Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Abstract Background Oesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia. Methods A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis. Results A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis. Conclusion Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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Risk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresiarisk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresia

10.21203/rs.3.rs-50683/v1 ◽

2020 ◽

Author(s):

Jinxi Huang ◽

Songming Hong ◽

Qiang Chen ◽

Zengchun Wang ◽

Dianming Wu ◽

...

Keyword(s):

Risk Factors ◽

Oesophageal Atresia ◽

Prognostic Nutritional Index ◽

Anastomotic Stenosis ◽

Multivariate Logistic Regression ◽

Anastomotic Complications ◽

One Stage ◽

Nutritional Index ◽

Anastomotic Fistula

Abstract Objective: The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia.Methods: A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2016 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis.Results: A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F=4.199, P=0.043), low birth weight (F=7.668, P=0.007) and long gap defects (F=6.107, P=0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2=4.499, P =0.034, OR=2.775) and long gap defects (Wald2=6.769, P =0.009, OR=4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F=5.338, P=0.023), anastomotic fistula (F=11.381, P=0.001), endoscopic surgery (F=6.343, P=0.013), preoperative neutrophil count (F=8.602, P=0.004), preoperative low albumin (F=8.410, P=0.005), and a preoperative prognostic nutritional index < 54 (F=5.54, P=0.02) were risk factors for long-term anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2=11.417, P =0.001, OR=8.798), endoscopic surgery (Wald2=9.633, P =0.002, OR=4.808), and a prognostic nutritional index < 54 (Wald2=4.540, P =0.002, OR=2.3798) were independent risk factors for long-term anastomotic stenosis.Conclusion: Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of long-term anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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The timing of oesophageal dilatations in anastomotic stenosis after one-stage anastomosis for congenital oesophageal atresia

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01656-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xue-Jie Gao ◽

Jin-Xi Huang ◽

Qiang Chen ◽

Song-Ming Hong ◽

Jun-Jie Hong ◽

...

Keyword(s):

Risk Factors ◽

Data Analysis ◽

Oesophageal Atresia ◽

Anastomotic Stenosis ◽

Retrospective Data ◽

One Stage ◽

Oesophageal Dilatation ◽

Retrospective Data Analysis ◽

Anastomotic Fistula ◽

Dilatation Group

Abstract Background In infants with congenital oesophageal atresia, anastomotic stenosis easily occurs after one-stage oesophageal anastomosis, leading to dysphagia. In severe cases, oesophageal dilatation is required. In this paper, the timing of oesophageal dilatation in infants with anastomotic stenosis was investigated through retrospective data analysis. Methods The clinical data of 107 infants with oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2015 to December 2018 were retrospectively analysed. Data such as the timing and frequency of oesophageal dilatation under gastroscopy after surgery were collected to analyse the timing of oesophageal dilatation in infants with different risk factors. Results For infants with refractory stenosis, the average number of dilatations in the early dilatation group (the first dilatation was performed within 6 months after the surgery) was 5.75 ± 0.5, which was higher than the average of 7.40 ± 1.35 times in the normal dilatation group (the first dilatation was performed 6 months after the surgery), P = 0.038. For the infants with anastomotic fistula and anastomotic stenosis, the number of oesophageal dilatations in the early dilatation group was 2.58 ± 2.02 times, which was less than the 6.38 ± 2.06 times in the normal dilatation group, P = 0.001. For infants with non-anastomotic fistula stenosis, early oesophageal dilatation could not reduce the total number of oesophageal dilatations. Conclusion Starting to perform oesophageal dilatation within 6 months after one-stage anastomosis for congenital oesophageal atresia can reduce the required number of dilatations in infants with postoperative anastomotic fistula and refractory anastomotic stenosis.

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The Timing of Oesophageal Dilatations in Anastomotic Stenosis After One-Stage Anastomosis for Congenital Oesophageal Atresia

10.21203/rs.3.rs-74817/v1 ◽

2020 ◽

Author(s):

Hong Ye ◽

qiang chen ◽

Jinxi Huang ◽

Junjie Hong ◽

songming hong

Keyword(s):

Risk Factors ◽

Data Analysis ◽

Oesophageal Atresia ◽

Anastomotic Stenosis ◽

Retrospective Data ◽

One Stage ◽

Oesophageal Dilatation ◽

Retrospective Data Analysis ◽

Anastomotic Fistula ◽

Dilatation Group

Abstract Background: In infants with congenital oesophageal atresia, anastomotic stenosis easily occurs after one-stage oesophageal anastomosis, leading to dysphagia. In severe cases, oesophageal dilatation is required. In this paper, the timing of oesophageal dilatation in infants with anastomotic stenosis was investigated through retrospective data analysis.Methods: The clinical data of 107 infants with oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2015 to December 2018 were retrospectively analysed. Data such as the timing and frequency of oesophageal dilatation under gastroscopy after surgery were collected to analyse the timing of oesophageal dilatation in infants with different risk factors.Results: For infants with refractory stenosis, the average number of dilatations in the early dilatation group (the first dilatation was performed within 6 months after the surgery) was 5.75±0.5, which was higher than the average of 7.40±1.35 times in the normal dilatation group (the first dilatation was performed 6 months after the surgery), P=0.038. For the infants with anastomotic fistula and anastomotic stenosis, the number of oesophageal dilatations in the early dilatation group was 2.58±2.02 times, which was less than the 6.38±2.06 times in the normal dilatation group, P=0.001. For infants with non-anastomotic fistula stenosis, early oesophageal dilatation could not reduce the total number of oesophageal dilatations.Conclusion: Starting to perform oesophageal dilatation within 6 months after one-stage anastomosis for congenital oesophageal atresia can reduce the required number of dilatations in infants with postoperative anastomotic fistula and refractory anastomotic stenosis.

