The Association of Preoperative Hematocrit With Adverse Events Following Exploratory Laparotomy in Septic Patients: A Retrospective Analysis

2020 ◽  
pp. 088506662096792
Author(s):  
Rahul Chaturvedi ◽  
Brittany N. Burton ◽  
Suraj Trivedi ◽  
Ulrich H. Schmidt ◽  
Rodney A. Gabriel
Keyword(s):  
Smoking Status ◽  
Multivariable Analysis ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Exploratory Laparotomy ◽  
P Value ◽  
Improvement Program ◽  
Preoperative Anemia ◽  
Surgical Quality ◽  
Secondary Endpoints

Background: Sepsis continues to be the leading cause of death in intensive care units and surgical patients comprise almost one third of all sepsis patients. Anemia is a modifiable risk factor for worse postoperative outcomes in sepsis patients. Here we aim to evaluate the association of preoperative anemia and postoperative mortality in sepsis patients undergoing exploratory laparotomy. Methods: The National Surgical Quality Improvement Program registry was used to query for preoperative sepsis patients undergoing exploratory laparotomy between 2014 and 2016. Preoperative hematocrit was stratified into 4 categories: ≥30% to polycythemia, <21%, 21 and less than 30%, and polycythemia. The primary outcome was 30-day mortality. Multivariable logistic regression was used to evaluate the association of preoperative hematocrit with primary and secondary endpoints. The multivariable analysis included preoperative hematocrit, gender, age, BMI, smoking status, functional status, hypertension, steroid use, bleeding disorder, and sepsis. The odds ratio (OR) with associated 95% confidence interval (CI) is reported for all outcomes. A p-value of less than <0.05 was considered statistically significant. Results: The unadjusted 30-day death rate was the highest for patients with preoperative hematocrit <21% (p < 0.001) compared to the other hematocrit cohorts. The odds of 30-day death was significantly increased for patients with preoperative hematocrit <21% (OR 2.39 95% CI: 1.28-4.49, p = 0.006) and 21-30% (OR 1.35, 95% CI: 1.05 -1.72, p = 0.017) compared to patients with preoperative hematocrit of ≥30% and less than polycythemic ranges (reference cohort). Conclusion: Preoperative anemia in sepsis patients undergoing surgery can lead to increased mortality, postoperative complications, and length of hospital stay. Diagnosing sepsis early in the hospital course can allow physicians more time to titrate anticoagulation medications and treat preoperative anemia.

scholarly journals Laparoscopic Nephroureterectomy is Associated with Higher Risk of Adverse Events compared to Laparoscopic Radical Nephrectomy

2016 ◽  
Vol 10 (3-4) ◽  
pp. 126 ◽  
Author(s):  
Ravin Bastiampillai ◽  
Luke T. Lavallée ◽  
Sonya Cnossen ◽  
Kelsey Witiuk ◽  
Ranjeeta Mallick ◽  
...  
Keyword(s):  
Radical Nephrectomy ◽  
Multivariable Analysis ◽  
P Value ◽  
Inclusion Criteria ◽  
Short Term ◽  
Improvement Program ◽  
Historical Cohort ◽  
Surgical Quality ◽  
Laparoscopic Radical Nephrectomy ◽  
Laparoscopic Nephroureterectomy

<p><strong>Background: </strong>Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may counsel both patients groups the same regarding peri-operative risks. The objective of this study is to compare complications following LRN and LNU.</p><p><strong>Patients and methods: </strong>A historical cohort of patients who received LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient and surgical characteristics, and outcomes up to 30-days post-operative were abstracted. Univariable and multivariable associations between procedure (LRN or LNU) and any adverse event were determined.</p><p><strong>Results: </strong>During the study period, 4904 patients met inclusion criteria. Of these, 4159 (85%) received a LRN while 745 (15%) received a LNU. LNU was associated with more complications than LRN (21% vs. 12%, respectively, p-value &lt;0.01). The most common complications for LNU vs. LRN, respectively, were: bleeding requiring blood transfusion (9.0% vs. 6.0%), urinary tract infection (4.6% vs. 1.5%), wound infection (1.3% vs. 1.8%), and unplanned intubation (2.3% vs. 0.9%). On multivariable analysis, LNU was associated with higher risk of any complication compared to LRN (RR 1.41, 95% CI 1.16-1.72).  </p><p><strong>Conclusions: </strong>Post-operative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery.<strong></strong></p>

scholarly journals Drain or No Drain Following Pancreaticoduodenectomy: The Unsolved Dilemma

