Evaluation of anemia as a postoperative risk factor in the evolution of patients with gastric resection for malignancies

Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

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EARLY ORAL RE-FEEDING ON ONCOLOGY PATIENTS SUBMITTED TO GASTRECTOMY FOR GASTRIC CANCER

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000300014 ◽

2015 ◽

Vol 28 (3) ◽

pp. 200-203 ◽

Cited By ~ 12

Author(s):

Andressa Madalozo LAFFITTE ◽

Camila Brandão POLAKOWSKI ◽

Massakazu KATO

Keyword(s):

Gastric Cancer ◽

Weight Loss ◽

Hospital Stay ◽

Gastrointestinal Symptoms ◽

Length Of Hospital Stay ◽

Partial Gastrectomy ◽

Abdominal Distension ◽

Infectious Complications ◽

Normal Weight ◽

Elective Resection

Background: There is no advantage in maintaining patients on oral fasting after gastrointestinal elective resection. The early feeding up to 48 h can be beneficial, because it reduces infectious complications and hospital stay. Aim: Evaluate the evolution and tolerance of early oral diet in postoperative period after gastrectomy for gastric cancer. Methods: Anthropometric assessment was performed on the day of surgery, weight, height, body mass index and weight loss were measured. Acceptance of diet was evaluated as food intake (amount accepted) and gastrointestinal symptoms such as nausea, vomiting, constipation, diarrhea, abdominal distension, postoperative complications and hospital stay. Results: The sample consisted of 23 patients, 17 with partial gastrectomy and six with total gastrectomy. In the assessment of nutritional status 9% were malnourished, 54.5% normal weight, 9% overweight and 27.2% obese, but 54% had weight loss. There was good acceptance of the diet in 96,9% of the sample. Nausea and abdominal distension were present in 4,3% and 65.2% constipation. Surgical complications according to the Clavien scalle, 13% had grade V, 4.3% grade IIIA, 8.7% grade I and 73% did not have complications. The length of hospital stay was 5±2.2 days. Conclusion: Early postoperative re-feeding in total and partial gastrectomy was well tolerated by patients.

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Preoperative Anemia in Hindfoot and Ankle Arthrodesis

Foot & Ankle Specialist ◽

10.1177/1938640016666921 ◽

2016 ◽

Vol 10 (2) ◽

pp. 109-115 ◽

Cited By ~ 4

Author(s):

Brian Dix ◽

Lisa Grant-McDonald ◽

Alan Catanzariti ◽

Karl Saltrick

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

Ankle Arthrodesis ◽

Delayed Union ◽

Infectious Complications ◽

Fisher Exact Test ◽

Preoperative Anemia ◽

Exact Test ◽

Vein Thrombosis

This is a retrospective study (n = 39) evaluating the postoperative outcomes of patients with mild to moderate preoperative anemia who underwent a hindfoot and/or ankle arthrodesis. In the study, 32 patients did not have preoperative anemia, and 7 had preoperative anemia. Mortality, length of hospital stay, blood transfusions, deep-vein thrombosis, infection, time to union, malunion, delayed union, nonunion, and ulceration were of particular interest. Comparative analyses between patients with preoperative anemia and those without were performed utilizing the independent samples t-test or by the nonparametric Mann-Whitney U-test. The Fisher exact test was used to analyze categorical data. The Shapiro-Wilk test was utilized to check normality. Statistical significance was defined at a 2-sided level of P <.05. Delayed union, nonunion, and malunion were all significantly increased in patients with preoperative anemia (P = .032, P = .004, and P = .028, respectively). Accordingly, the median total number of noninfectious complications (delayed union + nonunion + malunion) in patients with preoperative anemia (0.86 ± 0.38) was significantly higher than in patients without preoperative anemia (0.063 ± 0.25; P < .001). Patients with preoperative anemia had a significantly longer length of hospital stay in days (4.14 ± 2.61). Total infection was also significantly associated with preoperative anemia (P = .001). This study clearly demonstrated that infectious complications, noninfectious complications, and length of hospital stay in hindfoot and/or ankle arthrodesis was significantly affected by preoperative anemia. Thus, consideration should be given to addressing preoperative anemia prior to hindfoot and/or ankle arthrodesis. Levels of Evidence: Level II Study

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Reduced postoperative complications and length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol

10.26226/morressier.58f5b030d462b80296c9e486 ◽

2017 ◽

Author(s):

Javier Ripollés-Melchor

Keyword(s):

Postoperative Complications ◽

Colorectal Surgery ◽

Hospital Stay ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Enhanced Recovery Protocol

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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Preoperative Hyponatremia Is Associated with Reoperation and Prolonged Length of Hospital Stay following Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1641156 ◽

2018 ◽

Vol 32 (04) ◽

pp. 344-351 ◽

Cited By ~ 3

Author(s):

Matthew Abola ◽

Joseph Tanenbaum ◽

Thomas Bomberger ◽

Derrick Knapik ◽

Steven Fitzgerald ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Limited Information ◽

