Gender-Based Analysis of Perioperative Outcomes Associated with Lower Extremity Bypass

We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status ( P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence.

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Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

HSS Journal ® ◽

10.1177/15563316211014891 ◽

2021 ◽

pp. 155633162110148

Author(s):

Philipp Gerner ◽

Stavros G. Memtsoudis ◽

Crispiana Cozowicz ◽

Ottokar Stundner ◽

Mark Figgie ◽

...

Keyword(s):

Knee Arthroplasty ◽

Selection Criteria ◽

Perioperative Complications ◽

Perioperative Outcomes ◽

Cardiac Complications ◽

Complication Rates ◽

Major Complications ◽

Increased Risk ◽

Comorbidity Burden ◽

Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

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Abstract TP115: Carotid Endarterectomy in Young and Middle Aged Patients

Stroke ◽

10.1161/str.47.suppl_1.tp115 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Isibor J Arhuidese ◽

Tammam Obeid ◽

Besma Nejim ◽

Kanhua Yin ◽

Sophie Wang ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Physical Dependence ◽

Female Gender ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Middle Aged ◽

Improvement Program ◽

Chi Square ◽

Aged Patients ◽

Cardiac Intervention

Introduction: The increasing prevalence and earlier onset of risk factors has resulted in an expanding population of younger patients undergoing carotid endarterectomy (CEA) in recent times. Outcomes after CEA are largely unreported in these patients. In this study, we evaluate 30-day postoperative outcomes after CEA in an exclusive cohort of young and middle aged patients. Methods: We studied all patients aged 64 years and younger, who underwent CEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 to December, 2013. Univariate methods (Chi Square, ttest) were employed to compare patients’ characteristics. Multivariate regression adjusting for patient characteristics was used to identify predictors of adverse outcomes. Results: There were 15830 CEA’s performed in this cohort with a mean age of 58 (S.D:5.1) years. The majority of patients were male (59%), Caucasian (85%) and hypertensive (81%). Nearly half (46%) were symptomatic. Overall, 266 (1.7%) patients suffered stroke in the 30 day post-operative period, while mortality and myocardial infarction rates were 0.6% and 0.4% respectively. The significant predictors of stroke or death were female gender (OR: 1.49; 95%CI: 1.15-1.92; p=0.002), symptomatic status (OR: 1.69; 95%CI: 1.30-2.21; p<0.001), previous cardiac intervention (OR: 1.42; 95%CI: 1.04-1.93; p=0.026) and physical dependence (OR: 1.81; 95%CI: 1.16-2.82; p=0.01). The mean length of in-hospital stay was 3 (SD:5.6) days and complications within 30 days of surgery are shown in Table 1. Conclusions: Absolute stroke and mortality rates after CEA in young and middle aged patients are not different from those reported in the general population. Stroke and mortality are significantly higher in symptomatic, physically dependent patients and those with prior cardiac intervention. We recommend extra vigilance in the management of these patients in order to improve CEA outcomes.

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Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome

Hand ◽

10.1177/1558944718760037 ◽

2018 ◽

Vol 14 (5) ◽

pp. 636-640 ◽

Cited By ~ 2

Author(s):

Kevin T. Jubbal ◽

Dmitry Zavlin ◽

Joshua D. Harris ◽

Shari R. Liberman ◽

Anthony Echo

Keyword(s):

Thoracic Outlet Syndrome ◽

Operative Time ◽

Medical Complications ◽

Complication Rates ◽

Improvement Program ◽

Cervical Rib ◽

Rib Resection ◽

First Rib ◽

Increased Risk ◽

First Rib Resection

Background: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. Methods: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. Results: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. Conclusions: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.

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Lower Extremity Blood Flow Velocity in Obese versus Nonobese Pregnant Women

American Journal of Perinatology ◽

10.1055/s-0039-1679867 ◽

2019 ◽

Vol 37 (04) ◽

pp. 384-389 ◽

Cited By ~ 1

Author(s):

Eryn H. Dutta ◽

Ralph N. Burns ◽

Luis D. Pacheco ◽

Caroline C. Marrs ◽

Aristides Koutrouvelis ◽

...

