Evaluation of Perioperative outcomes of Delayed Recovery Cases from GA and their Correlation with Standard Anaesthesia Scoring Systems: An Observational Study

AbstractThere are several nephrometry scoring systems for predicting surgical complexity and potential perioperative morbidity. The R.E.N.A.L. scoring system, one of the most well-known nephrometry scoring systems, emphasizes the features on which it is based (Radius, Exophytic/endophytic, Nearness to collecting system or sinus, Anterior/posterior, and Location relative to polar lines). The ability of these nephrometry scoring systems to predict loss of renal function after robotic partial nephrectomy (RPN) remains controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n = 163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥ 20% from baseline to 6 months after RPN. Multivariable logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariable analyses indicated that tumor volume (cutoff value ≥ 14.11 cm3, indicating a sphere with a diameter ≥ approximately 3 cm) and tumor crossing of the axial renal midline were independent factors associated with a reduced eGFR (odds ratio [OR] 4.57; 95% confidence interval [CI] 1.69–12.30; P = 0.003 and OR 3.50; 95% CI 1.30–9.46; P = 0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC = 0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study

British Journal of Anaesthesia ◽

10.1016/j.bja.2020.01.017 ◽

2020 ◽

Vol 124 (5) ◽

pp. 638-647 ◽

Cited By ~ 8

Author(s):

Stavros G. Memtsoudis ◽

Megan Fiasconaro ◽

Ellen M. Soffin ◽

Jiabin Liu ◽

Lauren A. Wilson ◽

...

Keyword(s):

Observational Study ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Perioperative Outcomes ◽

Nationwide Observational Study

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The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study

PLoS ONE ◽

10.1371/journal.pone.0236339 ◽

2020 ◽

Vol 15 (7) ◽

pp. e0236339

Author(s):

Josh Hanson ◽

Simon Smith ◽

James Brooks ◽

Taissa Groch ◽

Sayonne Sivalingam ◽

...

Keyword(s):

Observational Study ◽

Scoring Systems ◽

Indigenous Australians

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Evaluation of Candida scoring systems to predict early candidemia: A prospective and observational study at a tertiary care hospital, Uttarakhand

Indian Journal of Critical Care Medicine ◽

10.4103/ijccm.ijccm_159_17 ◽

2017 ◽

Vol 21 (12) ◽

pp. 830-835

Author(s):

Priyanka Gupta ◽

Pratima Gupta ◽

Biswaroop Chatterjee ◽

Garima Mittal ◽

Shashank Prateek ◽

...

Keyword(s):

Observational Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Scoring Systems ◽

Care Hospital

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Analysis of intraoperative findings with clinico-pathological features in appendicitis-an observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20215138 ◽

2021 ◽

Vol 9 (1) ◽

pp. 96

Author(s):

Kumar Lakshman ◽

Shilpashree Channasandra Shekar ◽

Naveen Narayan ◽

Suhas NarayanaSwamy Gowda ◽

Veena Ghanteppagol ◽

...

Keyword(s):

Observational Study ◽

Categorical Data ◽

Scoring Systems ◽

Inflammatory Cells ◽

Clinical Findings ◽

Study Data ◽

Chronic Appendicitis ◽

Histopathological Findings ◽

Suspected Appendicitis ◽

Operative Findings

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens, suggestive of acute appendicitis.Conclusions: We conclude that the correlation of clinical findings, operative findings and the histopathological findings correlate with one another (p<0.001). The surgeon’s clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence the diagnostic accuracy of the surgeon is directly dependent on the surgeons’ expertise and there is no substitution for an experienced surgeon’s judgement.

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Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.676565 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ta Anh Tuan ◽

Nguyen Thi Thu Ha ◽

Tran Dang Xoay ◽

Tran Thi Kieu My ◽

Luong Thi Nghiem ◽

...

Keyword(s):

Septic Shock ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

Scoring Systems ◽

International Normalized Ratio ◽

Secondary Outcome ◽

Optimal Timing ◽

Survival Group ◽

D Dimer

Objective: To identify whether coagulation profiles using thromboelastometry are associated with outcomes in pediatric septic shock. The primary outcomes were the development of disseminated intravascular coagulation (DIC) and the severity of the pediatric intensive care unit (PICU) existing scoring systems, while the secondary outcome was hospital mortality. This study aimed to contribute to current findings of the limitations of conventional tests in determining the optimal timing of anticoagulation in sepsis.Design: A prospective, observational study conducted between August 2019 and August 2020.Setting: PICU at a pediatric tertiary hospital in Hanoi, Vietnam.Patients: Fifty-five pediatric patients who met the septic shock criteria were enrolled.Measurements and Main Results: Fifty-five patients with septic shock were recruited. At the time of diagnosis, thromboelastometry revealed normocoagulability, hypercoagulability, and hypocoagulability in 29, 29, and 42% of the patients, respectively (p > 0.05); however, most patients in the overt DIC and non-survival groups progressed to hypocoagulability (82 and 64%, respectively). The overt DIC, PELOD-2 > 8, PRISM-III > 11, and non-survival group had a significant hypocoagulable tendency according to thromboelastometry parameters [prolonged clotting time (CT) and clot formation time (CFT); and reduced α-angle (α), maximum clot firmness (MCF), thrombodynamic potential index (TPI)] compared to the non-overt DIC, PELOD-2 ≤ 8, PRISM-III score ≤ 11 and survival group (p < 0.05). Conventional parameters between the normocoagulable and hypercoagulable groups were not different (p > 0.05). Hypocoagulability was characterized by lower platelet count and fibrinogen level, higher prolonged prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), and higher D-dimer level than in hypercoagulability (p < 0.05). Hypocoagulable tendency on thromboelastometry had a higher hazard at a PT > 16.1 s [area under the curve (AUC) = 0.747, odds ratio (OR) = 10.5, p = 0.002], INR > 1.4 (AUC = 0.754, OR = 6.9, p = 0.001), fibrinogen <3.3 g/L (AUC = 0.728, OR = 9.9, p = 0.004), and D-dimer > 3,863 ng/mL (AUC = 0.728, OR = 6.7, p = 0.004).Conclusions: Hypocoagulable tendency using thromboelastometry is associated with the severity of septic shock. Conventional coagulation tests may fail to detect hypercoagulability, which is crucial in determining anticoagulation timing.