Improvement Program ◽

Prolonged Length ◽

Total Knee

AbstractHyponatremia is a risk factor for adverse surgical outcomes, but limited information is available on the prognosis of hyponatremic patients who undergo total knee arthroplasty (TKA). The purpose of this investigation was to compare the incidence of major morbidity (MM), 30-day readmission, 30-day reoperation, and length of hospital stay (LOS) between normonatremic and hypontremic TKA patients.The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all primary TKA procedures. Hyponatremia was defined as <135 mEq/L and normonatremia as 135 to 145 mEq/L; hypernatremic patients (>145 mEq/L) were excluded. Multivariable logistic regression was used to determine the association between hyponatremia and outcomes after adjusting for demographics and comorbidities. An α level of 0.002 was used and calculated using the Bonferroni correction. Our final analysis included 88,103 patients of which 3,763 were hyponatremic and 84,340 were normonatremic preoperatively. In our multivariable models, hyponatremic patients did not have significantly higher odds of experiencing an MM (odds ratio [OR]: 1.05; 99% confidence interval [CI] 0.93–1.19) or readmission (OR: 1.12; 99% CI: 1–1.24). However, patients with hyponatremia did experience significantly greater odds for reoperation (OR: 1.24; 99% CI: 1.05–1.46) and longer hospital stay (OR: 1.15; 99% CI: 1.09–1.21). We found that hyponatremic patients undergoing TKA had increased odds of reoperation and prolonged hospital stay. Preoperative hyponatremia may be a modifiable risk factor for adverse outcomes in patients undergoing TKA, and additional prospective studies are warranted to determine whether preoperative correction of hyponatremia can prevent complications.

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P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

Diseases of the Esophagus ◽

10.1093/dote/doz092.175 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Markar Sheraz ◽

Ni Melody ◽

Gisbertz Suzanne ◽

Straatman Jennifer ◽

van der Peet Donald ◽

...

Keyword(s):

Multivariate Analysis ◽

Postoperative Complications ◽

Minimally Invasive ◽

Hospital Stay ◽

Minimally Invasive Esophagectomy ◽

Univariate Analysis ◽

Length Of Hospital Stay ◽

Time Trial ◽

Reoperation Rate ◽

Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

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Impact of surgeon case volume on postoperative complications, mortality, medical costs and length of hospital stay after transurethral resection of the prostate (TURP): A nationwide population-based study in Taiwan

Urological Science ◽

10.1016/j.urols.2016.05.114 ◽

2016 ◽

Vol 27 (2) ◽

pp. S18

Author(s):

Chou Chen-wei ◽

Leonard S. Chuech ◽

Tu Yuan-po ◽

Hsu Fu-shun ◽

Lan Tzuo-Yun

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Transurethral Resection ◽

Length Of Hospital Stay ◽

Medical Costs ◽

Population Based ◽

Case Volume ◽

Population Based Study

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Bariatric patients' nutritional status as a risk factor for postoperative complications, prolonged length of hospital stay and hospital readmission: A retrospective cohort study

International Journal of Surgery ◽

10.1016/j.ijsu.2018.06.022 ◽

2018 ◽

Vol 56 ◽

pp. 210-214 ◽

Cited By ~ 1

Author(s):

Piotr Major ◽

Piotr Małczak ◽

Michał Wysocki ◽

Grzegorz Torbicz ◽

Natalia Gajewska ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Postoperative Complications ◽

Nutritional Status ◽

Retrospective Cohort Study ◽

Hospital Readmission ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

Prolonged Length ◽

Bariatric Patients

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Crystalloid Administration Is Associated with the Recovery of Pediatric Elective Roux-en-Y Hepaticojejunostomy

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1677544 ◽

2019 ◽

Vol 30 (02) ◽

pp. 187-192

Author(s):

Xingqin Tan ◽

Jianxia Liu ◽

Chunbao Guo

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Bowel Movement ◽

Length Of Hospital Stay ◽

Postoperative Recovery ◽

Fluid Administration ◽

Postoperative Complication Rate ◽

Crystalloid Fluid ◽

High Fluid ◽

Crystalloid Administration

Abstract Introduction Intraoperative fluid administration is important for postoperative recovery and might be associated with postoperative complications. Materials and Methods This retrospective review included 471 patients who underwent Roux-en-Y hepaticojejunostomy. Patients were separated into two groups based on whether they received low (<15.27 mL/kg/h) or high (>15.27 mL/kg/h) volumes of corrected crystalloid fluids. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 192 matched patients, clinical outcomes, including postoperative complications and length of hospital stay, were compared. Results Higher use of diuresis (p = 0.027) was found in the high fluid group. Receiving low volumes of crystalloids was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.31–1.07; p = 0.047) and first bowel movement (OR, 0.56; 95% CI, 0.38–0.98; p = 0.013). However, the occurrence of renal complications did not show significant differences between the groups. A lower postoperative complication rate (OR, 0.54; 95% CI, 0.42–0.94; p = 0.016) was noted in patients with low crystalloids compared with high crystalloids. The total length of hospital stay was longer in patients with high crystalloid fluid (9.21 ± 3.24 days) than patients with low volumes (7.83 ± 2.58 days; p = 0.012). Conclusion Low crystalloid fluid administration was associated with favorable postoperative outcomes.

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