Preoperative risk assessment of pancreatic surgery for pancreatic cancer by the surgical Apgar score.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 419-419
Author(s):  
Toru Aoyama ◽  
Yusuke Katayama ◽  
Masaaki Murakawa ◽  
Masahiro Asari ◽  
Koichiro Yamaoku ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Apgar Score ◽  
Pancreatic Surgery ◽  
Significant Risk ◽  
Cancer Center ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

419 Background: Postoperative morbidity is high after pancreatic surgery. Numerous studies have evaluated factors to predict the patients at risk. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS) calculated using three intraoperative parameters (estimated blood loss, lowest mean arterial pressure and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. Methods: We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathological data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade II or more were classified as having severe complications. Uni- and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Results: Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that a SAS of 0-4 points and a body mass index > 25 kg/m2 were significant independent risk factors for overall morbidity (P=0.024 and P=0.014, respectively). The rate of abdominal abscess formation was significantly higher in the patients with a SAS of 0-4 points, while the occurrence of a pancreatic fistula was significantly higher in the patients with a body mass index > 25 kg/m2. Conclusions: The SAS was a significant risk factor for surgical complications after pancreatic surgery for pancreatic cancer. Careful attention is required for these patients in order to help prevent complications and treat them as soon as they develop.

Risk Assessment of Pancreatic Surgery by Surgical Apgar Score and Body Mass Index

2016 ◽  
Vol 101 (5-6) ◽  
pp. 263-269 ◽  
Author(s):  
Toru Aoyama ◽  
Yusuke Katayama ◽  
Masaaki Murakawa ◽  
Koichiro Yamaoku ◽  
Amane Kanazawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Apgar Score ◽  
Pancreatic Surgery ◽  
Significant Risk ◽  
Cancer Center ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

Postoperative morbidity is high after pancreatic surgery. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS), calculated using 3 intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathologic data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade 2 or higher were classified as having severe complications. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that an SAS of 0 to 4 points and a body mass index ≥25 kg/m2 were significant independent risk factors for overall morbidity (P = 0.046 and P = 0.013). The SAS and body mass index were significant risk factors for surgical complications after pancreatic surgery for pancreatic cancer.

Concentrations of sex-hormone binding globulin and corticosteroid binding globulin in serum in relation to cardiovascular risk factors and to 12-year incidence of cardiovascular disease and overall mortality in postmenopausal women.

1986 ◽  
Vol 32 (1) ◽  
pp. 146-152 ◽  
Author(s):  
L Lapidus ◽  
G Lindstedt ◽  
P A Lundberg ◽  
C Bengtsson ◽  
T Gredmark
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Body Mass ◽  
Significant Risk ◽  
Sex Hormone ◽  
Sex Hormone Binding Globulin ◽  
Hormone Binding ◽  
Corticosteroid Binding Globulin ◽  
Overall Mortality

Abstract We determined sex-hormone binding globulin (SHBG) and corticosteroid binding globulin (CBG) by radioimmunoassay of serum samples from a group of 253 women, who were 54 or 60 years old when first studied in 1968-69. The SHBG concentration was highly significantly and inversely related to body mass, body mass index, waist-to-hip circumference ratio, and serum triglyceride concentration; CBG concentration was inversely related to body mass and body mass index. The concentration of neither protein was related to whether or not the subject smoked. Decrease in the concentration of SHBG, but not of CBG, was a significant risk factor for 12-year overall mortality. The plot of the 12-year incidence of myocardial infarction vs SHBG concentration was U-shaped. We recommend that SHBG be included when serum androgens or estrogens are being evaluated as risk factors for cardiovascular disease and death.

scholarly journals The Determinants of Chronic Bronchitis in Aboriginal Children and Youth

2012 ◽  
Vol 19 (6) ◽  
pp. e75-e80 ◽  
Author(s):  
Alomgir Hossain ◽  
Stephanie Konrad ◽  
James A Dosman ◽  
Ambikaipakan Senthilselvan ◽  
Jesse McCrosky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Chronic Bronchitis ◽  
Body Mass ◽  
Significant Risk ◽  
Population Characteristics ◽  
Children And Youth ◽  
Aboriginal Peoples ◽  
Cross Sectional ◽  
Aboriginal Children

BACKGROUND: There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples.OBJECTIVE: To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age.METHODS: Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: “Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB.RESULTS: The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000/year versus ≥$85,000/year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural/urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex.DISCUSSION: The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income.

scholarly journals Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248205
Author(s):  
Martina Aida Angeles ◽  
Carlos Martínez-Gómez ◽  
Mathilde Del ◽  
Federico Migliorelli ◽  
Manon Daix ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Peritoneal Carcinomatosis ◽  
Body Mass ◽  
Cytoreductive Surgery ◽  
Gastric Perforation ◽  
Univariate Analysis ◽  
Rare Event ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Background Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication. Methods We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation. Results Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05–1.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39–509.67], p = 0.029) remained significantly related to the primary outcome. Conclusions Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.