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Prognostic Nutritional Index Predicts Clinical Outcome in Patients with Cerebral Venous Sinus Thrombosis

10.21203/rs.3.rs-149813/v1 ◽

2021 ◽

Author(s):

Jiawei Zhao ◽

Kai Liu ◽

Shen Li ◽

Yuan Gao ◽

Lu Zhao ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Poor Prognosis ◽

Sinus Thrombosis ◽

Multivariate Logistic Regression Analysis ◽

Prognostic Nutritional Index ◽

Cerebral Venous Sinus Thrombosis ◽

Multivariate Logistic Regression ◽

Venous Sinus Thrombosis ◽

Nutritional Index

Abstract Background: Lower prognostic nutritional index (PNI) is related to poor prognosis of cardiovascular disease. However, little is known about PNI and its relationship with prognosis in cerebral venous sinus thrombosis (CVST).Methods: From January 2013 to June 2019, we retrospectively identified consecutive CVST patients. We selected patients in acute / subacute phase as subjects. Poor prognosis was defined as modified Rankin Scale (mRS) of 3-6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with poor prognosis. Results: A total of 297 subjects with 12-month follow-up data were enrolled. Thirty-three (11.1%) had poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833-0.978; P = 0.012). The optimal cut-off value for predicting a poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P<0.001). In addition, the nomogram we set up showed that lower PNI was an index of poor prognosis. The c-indexes for the cute/subacute patients with CVST was 0.872.Conclusions: Lower PNI is correlated with a higher risk of adverse clinical outcome in patients with acute/subacute CVST.

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Determinants of Low Birth Weight in Rural Areas of North West in Iran: 2013-2017 (A Case-Control Study)

10.21203/rs.2.11589/v1 ◽

2019 ◽

Author(s):

Hosein Rafiemanesh ◽

Seyed Rasoul Hashemi Aghdam ◽

Avaz Safarzadeh ◽

Sanaz Chapar ◽

Alireza Zemestani ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Case Control Study ◽

Case Control ◽

Maternal Weight ◽

Multivariate Logistic Regression ◽

Control Study

Abstract Background Low birth weight (LBW) is one of the main causes of death in children and is an important factor related to the growth and development of children. LBW is associated with causes but some of the risk factors may be due to the country or geographical region. Aim of this study was conducted to investigate the risk factors associated with LBW in the villages of Oskou county, northwest of Iran. Methods This study is a population-based case-control study and all the cases of LBW, that have occurred during the five years 2013-2017 in all villages of Oskou county, East Azerbaijan Province, Iran. Controls were selevted based on systematic random sampling in that same village and year. Chi-square and fisher's exact test analysed and then a univariate and multivariate logistic regression model was used to investigate possible factors. Results In this study 242 cases and 242 control groups were analyzed. Base on multivariate logistic regression important risk factors were LBW history (OR=25.87), mothers who used natural methods of contraception (OR=29.54), twin's birth (OR=24.04) and gestational age less than 37 weeks (OR=3.89). Conclusion According to the result of the present study the most important risk factors of LBW are as follows: Contraception method using, having a history of previous LBW newborn, twin's birth, gestational age, fathers’ occupation, mothers’ education, maternal weight, maternal weight gain during pregnancy and number of of caring during pregnancy.

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Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Nutrients ◽

10.3390/nu12020562 ◽

2020 ◽

Vol 12 (2) ◽

pp. 562 ◽

Cited By ~ 1

Author(s):

Jihion Yu ◽

Joon Pio Hong ◽

Hyunsuk Peter Suh ◽

Jun-Young Park ◽

Doo-Hwan Kim ◽

...

