Emergency Gastrointestinal Surgery in Patients Undergoing Antithrombotic Therapy in a Single General Hospital: a Propensity Score-matched Analysis

Abstract Background: This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. Methods: We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) were assessed. The optimal value of EBL was determined using the receiver operating characteristic curve. Results: Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 ml; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 113 ml) occurred 3 in 146 patients. Multivariate analysis using the full cohort revealed that anticoagulant drug use was an independent risk factor for severe bleeding (odds ratio, 6.50; 95% CI 1.4-36; p = 0.015). Conclusions: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery, although patients taking anticoagulant drugs or multiple antithrombotic drugs should undergo careful surgical performances and postoperative management.

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Emergency Gastrointestinal Surgery in Patients Undergoing Antithrombotic Therapy in a Single General Hospital: A Propensity Score-Matched Analysis

10.21203/rs.3.rs-80658/v1 ◽

2020 ◽

Author(s):

Shinya Abe ◽

Katsunori Ami ◽

Akira Katsuno ◽

Noriyasu Tamura ◽

Toshiko Harada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Surgical Outcomes ◽

Antithrombotic Therapy ◽

Perioperative Complications ◽

Gastrointestinal Surgery ◽

Perioperative Outcomes ◽

Severe Bleeding ◽

Antithrombotic Drugs ◽

Estimated Blood Loss

Abstract Background: This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear.Methods: We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) were assessed. The optimal value of EBL was determined using the receiver operating characteristic curve.Results: Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 ml; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 113 ml) occurred in 146 patients. Multivariate analysis using the full cohort revealed that anticoagulant drug use was an independent risk factor for severe bleeding (odds ratio, 6.50; 95% CI 1.4 - 36; p = 0.015). Conclusions: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery, although patients taking anticoagulant drugs or multiple antithrombotic drugs should undergo careful surgical performances and postoperative management.

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Emergency gastrointestinal surgery in patients undergoing antithrombotic therapy in a single general hospital: a propensity score-matched analysis

BMC Gastroenterology ◽

10.1186/s12876-021-01897-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shinya Abe ◽

Katsunori Ami ◽

Akira Katsuno ◽

Noriyasu Tamura ◽

Toshiko Harada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Surgical Outcomes ◽

Antithrombotic Therapy ◽

Postoperative Bleeding ◽

Gastrointestinal Surgery ◽

Bleeding Complications ◽

Perioperative Outcomes ◽

Severe Bleeding ◽

Estimated Blood Loss

Abstract Background This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. Methods We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed. Results Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications. Conclusions This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.

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Laparoscopic Approach to Adrenalectomy: Review of Perioperative Outcomes in a Single Center

The American Surgeon ◽

10.1177/000313481107700519 ◽

2011 ◽

Vol 77 (5) ◽

pp. 592-596 ◽

Cited By ~ 8

Author(s):

Phuong H. Nguyen ◽

Jennifer E. Keller ◽

Yuri W. Novitsky ◽

B. Todd Heniford ◽

Kent W. Kercher

Keyword(s):

Blood Loss ◽

Laparoscopic Adrenalectomy ◽

Average Length ◽

Perioperative Complications ◽

Laparoscopic Approach ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

American Society ◽

The Right ◽

American Society Of Anesthesiologists

Laparoscopic expertise increases the volume of adrenalectomies at referral centers. We report our 10-year experience with laparoscopic adrenalectomy. All laparoscopic adrenalectomies at a single institution were prospectively recorded in a surgical outcomes database. Patient demographics, operative/perioperative outcomes, and adrenal pathology were reviewed retrospectively. From March 1999 through July 2009, 154 laparoscopic adrenalectomies were performed in 150 patients. Average patient age was 49.9 years (range 15-82); mean body mass index was 31.1 kg/m2 (range 17-56). Pathologic diagnoses included hyperaldosteronism (n = 69), nonfunctional adenoma (n = 28), pheochromocytoma (n = 23), hypercortisolism (n = 14), malignancy (primary n = 3, metastasis n = 9), and cyst (n = 4). Seventy-three per cent (n = 110) occurred on the left, 23 per cent (n = 35) on the right, 2.6 per cent (n = 4) bilateral, and 0.6 per cent (n = 1) as extra-adrenal. The average tumor measured 3.6 cm (range 0.4-12). The average operative time was 156 minutes (range 62-409), the mean estimated blood loss was 60 mL (range 10–100), and mean American Society of Anesthesiologists score was 2.6 (range 1-4). Three operations (0.2%) were converted to open. Three patients (0.2%) experienced perioperative complications (respiratory failure, urinary tract infection, line sepsis, and readmission within 30 days). The average length of stay was 3.4 days (range 1–14) and mean follow-up was 96.9 days (5-2567). No wound-related complications or deaths occurred. Pathologic diagnosis was not associated with a particular side or development of a complication ( P > 0.5). Patients with pheochromocytomas had the longest operative times, highest estimated blood loss, and highest American Society of Anesthesiologists scores (218.2 minutes, 128 mL, 3.0; P < 0.004). Laparoscopic adrenalectomy is safe and effective. Removal of pheochromocytomas is more challenging and may be more appropriate for referral to a specialized center for optimal outcomes.