Risk factors for loss of lean body mass after gastrectomy for gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 79-79
Author(s):  
Toru Aoyama ◽  
Tsutomu Sato ◽  
Kenki Segami ◽  
Yukio Maezawa ◽  
Kazuki Kano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Mass Loss ◽  
Total Gastrectomy ◽  
Lean Body Mass ◽  
Body Mass ◽  
Surgical Complications ◽  
Significant Risk ◽  
Cancer Center ◽  
Body Mass Loss

79 Background: Lean body mass loss after surgery, which decreases compliance of adjuvant chemotherapy, is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. However, the risk factors of lean body mass loss remain unclear. Methods: The present study retrospectively examined the patients who underwent curative gastrectomy for gastric cancer between June 2010 and March 2014 at Kanagawa Cancer Center. All patients received perioperative care of the enhanced recovery after surgery protocol. % Lean body mass loss was calculated by percentile of lean body mass at one month after surgery to preoperative lean body mass. Severe lean body mass loss was defined as % lean body mass loss over 5%. Risk factors for severe lean body mass loss were determined by both univariate and multivariate logistic regression analyses. Results: Four-hundred eighty five patients were examined. Median age was 67 years. Operative procedure was total gastrectomy in 190 patients and distal gastrectomy in 295 patients. Surgical complications of grade 2 or more defined by Clavien-Dindo classification was observed in 78 patients including pancreatic fistula in 19, anastomotic leakage in 11 and abdominal abscess in 7. Mortality was observed in one patient. Both univariate and multivariate logistic analyses demonstrated that surgical complications (odds rate 3.576, p = 0.001), total gastrectomy (odds rate 2.522, p = 0.0001), and gender (odds rate 1.928, p = 0.001) were significant independent risk factors for severe lean body mass loss. Conclusions: Male, surgical complications, and total gastrectomy were significant risk factors for 5% of lean body mass loss at first month after gastrectomy. To maintain lean body mass after gastrectomy, the physician need careful attention for the patients who had these risk factors.

Risk factors for adult acquired subglottic stenosis

2016 ◽  
Vol 131 (3) ◽  
pp. 264-267 ◽  
Author(s):  
E A Nicolli ◽  
R M Carey ◽  
D Farquhar ◽  
S Haft ◽  
K P Alfonso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Economic Status ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Subglottic Stenosis ◽  
Patient Demographics ◽  
Obesity And Diabetes

AbstractObjective:The aetiology and outcomes for patients with acquired subglottic stenosis are highly variable. This study aimed to identify risk factors for subglottic stenosis and patient characteristics that predict long-term clinical outcomes.Methods:A retrospective review was performed on 63 patients with subglottic stenosis and 63 age-matched controls. Patient demographics and clinical characteristics were compared. Subglottic stenosis patients were further grouped according to tracheostomy status (i.e. tracheostomy never required, tracheostomy initially required but patient eventually decannulated, and tracheostomy-dependent). Patient factors from these three groups were then compared to evaluate risk factors for long-term tracheostomy dependence.Results:Compared to controls, patients with subglottic stenosis had a significantly higher body mass index (30.8vs26.0 kg/m2;p< 0.001) and were more likely to have diabetes (23.8 per centvs7.94 per cent;p= 0.01). Comparing tracheostomy outcomes within the subglottic stenosis group, body mass index trended towards significance (p= 0.08). Age, gender, socio-economic status, subglottic stenosis aetiology and other co-morbidities did not correlate with outcome.Conclusion:Obesity and diabetes are significant risk factors for acquiring subglottic stenosis. Further investigations are required to determine if obesity is also a predictor for failed tracheostomy decannulation in subglottic stenosis.

scholarly journals Underweight increases the risk of pulmonary tuberculosis in adult

2017 ◽  
Vol 36 (1) ◽  
pp. 4
Author(s):  
Galuh Chandra Irawan ◽  
Ani Margawati ◽  
Ali Rosidi
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Logistic Regression ◽  
Risk Factor ◽  
Pulmonary Tuberculosis ◽  
Body Mass ◽  
Low Income ◽  
Smoking Behavior ◽  
Significant Risk ◽  
Low Body Mass Index

