic amiodarone is safe and effective at reducing the incidence of POAF. Preventing this adverse event will not only improve outcomes for patients but also reduce the associated health resource utilization and costs. Trial registration ClinicalTrials.gov NCT04392921. Registered on 19 May 2020.

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Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study

Urologia Journal ◽

10.1177/0391560317751600 ◽

2018 ◽

Vol 85 (3) ◽

pp. 111-117 ◽

Cited By ~ 5

Author(s):

Carlo Pavone ◽

Luigi Candela ◽

Dario Fontana ◽

Alchiede Simonato

Keyword(s):

High Risk ◽

Postoperative Complications ◽

Observational Study ◽

Radical Cystectomy ◽

Charlson Comorbidity Index ◽

Odds Ratio ◽

Retrospective Observational Study ◽

High Risk Patients ◽

Risk Patients ◽

Comorbidity Index

Aim: Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes. Materials and methods: This is a monocentric retrospective observational study in which data of 65 patients have been analyzed. High-risk criteria: (a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more “high-risk” indicators. Postoperative complications were assessed through Clavien–Dindo classification. Results: Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I–II complications according to Clavien–Dindo occurred, in 23% grades III–IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05). Conclusion: Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.

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