scholarly journals Impact of Aspartate Aminotransferase–to–platelet Ratio Index Based Score to Assess Posthepatectomy Liver Failure in Patients With Hepatocellular Carcninoma

2022 ◽  
Author(s):  
Kyohei Yugawa ◽  
Takashi Maeda ◽  
Shigeyuki Nagata ◽  
Jin Shiraishi ◽  
Akihiro Sakai ◽  
...  
Keyword(s):  
Blood Loss ◽  
Liver Failure ◽  
Hepatic Resection ◽  
Aspartate Aminotransferase ◽  
Predictive Accuracy ◽  
Operating Time ◽  
Meld Score ◽  
Intraoperative Blood Loss ◽  
Scoring Model ◽  
Posthepatectomy Liver Failure

Abstract Background: Posthepatectomy liver failure (PHLF) is a life-threatening complication following hepatic resection. The aspartate aminotransferase-to-platelet ratio index (APRI) is a noninvasive model for assessing the liver functional reserve in patients with hepatocellular carcinoma (HCC). This study aimed to establish a scoring model to stratify patients with HCC at risk for PHLF.Methods: This single-center retrospective study included 451 patients who underwent hepatic resection for HCC between 2004 and 2017. Preoperative factors, including noninvasive liver fibrosis markers and intraoperative factors, were evaluated. The predictive impact for PHLF was evaluated using receiver operating characteristic (ROC) curves of these factors.Results: Of 451 patients, 30 (6.7%) developed severe PHLF (grade B/C). Multivariate logistic analysis indicated that APRI, model for end-stage liver disease (MELD) score, operating time, and intraoperative blood loss were significantly associated with severe PHLF. A scoring model (over 0–4 points) was calculated using these optimal cutoff values. The area under the ROC curve of the established score for severe PHLF was 0.88, which greatly improved the predictive accuracy compared with these factors alone (p < 0.05 for all). Conclusions: The scoring model-based APRI, MELD score, operating time, and intraoperative blood loss can predict severe PHLF in patients with HCC.

scholarly journals A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Li ◽  
Xi Liang ◽  
Shan Xu ◽  
Ye Xiong ◽  
Jianrong Huang
Keyword(s):  
Survival Rate ◽  
Blood Loss ◽  
Liver Failure ◽  
Control Group ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Liver Support ◽  
Liver Support System

AbstractWe aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

scholarly journals A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital

2019 ◽  
Vol 23 (04) ◽  
pp. e403-e407 ◽  
Author(s):  
Vinoth Manimaran ◽  
Sanjeev Mohanty ◽  
Satish Kumar Jayagandhi ◽  
Preethi Umamaheshwaran ◽  
Shivapriya Jeyabalakrishnan
Keyword(s):  
Blood Loss ◽  
Pulse Rate ◽  
Tertiary Care ◽  
Operating Time ◽  
Positive Association ◽  
Care Hospital ◽  
Intraoperative Blood Loss ◽  
Surgeon Experience ◽  
Patients At Risk ◽  
Risk Of Hemorrhage

Abstract Introduction Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.

scholarly journals Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

2020 ◽  
pp. 1-8
Author(s):  
Geraldine Yanlei Lei ◽  
Liang Shen ◽  
Sameer P. Junnarkar ◽  
CheongWei Terence Huey ◽  
JeeKeem Low ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Serum Bilirubin ◽  
Performance Indicator ◽  
Peak Serum ◽  
Intraoperative Blood Loss ◽  
Perioperative Outcome ◽  
Short Term ◽  
Cox's Regression

<b><i>Background/Purpose:</i></b> 90-day mortality is a key performance indicator for short-term perioperative outcome of hepatic resection (HR). Although many preoperative, intraoperative, and postoperative variables predict 90-day mortality following elective HR, only few are specific to hepatocellular carcinoma (HCC). This study aims to determine the predictors of 90-day mortality following elective HR for HCC. <b><i>Methods:</i></b> We report a retrospective analysis of patients who underwent elective HR between January 1, 2007, and December 31, 2017. Health status, perioperative variables, and the presence of post-hepatectomy liver failure (PHLF) were studied. Cox’s regression evaluated factors predicting 90-day mortality. <b><i>Results:</i></b> Two hundred and forty-four patients diagnosed with HCC underwent HR; 102 (41.8%) underwent a major HR. The postoperative 90-day mortality rate was 5.3%. Multivariate analysis demonstrated that Child-Pugh score (<i>p</i> &#x3c; 0.001), intraoperative blood loss (<i>p</i> = 0.013), the 50-50 criteria for PHLF (<i>p</i> &#x3c; 0.001) on postoperative day 5, and peak serum bilirubin &#x3e;119 µmol/L (<i>p</i> = 0.007) on postoperative day 3 predict 90-day mortality. <b><i>Conclusion:</i></b> In patients with HCC undergoing HR, Child-Pugh score, intraoperative blood loss, the 50-50 criteria for PHLF on postoperative day 5, and peak serum bilirubin &#x3e;119 µmol/L on postoperative day 3 predict 90-day mortality following elective HR for HCC.