<p>Background<br />Tuberculosis (TB) is a leading cause of morbidity and mortality, especially in middle- and low-income countries. The risk of developing TB may be related to nutritional status. Socioeconomic and behavioral factors are also shown to increase the susceptibility to TB infection. The objective of this study was to determine nutritional factors as risk factors of pulmonary TB in adult.</p><p>Methods<br />This was an observational study of case control design. The study subjects were community members consisting of 19 adult cases of pulmonary tuberculosis and 38 controls. Data on nutritional intakes were obtained by semiquantitative food frequency questionnaire (FFQ), while smoking behavior, history of DM, body mass index, education, and income were obtained by structured interviews. The data were analyzed by independent t-test and logistic regression for calculation of the odds ratio (OR).</p><p>Results<br />The bivariate test showed that the adequacy levels for energy (OR=6.8; 95% CI: 1.51-30.54), protein (OR=5.1; 95% CI: 1.52-17.14), vitamin A (OR=4.2; 5% CI: 1.31-13.54), vitamin C (OR=3.8;95% CI: 1.21-12.36), selenium (OR=4.2; 95% CI: 1.34-13.58), body mass index (OR=4.4; 95% CI: 1.32-14.35) and smoking behavior (OR=3.7; 95% CI: 1.15-11.9), were significant risk factors for pulmonary tuberculosis. Multiple logistic regression test showed that low body mass index (&lt;18.5 kg/m2) (OR=6.0; 95% CI: 1.32-27.18) was a the most influential risk factor of pulmonary tuberculosis.</p><p>Conclusion<br />Low body mass index is the most influential risk factor for pulmonary tuberculosis incidence in adult. Nutrition profile in adult is an important determinant of TB incidence.</p>

scholarly journals Overweight is Associated With Increased Incidence of Minor Complications After Reduction Mammoplasty: A Retrospective Analysis of 453 Consecutive Cases

2018 ◽  
Vol 107 (3) ◽  
pp. 230-235 ◽  
Author(s):  
M. Sutinen ◽  
E. Eskelinen ◽  
M. Kääriäinen
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Multivariate Analysis ◽  
Retrospective Analysis ◽  
Body Mass ◽  
Significant Risk ◽  
Reduction Mammoplasty ◽  
Tertiary Referral Center ◽  
Major Complications ◽  
Increased Risk

Background and Aims: Reduction mammoplasty alleviates macromastia symptoms and improves quality of life. We investigated a large series of consecutive reduction mammoplasties to assess various risk factors for both minor and major complications after the procedure. Materials and Methods: A retrospective analysis of 453 consecutive reduction mammoplasties was performed between 2007 and 2010 at an academic tertiary referral center to evaluate risk factors and complications. Results: The incidence of minor and major complications was 40.5% and 8.8%, respectively. Patients with minor complications had both a significantly higher mean body mass index (30.2 vs 28.0) and sternal notch to nipple distance (33.9 vs 32.4 cm) than patients who recovered without complications (p < 0.001 for both comparisons), as well as more visits to the outpatient clinic (p < 0.001). In the multivariate analysis, body mass index was found to be the only significant risk factor for minor complications (p < 0.001). Furthermore, patients with body mass index higher than 27 had a 2.6-fold greater risk of minor complications (p < 0.001). An increase of one unit in body mass index increased the probability of minor complications by 14.1% (p < 0.001). 22 (4.9%) patients developed a hematoma requiring evacuation in the operating room. The mean body mass index of patients who developed a hematoma was 26.4, a value lower than that of patients without this complication (mean 29.0; p = 0.003). This finding was significant also in the multivariate analysis (p = 0.002). Conclusion: A higher body mass index was strongly associated with an increased risk of minor complications after reduction mammoplasty. It is important to inform obese patients about the increased risk of complications and to encourage them to lose weight before surgery.

Predictive value of Surgical Apgar Score for long-term outcome in patients with gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 178-178
Author(s):  
Masanori Tokunaga ◽  
Tomoyuki Irino ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Apgar Score ◽  
Cancer Center ◽  
Curative Gastrectomy ◽  
Term Survival ◽  
Long Term Outcome ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Surgical Apgar Score

178 Background: Recently, a simple and easy complication prediction system, the surgical Apgar score (SAS) calculated according to three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. We previously reported on the predictive power of SAS for severe complications after gastrectomy. However, the impact of SAS on long-term survival is still unclear. The aim of the present study was to clarify the relationship between SAS and survival outcome in patients with gastric cancer undergoing curative gastrectomy. Methods: This study included 302 patients who underwent curative gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. When the SAS score was ≤ 6, patients were classified into an L-SAS group (n = 82), otherwise, they were classified into an H-SAS group (n = 220). Clinicopathological characteristics and survival outcomes were compared between the groups. Results: There was no difference in demographic data including sex and age between the groups. Total gastrectomy was more frequently performed in the L-SAS group (43%) than in the H-SAS group (21%; P < 0.001). The L-SAS group included patients with higher pT and pN stage. Five-year overall survival rate was worse in the L-SAS group (65.4%) than in the H-SAS group (82.7%; P < 0.001). Multivariate analysis, which included age, sex, histology, pT, pN, type of surgery and SAS as covariates, identified lower SAS (HR, 1.71, 95% C.I., 1.04-2.80) as well as age (HR, 1.62, 95% C.I., 1.10-2.40) and pN (HR, 2.05, 95% C.I., 1.19-3.52) as independent prognostic factors. Conclusions: The SAS was found to be a predictive factor for survival. Intraoperative bleeding and vital signs may affect survival of patients, and therefore warrant special attention from surgeons and anesthesiologists.

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