scholarly journals Impact of Obesity on Surgical Outcomes Following Laminectomy for Spinal Metastases

2018 ◽  
Vol 9 (3) ◽  
pp. 254-259 ◽  
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.

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.

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

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.

Minimally Invasive Esophagectomy

2019 ◽  
pp. 308-318
Author(s):  
Brandon Merling ◽  
Frank Dupont
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Anesthetic Management ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Perioperative Morbidity ◽  
Invasive Esophagectomy ◽  
Common Causes

Esophageal cancer is the eighth most common malignancy worldwide, producing a high morbidity and mortality rate around the globe. Minimally invasive esophagectomy (MIE) is most commonly performed on patients with this devastating disease. Esophagectomy is a high-risk procedure, and perioperative mortality remains around 5%–8%. Because esophageal cancer is associated with chronic alcohol and tobacco use, patients have serious comorbid conditions that affect anesthetic management and perioperative care. Among them, pulmonary complications and anastomotic failure remain the most common causes of perioperative morbidity and mortality. The anesthesiologist managing a patient during MIE must be able to reduce the effect of the patient’s multiple comorbidities intraoperatively while mitigating the factors that lead to adverse postoperative outcomes.

Primary Malignancy is an Independent Determinant of Morbidity and Mortality after Liver Resection

2017 ◽  
Vol 83 (5) ◽  
pp. 436-444 ◽  
Author(s):  
Marc W. Fromer ◽  
John P. Gaughan ◽  
Umur M. Atabek ◽  
Francis R. Spitz
Keyword(s):  
Liver Resection ◽  
Primary Liver Cancer ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
National Database ◽  
Matched Pair ◽  
Fisher Exact Test ◽  
Improvement Program ◽  
Risk Of Death ◽  
Liver Cancers

Although outcomes after liver resection have improved, there remains considerable perioperative morbidity and mortality with these procedures. Studies suggest a primary liver cancer diagnosis is associated with poorer outcomes, but the extent to which this is attributable to a higher degree of hepatic dysfunction is unclear. To better delineate this, we performed a matched pair analysis of primary versus metastatic malignancies using a national database. The American College of Surgeons National Surgical Quality Improvement Program (2005–2013) was analyzed to select elective liver resections. Diagnoses were sorted as follows: 1) primary liver cancers and 2) metastatic neoplasms. A literature review identified factors known to impact hepatectomy outcomes; these variables were evaluated by a univariate analysis. The most predictive factors were used to create similar groups from each diagnosis category via propensity matching. Multivariate regression was used to validate results in the wider study population. Outcomes were compared using chi-squared test and Fisher exact test. Matched groups of 4838 patients were similar by all variables, including indicators of liver function. A number of major complications were significantly more prevalent with a primary diagnosis; overall major morbidity rates in the metastatic and primary groups were 29.3 versus 41.6 per cent, respectively. The mortality rate for primary neoplasms was 4.6 per cent (vs 1.6%); this represents a risk of death nearly three-times greater (95% confidence interval = 2.20–3.81, P < 0.0001) in cancers of hepatic origin. Hepatectomy carries substantially higher perioperative risk when performed for primary liver cancers, independent of hepatic function and resection extent. This knowledge will help to improve treatment planning, patient education, and resource allocation in oncologic liver resection.

Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis

2020 ◽  
pp. 000313482097157
Author(s):  
Simon Peter T. Tiu ◽  
Luv N. Hajirawala ◽  
Claudia Leonardi ◽  
Kurt G. Davis ◽  
Guy R. Orangio ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Quality Improvement ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Short Term ◽  
Improvement Program ◽  
Delayed Surgery ◽  
Acs Nsqip ◽  
Urgent Surgery ◽  
Significant Difference

Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. Objective The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. Design The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Setting The ACS NSQIP database from 2013 to 2016 was evaluated. Patients Adult patients undergoing nonelective, nonemergency colectomy for UC. Main Outcome Measures 30-day morbidity and mortality. Results 921 patients underwent urgent inpatient surgery for UC. In univariate analysis, there was no significant difference between prompt and delayed surgery for wound infection, sepsis, return to operating room, or readmission. Limitations Retrospective study of a quality improvement database. Patients who underwent successful MRT did not receive surgery, so are not included in the database. Conclusions Delaying surgery to further attempt MRT does not alter short-term outcomes and may allow conversion to elective future surgery. Contrarily, medical optimization does not improve short-term outcomes.

