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

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.

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Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011069 ◽

2018 ◽

Vol 10 (2) ◽

pp. e011069 ◽

Cited By ~ 1

Author(s):

Nicholas Gregory Ross Bayfield ◽

Adrian Pannekoek ◽

David Hao Tian

Keyword(s):

Cardiac Surgery ◽

Smoking Status ◽

Meta Analysis ◽

Surgical Site Infections ◽

Neurological Complications ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Short Term ◽

Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

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Surgical prehabilitation using mobile health coaching in patients with obesity: A pilot study

Anaesthesia and Intensive Care ◽

10.1177/0310057x20947731 ◽

2020 ◽

Vol 48 (5) ◽

pp. 373-380

Author(s):

Kasia Kulinski ◽

Natalie A Smith

Keyword(s):

Risk Factors ◽

Mobile Health ◽

Elective Surgery ◽

Text Message ◽

Cost Effective ◽

Text Messages ◽

Morbidity And Mortality ◽

Perioperative Morbidity ◽

Increased Risk ◽

Patient Health

Many patients spend months waiting for elective procedures, and many have significant modifiable risk factors that could contribute to an increased risk of perioperative morbidity and mortality. The minimal direct contact that usually occurs with healthcare professionals during this period represents a missed opportunity to improve patient health and surgical outcomes. Patients with obesity comprise a large proportion of the surgical workload but are under-represented in prehabilitation studies. Our study piloted a mobile phone based, multidisciplinary, prehabilitation programme for patients with obesity awaiting elective surgery. A total of 22 participants were recruited via the Wollongong Hospital pre-admissions clinic in New South Wales, Australia, and 18 completed the study. All received the study intervention of four text messages per week for six months. Questionnaires addressing the self-reported outcome measures were performed at the start and completion of the study. Forty percent of participants lost weight and 40% of smokers decreased their cigarette intake over the study. Sixty percent reported an overall improved health score. Over 80% of patients found the programme effective for themselves, and all recommended that it be made available to other patients. The cost was A$1.20 per patient per month. Our study showed improvement in some of the risk factors for perioperative morbidity and mortality. With improved methods to increase enrolment, our overall impression is that text message–based mobile health prehabilitation may be a feasible, cost-effective and worthwhile intervention for patients with obesity.

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Frailty Predicts Morbidity and Mortality after Colectomy for Clostridium difficile Colitis

The American Surgeon ◽

10.1177/000313481808400511 ◽

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.

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Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽

10.1182/blood.v120.21.2088.2088 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2088-2088 ◽

Cited By ~ 1

Author(s):

Khaled M Musallam ◽

John B Porter ◽

Assaad Soweid ◽

Jamal J Hoballah ◽

Pierre M Sfeir ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Postoperative Mortality ◽

Major Surgery ◽

Vascular Events ◽

Improvement Program ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein ◽

The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

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Impact of Smoking Status on Perioperative Morbidity, Mortality, and Long-Term Survival Following Transthoracic Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-021-09720-6 ◽

2021 ◽

Author(s):

Sivesh K. Kamarajah ◽

Anantha Madhavan ◽

Jakub Chmelo ◽

Maziar Navidi ◽

Shajahan Wahed ◽

...

Keyword(s):

Esophageal Cancer ◽

Smoking Status ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Transthoracic Esophagectomy ◽

Anastomotic Leaks ◽

Term Survival ◽

Long Term Survival ◽

Perioperative Morbidity

Abstract Introduction Esophagectomy is a key component in the curative treatment of esophageal cancer. Little is understood about the impact of smoking status on perioperative morbidity and mortality and the long-term outcome of patients following esophagectomy. Objective This study aimed to evaluate morbidity and mortality according to smoking status in patients undergoing esophagectomy for esophageal cancer. Methods Consecutive patients undergoing two-stage transthoracic esophagectomy (TTE) for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between January 1997 and December 2016 at the Northern Oesophagogastric Unit were included from a prospectively maintained database. The main explanatory variable was smoking status, defined as current smoker, ex-smoker, and non-smoker. The primary outcome was overall survival (OS), while secondary outcomes included perioperative complications (overall, anastomotic leaks, and pulmonary complications) and survival (cancer-specific survival [CSS], recurrence-free survival [RFS]). Results During the study period, 1168 patients underwent esophagectomy for cancer. Of these, 24% (n = 282) were current smokers and only 30% (n = 356) had never smoked. The median OS of current smokers was significantly shorter than ex-smokers and non-smokers (median 36 vs. 42 vs. 48 months; p = 0.015). However, on adjusted analysis, there was no significant difference in long-term OS between smoking status in the entire cohort. The overall complication rates were significantly higher with current smokers compared with ex-smokers or non-smokers (73% vs. 66% vs. 62%; p = 0.018), and there were no significant differences in anastomotic leaks and pulmonary complications between the groups. On subgroup analysis by receipt of neoadjuvant therapy and tumor histology, smoking status did not impact long-term survival in adjusted multivariable analyses. Conclusion Although smoking is associated with higher rates of short-term perioperative morbidity, it does not affect long-term OS, CSS, and RFS following esophagectomy for esophageal cancer. Therefore, implementation of perioperative pathways to optimize patients may help reduce the risk of complications.