scholarly journals Microendoscope-Assisted Decompression Surgery With Resection of Bony Fragment for Treating a Separation of Lumbar Posterior Ring Apophysis in Young Athletes

2020 ◽  
pp. 219256822092929 ◽  
Author(s):  
Motohiro Okada ◽  
Munehito Yoshida ◽  
Akihito Minamide ◽  
Kazunori Nomura ◽  
Kazuhiro Maio ◽  
...  
Keyword(s):  
Blood Loss ◽  
Japanese Orthopaedic Association ◽  
Operating Time ◽  
Case Series ◽  
Decompression Surgery ◽  
Return To Sports ◽  
Intraoperative Blood Loss ◽  
Young Athletes ◽  
The Mean ◽  
Posterior Ring

Study Design: Case series. Objectives: To report the clinical outcomes of the decompression procedure using the microendoscopic discectomy system for the treatment of a separation of lumbar posterior ring apophysis in young active athletes. Methods: We retrospectively reviewed 17 cases that underwent the microendoscopic surgery to treat a symptomatic separated lumbar ring apophysis between 2001 and 2014 at our institute or our associated hospital. The cases consisted of 15 males and 2 females, with their ages ranging from 12 to 19 years. The surgeries were performed at total of 18 lumbar levels, including 15 L4/5 and 3 L5/S1 levels. All patients were young athletes. We evaluated the following: (1) the Japanese Orthopaedic Association (JOA) score for low back pain, (2) recovery rates using Hirabayashi’s method, (3) operating time, (4) intraoperative blood loss, (5) perioperative complications, (6) the status of comeback to sports, and (7) the period taken to return to sports. Results: The JOA score was improved after the surgery in all cases. Recovery rate was 92.0% ± 8.1%. The mean operating time per level was 89.2 ± 33.3 minutes. The mean intraoperative blood loss per level was 95.3 ± 93.1 mL. A pinhole size dural tear occurred in one case as a perioperative complication. All cases returned to sports. The mean period taken to return to sports was 10.9 ± 3.5 weeks. Conclusion: Microendoscopic decompression surgery is useful for treating a separation of lumbar posterior ring apophysis.

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

2015 ◽  
Vol 55 (4) ◽  
pp. 291-301 ◽  
Author(s):  
Shogo Tanaka ◽  
Shigekazu Takemura ◽  
Hiroji Shinkawa ◽  
Takayoshi Nishioka ◽  
Genya Hamano ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Activity Index ◽  
Disease Free Survival ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Hepatic Resection ◽  
Cirrhotic Patients

Background/Purpose: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging. Methods: Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH. Results: Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606). Conclusions: LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.

scholarly journals Laparoscopic Adrenalectomy for Adrenal Tumors

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sun Chuan-yu ◽  
Ho Yat-faat ◽  
Ding Wei-hong ◽  
Gou Yuan-cheng ◽  
Hu Qing-feng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Benign Tumor ◽  
Operating Time ◽  
Adrenal Tumors ◽  
Benign Tumors ◽  
Intraoperative Blood Loss ◽  
First Choice ◽  
Average Operating ◽  
Average Operating Time

Objective. To evaluate the indication and the clinical value of laparoscopic adrenalectomy of different types of adrenal tumor.Methods. From 2009 to 2014, a total of 110 patients were diagnosed with adrenal benign tumor by CT scan and we performed laparoscopic adrenalectomy. The laparoscopic approach has been the procedure of choice for surgery of benign adrenal tumors, and the upper limit of tumor size was thought to be 6 cm.Results. 109 of 110 cases were successful; only one was converted to open surgery due to bleeding. The average operating time and intraoperative blood loss of pheochromocytoma were significantly more than the benign tumors (P<0.05). After 3 months of follow-up, the preoperative symptoms were relieved and there was no recurrence.Conclusions. Laparoscopic adrenalectomy has the advantages of minimal invasion, less blood loss, fewer complications, quicker recovery, and shorter hospital stay. The full preparation before operation can decrease the average operating time and intraoperative blood loss of pheochromocytomas. Laparoscopic adrenalectomy should be considered as the first choice treatment for the resection of adrenal benign tumor.

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