P79 CRITICAL APPRAISAL ON THE IMPACT OF SMOKING STATUS ON PERIOPERATIVE MORBIDITY, MORTALITY AND LONG-TERM SURVIVAL FOLLOWING OESOPHAGECTOMY FOR OESOPHAGEAL CANCERS: A TERTIARY UNIT ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Navidi Maziar ◽  
Griffin S Michael ◽  
W Phillips Alexander
Keyword(s):  
Smoking Status ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Anastomotic Leaks ◽  
Term Survival ◽  
Long Term Survival ◽  
Perioperative Morbidity ◽  
Significant Difference ◽  
The Impact

Abstract Aim This study aimed to characterise morbidity and mortality profile by smoking status in patients undergoing oesophagectomy for oesophageal cancers. Background Oesophagectomy remains the mainstay for curative treatment of oesophageal cancer. Despite improvements in perioperative care, little is understood on the impact of smoking status on perioperative morbidity and mortality following oesophagectomy for oesophageal cancers. Methods Consecutive patients undergoing oesophagectomy cancer (adenocarcinoma or squamous cell carcinoma) between 1997 - 2016 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival. Secondary outcomes include overall complications, anastomotic leaks and pulmonary complications. Results During the study period, 1207 patients underwent oesophagectomy for cancer. Of these 1207 patients, most were current (74%) smokers with only 20% non-smokers. Median survival of current smokers was significantly shorter than ex-smokers and non-smokers (median: 35 vs 42 vs 44 months, p=0.031). On adjusted analysis, there were no significant difference in survival between non-smokers and ex-smokers with current smokers. Rates of overall complications were significantly higher with current smokers compared to ex-smokers or non-smokers (73% vs 66% vs 62%, p=0.015). There were no significant differences in anastomotic leaks and pulmonary complications between the groups. Conclusion In summary, this study demonstrated that current smokers have significantly reduced long-term survival compared to ex-smokers or never smokers, specifically patients undergoing surgery only or those with SCC. Future studies in patients with neoadjuvant therapy to further delineate genetic landscape of oesophageal cancers to identify high risk groups that may warrant further multimodality therapy.

scholarly journals Isolated severe blunt traumatic brain injury: effect of obesity on outcomes

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer T. Cone ◽  
Elizabeth R. Benjamin ◽  
Daniel B. Alfson ◽  
Demetrios Demetriades
Keyword(s):  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Treatment Center ◽  
Major Surgery ◽  
Thromboembolic Complications ◽  
Improvement Program ◽  
Obesity Class ◽  
Increased Risk ◽  
Class 1 ◽  
Underweight Patients