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Antithrombotic drugs do not increase intraoperative blood loss in emergency gastrointestinal surgery: a single-institution propensity score analysis

World Journal of Emergency Surgery ◽

10.1186/s13017-019-0284-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Tadashi Matsuoka ◽

Kenji Kobayashi ◽

Alan Kawarai Lefor ◽

Junichi Sasaki ◽

Hiroharu Shinozaki

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Propensity Score Matching ◽

Gastrointestinal Surgery ◽

Drug Group ◽

Control Group ◽

Intraoperative Blood Loss ◽

Antithrombotic Drugs ◽

Antithrombotic Drug ◽

Propensity Score Matching Analysis

Abstract Background The use of antithrombotic drugs is increasing with the aging population. Prior to elective procedures, antithrombotic drugs are often discontinued. For emergency procedures in patients taking antithrombotic drugs, their effect cannot be attenuated which may lead to an increased risk of hemorrhagic events. However, there are few studies showing increased intraoperative blood loss in patients taking antithrombotic drugs who undergo emergency gastrointestinal surgery. The aim of this study is to determine whether the use of antithrombotic agents increases intraoperative blood loss in emergency gastrointestinal surgery. Methods A retrospective review of patients who underwent emergency abdominal surgery between January 2013 and December 2017 was conducted. The primary outcome measure was intraoperative blood loss. Patients were divided into the antithrombotic drug group and a control group, and a propensity score was developed using multivariate logistic regression. We use 1:1 propensity score matching analysis to compare outcomes between the two groups. Results Of 1555 patients included in this study, 1184 patients, including 170 patients taking antithrombotic drugs, were eligible for propensity score matching analysis. A 1:1 matching yielded 117 well-balanced pairs. There was no statistically significant difference in intraoperative blood loss (antithrombotic drug group vs control group, median (interquartile): 60 (225–10) vs 100 (243–10) ml, p = 0.43). Conclusions This study suggests that antithrombotic drugs do not increase intraoperative blood loss in patients undergoing emergency gastrointestinal surgery. Emergency gastrointestinal surgery for patients currently taking antithrombotic drugs can be performed safely, and the use of antithrombotic drugs is not a reason to delay surgical intervention.

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Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

Journal of Neurosurgery Spine ◽

10.3171/2018.11.spine18927 ◽

2019 ◽

Vol 30 (6) ◽

pp. 822-832

Author(s):

Cecilia L. Dalle Ore ◽

Christopher P. Ames ◽

Vedat Deviren ◽

Darryl Lau

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Vena Cava ◽

Deformity Correction ◽

Perioperative Outcomes ◽

Medical Complications ◽

Filter Placement ◽

Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

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Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽

10.1186/s12893-020-01027-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshikazu Nagase ◽

Shinya Matsuzaki ◽

Masayuki Endo ◽

Takeya Hara ◽

Aiko Okada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Cesarean Delivery ◽

Clinical Features ◽

Surgical Outcomes ◽

Multivariate Regression ◽

Placenta Previa ◽

Control Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

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Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00374-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tadashi Matsuoka ◽

Nao Ichihara ◽

Hiroharu Shinozaki ◽

Kenji Kobayashi ◽

Alan Kawarai Lefor ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Blood Loss ◽

Emergency Surgery ◽

Retrospective Cohort ◽

Confounding Factors ◽

Intraoperative Blood Loss ◽

Antithrombotic Drugs ◽

Generalized Peritonitis ◽

Blood Loss Volume

Abstract Background The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan. Method This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates. Results A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery. Conclusion This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽

10.1186/s12894-020-00637-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Changwei Ji ◽

Qun Lu ◽

Wei Chen ◽

Feifei Zhang ◽

Hao Ji ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Laparoscopic Adrenalectomy ◽

Perioperative Outcomes ◽

Adrenal Tumors ◽

Transfusion Rate ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02429-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Lu Fang ◽

Huan Li ◽

Tao Zhang ◽

Rui Liu ◽

Taotao Zhang ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Univariate Analysis ◽

Warm Ischemia ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Estimated Blood Loss ◽

Perinephric Fat

Abstract Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

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