Keyword(s):

Logistic Regression ◽

Hospital Stay ◽

Free Flap ◽

Odds Ratio ◽

Prognostic Nutritional Index ◽

Multivariate Logistic Regression ◽

Duration Of Hospital Stay ◽

Nutritional Index ◽

Flap Failure ◽

Extremity Reconstruction

The nutritional condition of patients is an important prognostic factor in various diseases. Free flap failure is a serious complication in patients undergoing free flap reconstruction, increasing morbidity and hospital costs. We evaluated the predictive factors, including the prognostic nutritional index (PNI), associated with free flap failure in extremity reconstruction. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3), with a PNI <40 defined as low. Univariate and multivariate logistic regression analyses were performed to evaluate factors predictive of free flap failure. Postoperative outcomes, including duration of hospital stay and rate and duration of intensive care unit admission, were also evaluated. Of the 625 patients included, 38 (6.1%) experienced free flap failure. Multivariate logistic regression analysis revealed that predictors of free flap failure were female (odds ratio: 2.094; p = 0.031) and a low PNI (odds ratio: 3.859; p <0.001). The duration of hospital stay was significantly longer in patients who did than those who did not experience free flap failure (62.1 ± 55.5 days vs. 28.3 ± 24.4 days, p <0.001). A low PNI is associated with free flap failure, leading to prolonged hospital stay. This result suggests that the PNI can be simply and effectively used to predict free flap failure.

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Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study

10.21203/rs.2.12404/v1 ◽

2019 ◽

Author(s):

Sintayehu Mengesha ◽

Mesay Hailu Dangisso

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Birth Weight ◽

Associated Factors ◽

Cross Sectional Study ◽

Southern Ethiopia ◽

Sectional Study ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Prolonged Labour

Abstract Abstract Background Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden for parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia Methods: A facility based cross-sectional study was conducted between 1 August 2015 and 30 July 2016. We randomly selected medical records of women from a hospital delivery registry. The data were coded, entered, cleaned, and analysed by SPSS version 20. Bivariate analysis was employed to assess the association between independent and dependent variables. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding. The ethical clearance for the study was obtained from the Institutional Review Board of College of Medicine and Health Sciences, Hawassa University. Results: Of 374 reviewed records of women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Majority, 15 (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (<2500grams) (AOR: 10.70, 95% CI 3.18-35.97) than normal birth-weight babies (2500-<4000). Women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76-84.12) more likely to have stillbirths than women without a prolonged labour. Women with obstetric complications were 19.8 times more likely to have stillbirths than women without obstetric complications. Similarly, women with at least 2 pregnancies were more likely to have stillbirths than women with less than two pregnancies (AOR: 4.39, 95% CI 1.21-15.85). Conclusion: We found a higher proportion of stillbirths than the National report and studies from other countries. Modifiable risk factors contributed to a higher risk of stillbirths in the study setting. Therefore, early identification and management of complications and reducing delays in getting care at each level of health system could avert preventable stillbirths. Key words: stillbirths, pregnancy outcomes, maternal health, Sothern Ethiopia

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Complement 3 and Prognostic Nutritional Index Distinguish Kawasaki Disease from Fever Illness with Nomogram

10.21203/rs.3.rs-424179/v1 ◽

2021 ◽

Author(s):

Yi-Shuang Huang ◽

Xiao-Ping Liu ◽

Han-Bing Xia ◽

Li-Na Cui ◽

Xin-Ling Lang ◽

...

Keyword(s):

Logistic Regression ◽

Laboratory Data ◽

Prognostic Nutritional Index ◽

Training Group ◽

Total Leukocyte Count ◽

Validation Group ◽

Multivariate Logistic Regression ◽

Lymphocyte Ratio ◽

Nutritional Index ◽

Immunological Factors

Abstract Objective: This study aimed to establish a model to distinguish Kawasaki diseases(KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 KD and 494 children with febrile diseases). Of those, 415 patients were selected to be the training group and 277 patients to be the validation group. Laboratory data, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and immunological factors, were retrospectively collected for analysis after admission. We used univariate and multivariate logistic regression and nomogram for analysis. Result: Patients with KD showed significantly higher C3 and lower PNI. After multivariate logistic regression, total leukocyte count, PNI, C3, and NLR showed significance (p<0.05) and then performed well with the nomogram model. The areas under the ROC in the training group and the validation group were 0.858 and 0.825, respectively. The calibration curves of the two groups for the probability of KD showed near agreement to the actual probability. Conclusion: Compared to children with febrile diseases, patients with KD showed increased C3 and decreased nutritional index of PNI. The nomogram established with these factors can effectively identify KD from febrile illness in children.

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Short-Term Outcomes Following Removal of Infected Hernia Mesh

The American Surgeon ◽

10.1177/00031348211024189 ◽

2021 ◽

pp. 000313482110241

Author(s):

Christine Tung ◽

Junko Ozao-Choy ◽

Dennis Y. Kim ◽

Christian de Virgilio ◽

Ashkan Moazzez

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Logistic Regression ◽

Body Mass ◽

Smoking History ◽

Multivariate Logistic Regression ◽

Short Term ◽

Mesh Removal ◽

Mesh Placement ◽

Infected Mesh

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.

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Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

Burns & Trauma ◽

10.1093/burnst/tkaa037 ◽

2020 ◽

Vol 8 ◽

Author(s):

Chen Dong ◽

Minhui Zhu ◽

Luguang Huang ◽

Wei Liu ◽

Hengxin Liu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Treatment Failure ◽

Logistic Regression Analysis ◽

Disease Duration ◽

Multivariate Logistic Regression Analysis ◽

Tissue Expansion ◽

Multivariate Logistic Regression ◽

Hematoma Evacuation

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

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