Keyword(s):

Lower Extremity ◽

Pregnant Women ◽

Lower Extremities ◽

Duplex Ultrasound ◽

Volume Flow ◽

Venous Stasis ◽

Chi Square ◽

Mean Velocity ◽

Venous Flow ◽

Increased Risk

Objective Obesity and pregnancy are risk factors for venous thromboembolism (VTE). In nonpregnant individuals, abdominal obesity is associated with venous insufficiency. This study aimed to compare venous Doppler volume flow and velocity in the lower extremities of obese versus nonobese women. Study Design A prospective cohort study was performed. Duplex ultrasound examined bilateral lower extremity venous flow and velocity (time-averaged mean velocity, TAMV). Flow was analyzed at the superficial femoral (SFV), distal external iliac (DEI), common femoral, profunda femoris, and popliteal veins. Mann–Whitney U-test, Spearman's correlation, and chi-square tests were used, with a significance of p < 0.05. Results Left SFV TAMV and volume flow were higher in the obese group (5.1 [4.1–5.7] vs. 2.8 [1.7–3.4] cm/second; p < 0.001) and (89 [73–119] vs. 48 [26–62] cm/minute; p = 0.005). Significant differences were noted for right DEI flow (obese 326 [221–833] vs. nonobese 182 [104–355] cm/minute; p = 0.049). The right femoral profunda flow was also higher in obese (49 [40–93] cm/minute) compared with nonobese (31 [22–52] cm/minute; p = 0.041). Conclusion Volume flow and TAMV in the lower extremities of obese gravidas are higher compared with nonobese ones. Thus, the increased risk of VTE among obese pregnant women may not be caused by venous stasis.

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Perioperative outcomes following surgical resection of renal cell carcinoma with upper level IVC thrombus: A contemporary multicenter experience.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.498 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 498-498

Author(s):

Edwin Jason Abel ◽

R. Houston Thompson ◽

Vitaly Margulis ◽

Jennifer E. Heckman ◽

Megan M. Merrill ◽

...

Keyword(s):

Serum Albumin ◽

Perioperative Outcomes ◽

Hepatic Veins ◽

Complication Rates ◽

Perioperative Mortality ◽

Major Complications ◽

Increased Risk ◽

Ivc Thrombus ◽

Upper Level ◽

Low Serum

498 Background: Surgery for RCC patients with IVC thrombus above the hepatic veins is complex and associated with an increased risk of perioperative morbidity and mortality. However, minimal data exist that describe contemporary perioperative outcomes at major referral centers or the prognostic factors associated with adverse surgical outcomes. The objective of this study is to determine the preoperative predictors of major complications and 90 day mortality after surgery in RCC patients with IVC thrombus above the hepatic veins. Methods: Records were reviewed of all RCC patients with IVC tumor thrombus above hepatic veins who had surgery from 1/2000 to 12/2012 at Mayo Clinic, MD Anderson, UT Southwestern and the University of Wisconsin. Major complications were recorded were defined as 3A or greater according to the Clavien- Dindo system within 90 days of surgery. Univariate and multivariate (MV) analyses were used to evaluate associations of preoperative clinical, pathological or laboratory variables with risk of major complications or 90-day mortality. Results: A total of 162 patients were identified for study (thrombus level 3,4 in 69 and 93 patients, respectively, according to Neves classification). Cardiopulmonary bypass was used in 60/162 (37.5%), while 40 (24.7%) patients underwent pre-operative angioembolization. Major complications were reported in 55 (34.0%) patients, with the most common being respiratory (12.4%), hematologic (9.2%) and cardiac (8.6%). On MV analysis, preoperative systemic symptoms and level 4 thrombus were independently associated with an increased risk of major complications. Mortality was reported in 17 (10.5%) patients within 90 days after surgery. On MV analysis, ECOG performance status and low serum albumin were independently associated with increased risk of 90 day mortality. Conclusions: Contemporary perioperative mortality and major complication rates for RCC patients with upper level thrombus are 10 and 34%, respectively. ECOG PS >1 and low serum albumin are associated with an increased risk of perioperative mortality, and should be considered when selecting patients for neoadjuvant systemic therapy trials.

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Parental age is related to the occurrence of cleft lip and palate in Brazilian populations

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v15i2.8648758 ◽

2017 ◽

Vol 15 (2) ◽

pp. 167

Author(s):

Paulo Henrique Pimenta de Carvalho ◽

Renato Assis Machado ◽

Silvia Regina de Almeida Reis ◽

Daniella Reis Barbosa Martelli ◽

Verônica Oliveira Dias ◽

...

Keyword(s):

Maternal Age ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Multinomial Logistic Regression ◽

