Upper abdominal shape as a risk factor of extended operation time and severe postoperative complications in HCC hepatectomy through subcostal incision

Abstract Purpose The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG). Methods This was a retrospective study that included 425 patients undergoing LADG from January 2013 to January 2021 at a single clinical center. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The abdominal parameters and short-term surgical outcomes were analyzed. Results In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p=0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p=0.007), lower LSA (p=0.035), lower PAAD (p=0.000), lower SFT (p=0.004), lower APD (p=0.000) and lower LRD (p=0.014) groups. The estimated blood loss was significantly less in the lower BMI (p=0.035), lower LSA (p=0.001), lower PAAD (p=0.012), lower SFT (p=0.003), lower APD (p=0.000) and lower LRD (p=0.005) groups. The complications were fewer in the lower LSA (p=0.012), lower APD (p=0.043) and lower LRD (p=0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p=0.027) and lower SFT (p=0.004) groups, and the lower SFT group had fewer complications (p=0.020). Furthermore, in multivariate analysis, higher PAAD (p=0.029, odds ratio=1.030, 95% CI=1.003-1.058) was an independent factor for predicting postoperative complications in males. Conclusion Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

Download Full-text

Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

The Journal of Knee Surgery ◽

10.1055/s-0039-1688960 ◽

2019 ◽

Vol 33 (09) ◽

pp. 912-918 ◽

Cited By ~ 1

Author(s):

Kevin Rezzadeh ◽

Omar A. Behery ◽

Benjamin S. Kester ◽

Tara Dogra ◽

Jonathon Vigdorchik ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Postoperative Complications ◽

Significant Risk ◽

Operation Time ◽

Significant Risk Factor ◽

Perioperative Outcomes ◽

Patellofemoral Arthroplasty ◽

Short Term ◽

Hospital Stays

AbstractThere is a paucity of literature regarding the short-term readmission, reoperation, and complication rates of patellofemoral arthroplasty (PFA). The purpose of this study is to determine the incidence and risk factors of 30-day postoperative complications in patients undergoing PFA. A retrospective cohort study of subjects who underwent PFA from 2010 to 2015 was performed using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Perioperative outcomes and 30-day postoperative complications were ascertained, and patient demographics and comorbidities were analyzed using linear and binomial logistic regression analyses to determine risk factors for postoperative complications. Among the 1,069 patients identified in the NSQIP database, there was a 30-day readmission rate of 4.3% and a 30-day reoperation rate of 1.5%. The leading complications identified were bleeding requiring transfusion (11.7%), urinary tract infection (0.8%), and deep vein thrombosis (DVT) (0.8%). Younger age was a risk factor for superficial wound infection (p = 0.012). Older age was a significant risk factor for longer hospital stays, readmission, bleeding requiring transfusion, urinary tract infection, and pneumonia (p < 0.05 for all). Male sex was a risk factor for longer operation time and DVT (p = 0.001 and p = 0.017, respectively), while female sex was associated with greater incidence of bleeding requiring transfusion (p = 0.049). Elevated body mass index (BMI) was a risk factor for longer hospital stays, greater total operation time, and bleeding requiring transfusion (p < 0.001, p < 0.001, and p = 0.001, respectively). Nonwhite race was a significant risk factor for readmission (p = 0.008). This represents the largest study on early readmissions and the associated risk factors after PFA. PFA 30-day readmission and reoperation rates were <5%. Older age and elevated BMI were both identified as risk factors for adverse perioperative outcomes, including longer operation times, longer hospital stays, and bleeding requiring transfusion.

Download Full-text

“Cold” polypectomy for colorectal polyps: prospective randomized trial

Koloproktologia ◽

10.33878/2073-7556-2021-20-2-65-73 ◽

2021 ◽

Vol 20 (2) ◽

pp. 65-73

Author(s):

O. S. Toporkova ◽

V. V. Veselov ◽

Yu. E. Vaganov ◽

M. A. Nagudov ◽

O. A. Majnovskaya ◽

...