2019 ◽  
Vol 109 (3) ◽  
pp. 228-237 ◽  
Author(s):  
A. Zaghal ◽  
H. Tamim ◽  
S. Habib ◽  
R. Jaafar ◽  
D. Mukherji ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Delayed Gastric Emptying ◽  
Length Of Hospital Stay ◽  
Pancreatic Tumors ◽  
Risk Category ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Length ◽  
American College Of Surgeons ◽  
Drain Group

Background and aims: There is no consensus regarding the routine placement of intra-abdominal drains after pancreaticoduodenectomy. We aim to determine the effects of intraperitoneal drain placement during pancreaticoduodenectomy on 30-day postoperative morbidity and mortality. Methods: Patients who underwent pancreaticoduodenectomy for pancreatic tumors were identified from the 2014–2015 American College of Surgeons—National Surgical Quality Improvement Program Database. Univariate and multivariate analyses adjusting for known prognostic variables were performed. A subgroup analysis was performed based on the risk for development of postoperative pancreatic leak determined by the pancreatic duct caliber, parenchymal texture, and body mass index. Results: A total of 6858 patients with pancreatic tumors who underwent pancreaticoduodenectomy were identified in the 2014–2015 American College of Surgeons—National Surgical Quality Improvement Program Database dataset. In all, 87.4% of patients had intraperitoneal drains placed. A 30-day mortality rate was higher in the no-drain group (2.9% vs. 1.7%, P = 0.003). Patients in the drain group had a higher incidence of overall morbidity (49.5% vs. 41.2%, P = 0.0008), delayed gastric emptying (18.1% vs. 13.7%, P = 0.004), pancreatic fistulae (19.4% vs. 9.9%, P ⩽ 0.0001), and prolonged length of hospital stay over 10 days (43.7% vs. 34.9%, P < 0.0001). Subgroup analysis based on risk categories revealed a higher 30-day mortality rate in the no-drain group among patients with high-risk features (3.1% vs. 1.6%, P = 0.02). Delayed gastric emptying and pancreatic fistula development remained significantly higher in the drain group only in the high-risk category. Prolonged length of hospital stay and composite morbidity remained higher in the drain group regardless of the risk category. Conclusion: To our knowledge, this is the largest study to date that aims at clarifying the pros and cons of the intraperitoneal drain placement during pancreaticoduodenectomy for pancreatic tumors. We showed a higher 30-day mortality rate if drain insertion was omitted during pancreaticoduodenectomy in patients with softer pancreatic textures, smaller pancreatic duct caliber, and body mass index over 25. Postoperative 30-day morbidity rate was higher if a drain was inserted regardless of the risk category. Further randomized controlled trials with prospective evaluation of stratification factors for fistula risk are needed to establish a clear recommendation.

Peripheral Nerve Injury during Abdominal-Pelvic Surgery: Analysis of the National Surgical Quality Improvement Program Database

2017 ◽  
Vol 83 (11) ◽  
pp. 1214-1219 ◽  
Author(s):  
Christopher J.D. Wallis ◽  
Sarah Peltz ◽  
James Byrne ◽  
Jamie Kroft ◽  
Paul Karanicolas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Peripheral Nerve Injury ◽  
Odds Ratio ◽  
Open Surgery ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
Preventable Complication

Peripheral nerve injury (PNI) is a rare but preventable complication of surgery. We sought to assess whether the use of minimally invasive surgery (MIS) affects the occurrence of PNI. Using the American College of Surgeons National Surgical Quality Improvement Program database, we examined rates of PNI among patients undergoing appendectomy, hysterectomy, colectomy, or radical prostatectomy between 2005 and 2012. We assessed the effect of MIS, as compared with open surgery, on PNI occurrence using logistic regression. Among 297,532 patients, of whom 175,884 (59.1%) underwent MIS, the rate of PNI was 0.03 per cent. Forty-four patients treated using MIS had PNI (0.03%) as compared with 63 who underwent open surgery (0.05%; P = 0.0002). There was a significant decrease in the proportion of surgeries resulting in PNI (P < 0.0001) over time. In univariate analysis, MIS was associated with a decreased occurrence of PNI (odds ratio 0.48, 95% confidence interval 0.33–0.71), but this became nonsignificant on multivariable analysis (odds ratio 0.71, 95% confidence interval 0.47–1.09). Increased operative time and smoking status were the only factors independently associated with an increased risk of PNI on multivariable analysis. MIS techniques during common abdominal-pelvic surgeries do not appear to increase the risk of PNI. Prolonged operative time and smoking are independently associated with an increased risk of PNI. Quality improvement initiatives to increase awareness of PNI and identify patients at increased risk of this preventable complication should be considered.

scholarly journals Hypoalbuminemia Is Associated With Increased Postoperative Mortality and Complications in Hand Surgery