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Impact of Obesity on Surgical Outcomes Following Laminectomy for Spinal Metastases

Global Spine Journal ◽

10.1177/2192568218780355 ◽

2018 ◽

Vol 9 (3) ◽

pp. 254-259 ◽

Cited By ~ 2

Author(s):

Zoe B. Cheung ◽

Khushdeep S. Vig ◽

Samuel J. W. White ◽

Mauricio C. Lima ◽

Awais K. Hussain ◽

...

Keyword(s):

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Spinal Metastases ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Improvement Program ◽

Clinical Registry ◽

Perioperative Morbidity ◽

Preoperative Risk Factors ◽

Nonobese Group

Study Design: Retrospective cohort study. Objectives: To determine the effect of obesity (body mass index >30 kg/m2) on perioperative morbidity and mortality after surgical decompression of spinal metastases. Methods: The American College of Surgeons National Surgical Quality Improvement Program database is a large multicenter clinical registry that collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent decompression with laminectomy for treatment of metastatic spinal lesions between 2010 and 2014. Patients were separated into 2 cohorts based on the presence of absence of obesity. Univariate analysis and multivariate logistic regression analysis were used to analyze the effect of obesity on perioperative morbidity and mortality. Results: There was a significantly higher rate of venous thromboembolism (VTE; obese 6.6% vs nonobese 4.2%; P = .01) and pulmonary complications (obese 2.6% vs nonobese 2.2%; P = .046) in the obese group compared with the nonobese group. The nonobese group had prolonged hospitalization (obese 62.0% vs nonobese 69.0%; P = .001) and a higher incidence of blood transfusions (obese 26.8% vs nonobese 34.2%; P < .001). On multivariate analysis, obesity was found to be an independent risk factor for VTE (odds ratio = 1.75, confidence interval = 1.17-2.63, P = .007). Conclusions: Obese patients were predisposed to an elevated risk of VTE following laminectomy for spinal metastases. Early postoperative mobilization and a low threshold to evaluate for perioperative VTE are important in these patients in order to appropriately diagnose and treat these complications and minimize morbidity.

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Perioperative management of patients with poorly functioning ventricles in the setting of the functionally univentricular heart

Cardiology in the Young ◽

10.1017/s1047951105002325 ◽

2006 ◽

Vol 16 (S1) ◽

pp. 47-54 ◽

Cited By ~ 5

Author(s):

Joseph W. Rossano ◽

Anthony C. Chang

Keyword(s):

Diastolic Dysfunction ◽

Perioperative Management ◽

Ventricular Dysfunction ◽

Morbidity And Mortality ◽

Univentricular Heart ◽

Perioperative Morbidity ◽

Ventricular Geometry ◽

Increased Risk ◽

Surgical Palliation

The patient with a functionally univentricular heart is at increased risk for ventricular dysfunction for a variety of reasons. At birth, the pulmonary and systemic circulations are in parallel, leading to pulmonary overcirculation and a volume-loaded functional ventricle. Significant atrioventricular valvar regurgitation, abnormal ventriculoarterial coupling, diastolic dysfunction, and altered ventricular geometry can also contribute to long-term ventricular dysfunction. These collected circumstances place the patient at increased risk for perioperative morbidity and mortality. We will discuss in this review the pathophysiology that leads to ventricular dysfunction at each stage of surgical palliation, as well as the strategies for perioperative management. In addition, we will highlight novel strategies for management of ventricular dysfunction.

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

Journal of Intensive Care Medicine ◽

10.1177/0885066620967925 ◽

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.

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Perioperative Outcomes after Unilateral and Bilateral Total Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0b013e3181bfab7d ◽

2009 ◽

Vol 111 (6) ◽

pp. 1206-1216 ◽

Cited By ~ 121

Author(s):

Stavros G. Memtsoudis ◽

Yan Ma ◽

Alejandro González Della Valle ◽

Madhu Mazumdar ◽

Licia K. Gaber-Baylis ◽

...