Keyword(s):

Risk Factor ◽

Postoperative Complications ◽

Randomized Trial ◽

Intraoperative Complications ◽

Univariate Analysis ◽

Operation Time ◽

Colorectal Polyps ◽

Prospective Randomized Trial ◽

Control Group ◽

Number Of Patients

Background: endoscopic electroexcision is the standard technique for the removal of colorectal polyps. However, it is associated with the postoperative morbidity. In order to reduce the incidence of complications, “cold” excision seems to be an alternative option.Aim: to improve the results of endoscopic treatment for patients with colorectal polyps.Patients and methods: from September 2019 to September 2020, 160 patients ≥ 18 years old (80 in each group), who underwent endoscopic removal of colorectal polyps ≤ 10 mm in size by cold excision (132 lesions) and traditional polypectomy (129 lesions), were included in a prospective randomized trial. All removed specimens were studied histologically with an assessment of the resection margins (R0/R1). The analysis of the postoperative complications after endoscopic polypectomy and the incidence of Rx resection after removal of polyps by both techniques was done.Results: the compared groups were homogenous in the number of patients, gender, age, and comobridities. There were no significant differences in the number of removed polyps, their site and the type according to endoscopic classifications. The operation time was significantly higher in the conventional polypectomy group compared with the “cold” one (p = 0.0001). There were no significant differences in the intraoperative complications rate between the two groups (p = 0.06). There were no postoperative complications in the “cold” group. In the control group postoperative complications occurred after 12 out of 129 polyps removal (p = 0.001). The univariate analysis showed that a risk factor for the development of postoperative complications after conventional polypectomy is the lack of submucosal lifting (OR: 15.3, 95% CI: 1.9-125.6, p = 0.01). Histopathology of the removed specimens showed that in both groups most of the procedures were considered as R0 resections (54% in the main group, 56.4% in the control group, p = 0.8). The polyp size ≤ 4 mm identified as a risk factor for R1, Rx resection (OR: 2.4, 95% CI: 1.3–4.7, p = 0.007).Conclusion: “cold” polypectomy is an effective and safe method and may be recommended as an alternative technique for the removal of non-pedunculated colorectal polyps ≤ 10 mm.

Download Full-text

A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Frontiers in Surgery ◽

10.3389/fsurg.2021.768434 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wei Tao ◽

Yu-Xi Cheng ◽

Xiao-Yu Liu ◽

Bin Zhang ◽

Chao Yuan ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Outcomes ◽

Distal Gastrectomy ◽

Subcutaneous Fat ◽

Operation Time ◽

Short Term ◽

Predictive Index ◽

Xiphoid Process ◽

Estimated Blood Loss ◽

Abdominal Shape

Background: The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes.Methods: This was a retrospective study that included 425 patients undergoing laparoscopic distal gastrectomy plus D2 lymph node dissection (LADG) from January 2013 to January 2021. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The parameters and short-term surgical outcomes were analyzed.Results: In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p = 0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p = 0.007), lower LSA (p = 0.035), lower PAAD (p = 0.000), lower SFT (p = 0.004), lower APD (p = 0.000) and lower LRD (p = 0.014) groups. The estimated blood loss was significantly less in the lower BMI (p = 0.035), lower LSA (p = 0.001), lower PAAD (p = 0.012), lower SFT (p = 0.003), lower APD (p = 0.000) and lower LRD (p = 0.005) groups. The complications were fewer in the lower LSA (p = 0.012), lower APD (p = 0.043) and lower LRD (p = 0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p = 0.027) and lower SFT (p = 0.004) groups, and the lower SFT group had fewer complications (p = 0.020). Furthermore, in multivariate analysis, higher PAAD (p = 0.037, odds ratio = 1.030, 95% CI = 1.002–1.059) was an independent factor for predicting postoperative complications in males.Conclusion: Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

Download Full-text

Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

HPB Surgery ◽

10.1155/2011/761315 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Kamil Gulpinar ◽

Suleyman Ozdemir ◽

S. Erpulat Ozis ◽

Turgut Aydin ◽

Atila Korkmaz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Abdominal Wall ◽

Single Incision ◽

Single Port ◽

Operation Time ◽

Scar Formation ◽

Single Incision Laparoscopic Cholecystectomy ◽

Skin Scar

Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

Download Full-text

Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04186-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Bin Li ◽