Female Gender ◽

Paternal Age ◽

Chi Square ◽

Oral Cleft ◽

Multinomial Logistic Regression Analysis ◽

Increased Risk

Aim: To evaluate the association of environmental risk factors, particularly paternal and maternal age, with gender and type of oral cleft in newborn with nonsyndromic cleft lip with or without cleft palate (NSCL/P). Methods: This study included 1,346 children with NSCL/P of two Brazilian Services for treatment of craniofacial deformities. Parental ages were classified into the following groups: maternal age <35, 36-39, and ≥40 years; paternal age <39 and ≥40 years. The data was analyzed with chi-square test and multinomial logistic regression analysis. The odds ratios were estimated with a 95% confidence interval. Results: Of the 1,346 children included in this study, CLP was the type of NSCL/P with highest prevalence, followed by, respectively, CL and CP. There was a greater occurrence of NSCL/P in males compared to females (55.8% versus 44.2%). CLP was more common in men, while the CL and CP were more prevalent in women (p=0.000). No association between maternal age and clefts was observed (p=0.747). However, there was evidence of association between father’s aged ≥40 years old and NSCL/P (p=0.031). When patients with CP were analyzed separately, no association between the father’s age and the child’s gender (p=0.728) was observed, i.e. the female gender prevails among patients with CP, regardless of the father’s age. Conclusions: This study showed that there were differences in the distribution of the non-syndromic cleft lip and/or palate and the gender, and fathers aged ≥40 years old may have increased risk of oral cleft. Further studies involving different populations are needed for a better understanding of the effect of maternal and paternal ages as a risk factor for the occurrence of oral clefts.

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Proximal versus Distal Recipient Vessels in Lower Extremity Reconstruction: A Retrospective Series and Systematic Review

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1621746 ◽

2018 ◽

Vol 34 (05) ◽

pp. 334-340 ◽

Cited By ~ 3

Author(s):

Zachary Borab ◽

William Rifkin ◽

Adam Jacoby ◽

Z-Hye Lee ◽

Lavinia Anzai ◽

...

Keyword(s):

Systematic Review ◽

Lower Extremity ◽

Free Flaps ◽

Pooled Analysis ◽

Perioperative Outcomes ◽

Complication Rates ◽

Recipient Vessel ◽

Lower Extremity Reconstruction ◽

Extremity Reconstruction ◽

The Impact

Background Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed outcomes when performing anastomoses distal to the zone of injury. We investigated the impact of recipient vessel location on free flap outcomes. Methods Retrospective review (1979–2016); 312 soft tissue free flaps for open tibia fractures met inclusion criteria. Flap characteristics and perioperative outcomes were examined. Systematic review identified articles evaluating anastomosis location and flap outcomes; pooled data analysis was performed. Results More anastomoses were performed proximal to the zone of injury (80.7%) than distal (19.3%). Distal anastomoses were not associated with increased take back rates (19.6%) compared with proximal (23.8%) anastomoses (p = 0.356). Regression analysis comparing proximal and distal anastomoses found no difference in partial flap failures (7.4% vs 11.9%; p = 0.978) or total flap failures (9.3% vs 9.3%; p = 0.815) when controlling for the presence of arterial injury, flap type, and time from injury to coverage. Systematic review yielded 11 articles with 1,245 proximal and 127 distal anastomoses for comparison. Pooled analysis (p = 0.58) and weighted comparative analysis (p = 0.39) found no difference in flap failure rates between proximal and distal groups. Conclusion Our results are congruent with the current lower extremity literature and demonstrate no difference in perioperative complication rates between anastomoses performed proximal or distal to the zone of injury. These findings suggest that anastomotic location choice should be based primarily on recipient vessel quality/flow and ease of access/exposure rather than orientation relative to the zone of injury.

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Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

10.21203/rs.3.rs-21755/v2 ◽

2020 ◽

Author(s):

Sung Mu Heo ◽

Ian Harris ◽

Justine Naylor ◽

Adriane Lewin

Keyword(s):

Knee Arthroplasty ◽

Joint Stiffness ◽

Female Gender ◽

Complication Rates ◽

Patient Factors ◽

Factors Associated ◽

Total Hip ◽

Operative Care ◽

Increased Risk ◽

Patient Reported

Abstract Background: Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods: Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results: In the 8,444 procedures included for analysis, major complications were reported by 9.5% and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0% and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7% and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients.Conclusion: We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.

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Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

Journal of Oncology ◽

10.1155/2020/7282846 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Kathryn E. Gallaway ◽

Junho Ahn ◽

Alexandra K. Callan

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Soft Tissue Sarcomas ◽

Surgical Site Infections ◽

Small Sample ◽

Wound Complications ◽

Complication Rates ◽

Improvement Program ◽

Primary Bone ◽

Tract Infections

Background. Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose. This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods. A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results. One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion. Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.

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ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients

Global Spine Journal ◽

10.1177/2192568217700106 ◽

2017 ◽

Vol 7 (8) ◽

pp. 719-726 ◽

Cited By ~ 15

Author(s):

Sulaiman Somani ◽

John Di Capua ◽

Jun S. Kim ◽

Kevin Phan ◽

Nathan J. Lee ◽

...

Keyword(s):

Logistic Regression ◽

Risk Stratification ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Wound Complications ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Improvement Program ◽

Asa Classification ◽

Increased Risk

Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.

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