Hand ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 547-555 ◽  
Author(s):  
Timothy J. Luchetti ◽  
Andrew Chung ◽  
Neil Olmscheid ◽  
Daniel D. Bohl ◽  
Joshua W. Hustedt
Keyword(s):  
Serum Albumin ◽  
Smoking Status ◽  
Postoperative Mortality ◽  
Hand Surgery ◽  
Normal Serum ◽  
Morbidity And Mortality ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Stage Renal Disease

Background: Malnutrition has been associated with increased perioperative morbidity and mortality in orthopedic surgery. This study was designed with the hypothesis that preoperative hypoalbuminemia, a marker for malnutrition, is associated with increased complications after hand surgery. Methods: A retrospective cohort study of 208 hand-specific Current Procedural Terminology codes was conducted with the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013. In all, 629 patients with low serum albumin were compared with 4079 patients with normal serum albumin. The effect of hypoalbuminemia was tested for association with 30-day postoperative mortality, and major and minor complications. Results: Hypoalbuminemia was independently associated with emergency surgery, diabetes mellitus, dependent functional status, hypertension, end-stage renal disease, current smoking status, and anemia. Patients with hypoalbuminemia had a higher rate of mortality, minor complications, and major complications. Conclusions: Hypoalbuminemia is associated with an increased risk of postoperative morbidity and mortality in patients undergoing hand surgery. As such, increased focus on perioperative nutrition optimization may lead to improved outcomes for patients undergoing hand surgery.

Frailty Predicts Morbidity and Mortality after Colectomy for Clostridium difficile Colitis

2018 ◽  
Vol 84 (5) ◽  
pp. 628-632
Author(s):  
Raghunandan Venkat ◽  
Viraj Pandit ◽  
Edwin Telemi ◽  
Oleksandr Trofymenko ◽  
Twinkle K. Pandian ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Frailty Index ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Class Iii ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Length ◽  
Increased Risk ◽  
Clostridium Difficile Colitis

Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for Clostridium difficile colitis. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 470 patients with a diagnosis of C. difficile colitis were used in the study. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used with the National Surgical Quality and Improvement Program to assess frailty. Outcome measures included serious morbidity, overall morbidity, and Clavien IV (requiring ICU) and Clavien V (mortality) complications. The median age was 70 years and body mass index was 26.9 kg/m2. 55.6 per cent of patients were females. 98.5 per cent of patients were assigned American Society of Anesthesiologists Class III or higher. The median mFI was 0.27 (0–0.63). Because mFI increased from 0 (non-frail) to 0.55 and above, the overall morbidity increased from 53.3 per cent to 84.4 per cent and serious morbidity increased from 43.3 per cent to 78.1 per cent. The Clavien IV complication rate increased from 30.0 per cent to 75.0 per cent. The mortality rate increased from 6.7 per cent to 56.2 per cent. On a multivariate analysis, mFI was an independent predictor ofoverall morbidity (AOR: 13.0; P < 0.05), mortality (AOR: 8.8; P = 0.018), cardiopulmonary complications (AOR: 6.8; P = 0.026), and prolonged length of hospital stay (AOR: 6.6; P = 0.045). Frailty is associated with increased risk of complications in C. difficile colitis patients undergoing colectomy. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients who generally have significant morbidity and mortality to begin with.

Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery

2017 ◽  
Vol 83 (10) ◽  
pp. 1089-1094
Author(s):  
Anaar Siletz ◽  
Jonathan Grotts ◽  
Catherine Lewis ◽  
Areti Tillou ◽  
Henry Magill Cryer ◽  
...  
Keyword(s):  
Open Surgery ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Nursing Facilities ◽  
Improvement Program ◽  
Surgical Quality ◽  
Skilled Nursing ◽  
Academic Center ◽  
Indications For Operation

The objective of this study was to evaluate usage and outcomes of emergency laparoscopic versus open surgery at a single tertiary academic center. Over a three-year period 165 patients were identified retrospectively using National Surgical Quality Improvement Program results. Appendectomies and cholecystectomies were excluded. Open and laparoscopic approaches were compared regarding preoperative and operative characteristics, the development of postoperative complications, 30-day mortality, and length of hospital stay. Indications for operation were similar between groups. Patients who underwent open surgery had more severe comorbidities and higher ASA class. Laparoscopy was associated with reduced complication rates, operative time, length of stay, and discharges to skilled nursing facilities on univariate analysis. In a multivariate model, surgical approach was not associated with the development of complications. Older age, dependent status, and dyspnea were predictors of conversion from attempted laparoscopic to open approaches.