Keyword(s):

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Morbidity And Mortality ◽

Perioperative Outcomes ◽

Perioperative Morbidity ◽

Increased Risk ◽

Comorbidity Burden ◽

Total Knee ◽

Independent Risk Factors

Background The safety of bilateral total knee arthroplasties (BTKAs) during the same hospitalization remains controversial. The authors sought to study differences in perioperative outcomes between unilateral and BTKA and to further compare BTKAs performed during the same versus different operations during the same hospitalization. Methods Nationwide Inpatient Sample data from 1998 to 2006 were analyzed. Entries for unilateral and BTKA procedures performed on the same day (simultaneous) and separate days (staged) during the same hospitalization were identified. Patient and healthcare system-related demographics were determined. The incidences of in-hospital mortality and procedure-related complications were estimated and compared between groups. Multivariate regression was used to identify independent risk factors for morbidity and mortality. Results Despite younger average age and lower comorbidity burden, procedure-related complications and in-hospital mortality were more frequent after BTKA than after unilateral procedures (9.45% vs. 7.07% and 0.30% vs. 0.14%; P < 0.0001 each). An increased rate of complications was associated with a staged versus simultaneous approach with no difference in mortality (10.30% vs. 9.15%; P < 0.0001 and 0.29% vs. 0.26%; P = 0.2875). Independent predictors for in-hospital mortality included BTKA (simultaneous: odds ratio, 2.23 [95% confidence interval, 1.69-2.95]; P < 0.0001; staged: odds ratio, 2.01 [confidence interval, 1.28-3.41]; P = 0.0031), male sex (odds ratio, 2.02 [confidence interval, 1.75-2.34]; P < 0.0001), age older than 75 yr (odds ratio, 3.96 [confidence interval, 2.77-5.66]; P < 0.0001), and the presence of a number of comorbidities and complications. Conclusion BTKAs carry increased risk of perioperative morbidity and mortality compared with unilateral procedures. Staging BTKA procedures during the same hospitalization offers no mortality benefit and may even expose patients to increased morbidity.

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Predictors of COVID-19 Mortality in Residents of Flint, Michigan: Effect of Age, Gender, Smoking, and Health Plan

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.111 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s57-s58

Author(s):

Mariam Younas ◽

Danielle Osterholzer ◽

Philip McDonald ◽

Carlos Rios-Bedoya ◽

Ghassan Bachuwa ◽

...

Keyword(s):

Risk Factors ◽

Health Plan ◽

Smoking Status ◽

Medical Center ◽

Strong Predictor ◽

Case Fatality ◽

Obstructive Sleep ◽

Increased Risk ◽

Potential Risk Factors ◽

Stage Renal Disease

Background: Current literature suggests that older age, hypertension, and diabetes mellitus confer a significant increased risk of mortality among patients with COVID-19. The purpose of this study is to further characterize the predictors of mortality in patients with COVID-19 in residents of Flint, Michigan, based on variables such as gender, age, smoking status, health insurance plan, and comorbidities. Methods: Hurley Medical Center, is a 443-bed public, nonprofit, teaching medical center located in Flint, Michigan. In total, 289 consecutive adult patients (aged ≥18 years) with confirmed SARS-CoV-2 infection by nasal polymerase chain reaction (PCR), admitted and discharged from our facility from March 2020 through June 2020, were retrospectively analyzed. Results: During the 4-month study period, the overall in-hospital case fatality rate (CFR) was 18% (51 of 289), with highest CFR in the age group aged 60–69 years (36%; P = .06). Nonsurvivors tended to be older with mean age of 67 years (95% CI, 61.6–71.8) versus survivors with mean age of 60 years (95% CI, 57.7–62.4). Highest mortality was seen in patients with Medicare or Medicaid as their sole health plan (39%, P = .59). Men comprised 51% (148 of 289) of the cohort with CFR of 21% versus 14% in females. Females tended to be younger with a higher body mass index (BMI) than their male counterparts (mean age of 58 years, mean BMI of 35 in women vs a mean age of 62 and BMI of 29 in men). A higher proportion of deceased were active smokers (51%; P = .02). CFR was highest in patients with hypertension (92%,; P = .15), followed by diabetes (44%; P = .85), chronic kidney disease (CKD) (31%; P = .10), obstructive sleep apnea (OSA) (28%; P = .25), asthma (22%; P = .64), and coronary artery disease (22%; P = .34). It was lowest in patients with end-stage renal disease (3%; P = .69). Conclusions: Our study suggests trends towards higher mortality with male sex, hypertension and diabetes, along with other comorbidities. Smoking seems to be a strong predictor of mortality in this cohort. Further studies are needed to ascertain the relationship between possible risk factors with COVID-19 mortality in residents of Flint, Michigan. Describing and understanding the potential risk factors is the key to improving outcomes in this population.Funding: NoDisclosures: None

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