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Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study

World Journal of Gastrointestinal Surgery ◽

10.4240/wjgs.v12.i6.287 ◽

2020 ◽

Vol 12 (6) ◽

pp. 287-297

Author(s):

Fulvio Tagliabue ◽

Morena Burati ◽

Marco Chiarelli ◽

Luca Fumagalli ◽

Angelo Guttadauro ◽

...

Keyword(s):

Observational Study ◽

Right Colectomy ◽

Perioperative Outcomes ◽

Laparoscopic Right Colectomy

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Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational study in Korea

BMJ Open ◽

10.1136/bmjopen-2018-024007 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024007 ◽

Cited By ~ 2

Author(s):

Ju young Hong ◽

Je Sung You ◽

Min Joung Kim ◽

Hye Sun Lee ◽

Yoo Seok Park ◽

...

Keyword(s):

Observational Study ◽

Subarachnoid Haemorrhage ◽

Characteristic Curve ◽

External Validation ◽

Scoring Systems ◽

Retrospective Observational Study ◽

World Federation ◽

Ecg Changes ◽

T Wave ◽

St Depression

ObjectivesTo develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.DesignRetrospective, observational studySettingEmergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.ParticipantsAdult patients with SAH were enrolled. Exclusion criteria were age <19 years, no baseline ECG, cardiac arrest on arrival, traumatic SAH, referral from other hospital and referral to other hospitals from the ED.Primary outcome measuresThe 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.ResultsA total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p<0.001, 0.913 vs 0.826; p<0.001, and 0.885 vs 0.746; p<0.001, respectively). The calibration plots showed excellent agreement. In the external validation, the discrimination of the newly developed nomograms incorporating the three scoring systems was also good, with an area under the receiver-operating characteristic curve value of 0.809, 0.812 and 0.772, respectively.ConclusionsWe developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.

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A Comprehensive Comparison of Guy’s Stone Score, CROES Nomogram, S.T.O.N.E. Nephrolithometry, and the Seoul Renal Stone Complexity Scoring System in Predicting Perioperative Outcomes after Percutaneous Nephrolithotomy

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.08.10687 ◽

2020 ◽

Vol 103 (8) ◽

pp. 762-766

Keyword(s):

Free Group ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Scoring System ◽

Renal Stone ◽

Length Of Hospital Stay ◽

Scoring Systems ◽

Postoperative Outcomes ◽

Perioperative Outcomes ◽

National University

Background: Various nephrolithometry scoring systems (NSS) are proposed to determine the structural configuration of kidney stones. Nevertheless, evidence of the comparison among these scoring systems in anticipating postoperative outcomes after percutaneous nephrolithotomy (PCNL) are limited. Objective: To compare the correlation of four NSS with stone-free rates and perioperative results following PCNL. Materials and Methods: The authors examined a retrospective study of patients with kidney stones who received PCNL. One hundred seventy-two patients admitted for surgery at Ramathibodi Hospital were assessed. Four NSS were compared, Guy’s Stone Score (GSS), the Clinical Research Office of the Endourological Society nephrolithometric nomogram (CROES), S.T.O.N.E. Nephrolithometry (STONE), and the Seoul National University Renal Stone Complexity (S-ReSC) scoring system. The authors evaluated the correlations between these four scoring systems with stone-free rates and postoperative outcomes. Results: The stone-free status was 53.5%. There were significant differences in the mean scores of the four systems between the stone-free group and the not stone-free group (1.97 versus 3.70, p<0.05 in GSS; 242.40 versus 159.28, p<0.05 in CROES; 6.64 versus 9.08, p<0.05 in STONE; and 3.44 versus 8.41, p<0.05 in S-ReSC). Multivariate analysis revealed only S-ReSC as independent preoperative factors for PCNL success (p<0.001). Moreover, each scale had a significant correlation with blood loss, length of hospital stay, and operative time. Three scoring systems, all except STONE, were significantly associated with percentage change in estimated glomerular filtration rates (eGFR). There was no significant association among all four scoring systems with postoperative complications. Conclusion: All four NSS represent excellent predictors for stone-free rates and correlate well with surgical outcomes. Keywords: GSS, CROES, STONE, S-ReSC, Percutaneous nephrolithotomy

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