Institutional databases may underestimate the risk factors for 30-day unplanned readmissions compared to national databases

2020 ◽  
Vol 33 (6) ◽  
pp. 845-853 ◽  
Author(s):  
Shyam J. Kurian ◽  
Yagiz Ugur Yolcu ◽  
Jad Zreik ◽  
Mohammed Ali Alvi ◽  
Brett A. Freedman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Fusion ◽  
Length Of Hospital Stay ◽  
Single Institution ◽  
Improvement Program ◽  
Common Risk Factor ◽  
Surgical Quality ◽  
Index Procedure ◽  
Multivariable Analyses ◽  
National Databases

OBJECTIVEThe National Surgical Quality Improvement Program (NSQIP) and National Readmissions Database (NRD) are two widely used databases for research studies. However, they may not provide generalizable information in regard to individual institutions. Therefore, the objective of the present study was to evaluate 30-day readmissions following anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF) procedures by using these two national databases and an institutional cohort.METHODSThe NSQIP and NRD were queried for patients undergoing elective ACDF and PLF, with the addition of an institutional cohort. The outcome of interest was 30-day readmissions following ACDF and PLF, which were unplanned and related to the index procedure. Subsequently, univariable and multivariable analyses were conducted to determine the predictors of 30-day readmissions by using both databases and the institutional cohort.RESULTSAmong all identified risk factors, only hypertension was found to be a common risk factor between NRD and the institutional cohort following ACDF. NSQIP and the institutional cohort both showed length of hospital stay to be a significant predictor for 30-day related readmission following PLF. There were no overlapping variables among all 3 cohorts for either ACDF or PLF. Additionally, the national databases identified a greater number of risk factors for 30-day related readmissions than did the institutional cohort for both procedures.CONCLUSIONSOverall, significant differences were seen among all 3 cohorts with regard to top predictors of 30-day unplanned readmissions following ACDF and PLF. The higher quantity of significant predictors found in the national databases may suggest that looking at single-institution series for such analyses may result in underestimation of important variables affecting patient outcomes, and that big data may be helpful in addressing this concern.

Final results and subgroup analyses of the phase 3 CAIRO3 study: Maintenance treatment with capecitabine and bevacizumab versus observation after induction treatment with chemotherapy and bevacizumab in metastatic colorectal cancer (mCRC).

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. LBA388-LBA388 ◽  
Author(s):  
Miriam Koopman ◽  
Lieke Simkens ◽  
Anne May ◽  
Linda Mol ◽  
Harm van Tinteren ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Maintenance Treatment ◽  
Multivariable Analysis ◽  
Induction Treatment ◽  
P Value ◽  
Secondary Endpoints ◽  
Multivariable Analyses ◽  
Positive Effect

LBA388 Background: The optimal duration of chemotherapy and bevacizumab (bev) in mCRC is not well established. The CAIRO3 study investigated the efficacy of maintenance treatment with capecitabine (cap) + bev versus observation in mCRC patients (pts) not progressing during induction treatment with cap, oxaliplatin, and bev (CAPOX-B). Methods: Previously untreated mCRC pts, PS 0-1, with stable disease or better after six cycles of CAPOX-B were randomized between observation (arm A) or maintenance treatment with cap 625 mg/m2 bid daily continuously + bev 7.5 mg/kg iv q 3 weeks (arm B). Upon first progression (PFS1), pts in both arms were to be treated with CAPOX-B until 2nd progression (PFS2, primary endpoint). Secondary endpoints were overall survival (OS) and time to 2nd progression (TTP2), which was defined as the time to progression or death on any treatment following PFS1, and quality of life. Preplanned subsetanalyses were performed. Results: A total of 558 pts were randomized. Median follow-up is 48 months. Upon PFS1, CAPOX-B was reintroduced in 61% of pts in arm A and 48% in arm B. Multivariable analyses for survival, with treatment adjusted for a series of pre-specified potentially confounding factors at baseline showed significant interactions for treatment (observation vs. maintenance) with resection of the primary tumor (yes vs. no) and synchronous or metachronous metastases at baseline (p values for interaction <0.0001). Especially pts with synchronous metastases with resected primary tumor (n=180) appear to benefit from maintenance treatment; median OS 18.0 months (observation arm) vs. 25.0 months (maintenance arm) (log-rank p value: <0.0001). Conclusions: Multivariable analysis showed significant interaction of treatment with some baseline covariates which were not equally distributed among both arms. The positive effect on survival for maintenance treatment with cap + bev is most obvious in pts with synchronous disease in whom the primary tumor was resected. Further details and final results on survival will be presented at the meeting. Clinical trial information: NCT00442637.

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