Xianglong Meng ◽

Xinuo Zhang ◽

Yong Hai

Keyword(s):

Risk Factor ◽

Postoperative Complications ◽

Posterior Approach ◽

Frailty Index ◽

Cardiac Complications ◽

Corrective Surgery ◽

Degenerative Scoliosis ◽

Acute Renal Dysfunction ◽

Radiographic Measurements ◽

Single Approach

Abstract Background With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined. Methods ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years. Results A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences. Conclusions Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

Download Full-text

Lymphocyte C-reactive protein ratio: A new biomarker to predict early complications after gastrointestinal oncologic surgery

Cancer Biomarkers ◽

10.3233/cbm-210251 ◽

2021 ◽

pp. 1-9

Author(s):

Murat Yildirim ◽

Bulent Koca

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Inflammatory Markers ◽

Operation Time ◽

C Reactive Protein ◽

Oncologic Surgery ◽

Protein Ratio ◽

Colorectal Cancer Surgery ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS: Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS: Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9–94.8) sensitivity, and 85.7% (73.6–95.4) selectivity. CONCLUSION: Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.

Download Full-text

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211016252 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110162

Author(s):

Matthew S. Broggi ◽

Philip O. Oladeji ◽

Syed Tahmid ◽

Roberto Hernandez-Irizarry ◽

Jerad Allen

Keyword(s):

Risk Factor ◽

Hip Fracture ◽

Postoperative Complications ◽

Hip Fractures ◽

Depressive Disorders ◽

Surgical Site Infections ◽

Wound Complications ◽

Non Union ◽

Hip Fracture Surgery ◽

Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

Download Full-text

Is sarcopenia really a risk factor in the development of postoperative complications?

Surgical Oncology ◽

10.1016/j.suronc.2021.101527 ◽

2021 ◽

Vol 37 ◽

pp. 101527

Author(s):

Gül Bora Makal ◽

Aydın Aslan

Keyword(s):

Risk Factor ◽

Postoperative Complications

Download Full-text

Relationship between Oral Bacterial Count and Postoperative Complications among Patients with Cardiovascular Disease Treated by Surgery: A Retrospective Cohort Study

Healthcare ◽

10.3390/healthcare9070850 ◽

2021 ◽

Vol 9 (7) ◽

pp. 850

Author(s):

Rie Osako ◽

Yuhei Matsuda ◽

Chieko Itohara ◽

Yuka Sukegawa-Takahashi ◽

Shintaro Sukegawa ◽

...

Keyword(s):

Cardiovascular Disease ◽

Postoperative Complications ◽

Operation Time ◽

Bacterial Count ◽

Cardiovascular Complications ◽

Pericardial Fluid ◽

Bacterial Counts ◽

Lung Torsion ◽

Propensity Score Adjustment ◽

The Relationship

In this retrospective observational study, we evaluated the relationship between perioperative oral bacterial counts and postoperative complications in cardiovascular disease (CVD) patients. From April 2012 to December 2018, all patients scheduled for surgery received perioperative oral management (POM) by oral specialists at a single center. Tongue dorsum bacterial counts were measured on the pre-hospitalization day, preoperatively, and postoperatively. Background data were collected retrospectively. Among the 470 consecutive patients, the postoperative complication incidence rate was 10.4% (pericardial fluid storage, n = 21; postoperative pneumonia, n = 13; surgical site infection, n = 9; mediastinitis, n = 2; and seroma, postoperative infective endocarditis, lung torsion, and pericardial effusion, n = 1 each). Oral bacterial counts were significantly higher in the pre-hospitalization than in the pre- and postoperative samples (p < 0.05). Sex, cerebrovascular disease, and operation time differed significantly between complications and no-complications groups (p < 0.05). Multivariate analysis with propensity score adjustment showed a significant association between postoperative oral bacterial count and postoperative complications (odds ratio 1.26; 95% confidence interval, 1.00–1.60; p = 0.05). Since the development of cardiovascular complications is a multifactorial process, the present study cannot show that POM reduces complications but indicates POM may prevent complications in CVD patients.

Download Full-text