OBJECTIVEObesity has been widely reported to confer significant morbidity and mortality in both medical and surgical patients. However, contemporary data indicate that obesity may confer protection after both critical illness and certain types of major surgery. The authors hypothesized that this “obesity paradox” may apply to patients with isolated severe blunt traumatic brain injuries (TBIs).METHODSThe Trauma Quality Improvement Program (TQIP) database was queried for patients with isolated severe blunt TBI (head Abbreviated Injury Scale [AIS] score 3–5, all other body areas AIS < 3). Patient data were divided based on WHO classification levels for BMI: underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class 1 (30.0–34.9 kg/m2), obesity class 2 (35.0–39.9 kg/m2), and obesity class 3 (≥ 40.0 kg/m2). The role of BMI in patient outcomes was assessed using regression models.RESULTSIn total, 103,280 patients were identified with isolated severe blunt TBI. Data were excluded for patients aged < 20 or > 89 years or with BMI < 10 or > 55 kg/m2 and for patients who were transferred from another treatment center or who showed no signs of life upon presentation, leaving data from 38,446 patients for analysis. Obesity was not found to confer a survival advantage on univariate analysis. On multivariate analysis, underweight patients as well as obesity class 1 and 3 patients had a higher rate of mortality (OR 1.86, 95% CI 1.48–2.34; OR 1.18, 95% CI 1.01–1.37; and OR 1.41, 95% CI 1.03–1.93, respectively). Increased obesity class was associated with an increased risk of respiratory complications (obesity class 1: OR 1.19, 95% CI 1.03–1.37; obesity class 2: OR 1.30, 95% CI 1.05–1.62; obesity class 3: OR 1.55, 95% CI 1.18–2.05) and thromboembolic complications (overweight: OR 1.43, 95% CI 1.16–1.76; obesity class 1: OR 1.45, 95% CI 1.11–1.88; obesity class 2: OR 1.55, 95% CI 1.05–2.29) despite a decreased risk of overall complications (obesity class 2: OR 0.82, 95% CI 0.73–0.92; obesity class 3: OR 0.83, 95% CI 0.72–0.97). Underweight patients had a significantly increased risk of overall complications (OR 1.39, 95% CI 1.24–1.57).CONCLUSIONSAlthough there was an obesity-associated decrease in overall complications, the study data did not demonstrate a paradoxical protective effect of obesity on mortality after isolated severe blunt TBI. Obese patients with isolated severe blunt TBI are at increased risk of respiratory and venous thromboembolic complications. However, underweight patients appear to be at highest risk after severe blunt TBI, with significantly increased risks of morbidity and mortality.

Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort

2018 ◽  
Vol 28 (8) ◽  
pp. 1606-1615
Author(s):  
Alexandra L. Martin ◽  
J. Ryan Stewart ◽  
Harshitha Girithara-Gopalan ◽  
Jeremy T. Gaskins ◽  
Nicole J. McConnell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
Improvement Program ◽  
Surgical Quality ◽  
Vulvar Reconstruction ◽  
Increased Risk ◽  
American Society ◽  
American Society Of Anesthesiologists

ObjectivesThe objective of this study was to determine complications associated with primary closure compared with reconstruction after vulvar excision and predisposing factors to these complications.MethodsPatients undergoing vulvar excision with or without reconstruction from 2011 to 2015 were abstracted from the National Surgical Quality Improvement Program database. Common Procedural Terminology codes were used to characterize surgical procedures as vulvar excision alone or vulvar excision with reconstruction. Patient characteristics and 30-day outcomes were used to compare the 2 procedures. Descriptive and univariate statistics were performed. Adjusted odds ratios and confidence intervals were calculated using a logistic regression model to control for potential confounders. Two-sided α with P < 0.05 was designated as significant.ResultsA total of 2698 patients were identified; 78 (2.9%) underwent reconstruction. There were no differences in age, race, body mass index, diabetes, hypertension, tobacco use, heart failure, renal failure, or functional status between the 2 groups. American Society of Anesthesiologists class 3 and 4 patients and those with disseminated cancer were more likely to undergo reconstruction (both P < 0.001). On univariate analysis, reconstruction was associated with increased risk of readmission, surgical site infection, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, sepsis, septic shock, unplanned reoperation, longer hospital stay, need for skilled nursing or subacute rehab on discharge, and death within 30 days. On logistic regression analysis, disseminated cancer, American Society of Anesthesiologists classes 3 and 4 and reconstruction remained significant risk factors for readmission and any postoperative complication.ConclusionsPatients undergoing vulvar excision with reconstruction are at increased risk for readmission and postoperative complications compared with those undergoing excision alone. Careful patient selection and efforts to optimize surgical readiness are needed to improve outcomes. Long-term data could help determine if these 30-day outcomes are a reliable measure of surgical quality in vulvar surgery.

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