Peculiarities of the postoperative period and postoperative consequences of left hemicolectomy in patients with obesity

Annotation. Obesity is considered a risk factor for postoperative complications and postoperative mortality. The aim of the study was to assess the impact of obesity on the postoperative period and the level of postoperative mortality after left hemicolectomy. A retrospective analysis of the medical records of 217 patients who underwent left hemicolectomy for colon tumors was performed. Assessment of comorbid conditions was performed using the Charlson index. Postoperative complications were assessed according to the Clavien-Dindo classification. The calculation of postoperative survival was performed by the Kaplan-Mayer method. Database formation and statistical analysis were performed using Microsoft Excel and STATISTICA 10.0. It was determined that the mean values of the Charlson index did not differ significantly between the two groups (6,31 ± 2,07 and 6,33 ± 2,08 respectively), but there was a significantly higher level of endocrine diseases in the group of obese patients. Non-disseminated (I-II) stages of the tumor process predominated in patients of both groups (60% and 57.5%, respectively). Among non-obese patients n = 107 (51.8%) patients had an uncomplicated postoperative period and n = 59 (28.5%) patients had mild complications that were not associated with the surgical site, but were associated with concomitant chronic pathology of other organs and systems, and did not require any invasive interventions. In contrast, among obese patients n = 6 (60%) patients had severe early postoperative complications requiring surgery, and n = 2 (20%) patients underwent relaparotomy. The rate of early postoperative mortality differed significantly between the two groups and was significantly higher among obese patients (40% vs 6.8% among non-obese patients). This study showed a significantly higher percentage of postoperative mortality and severity of postoperative complications in the group of obese patients. The prospect of further research is to study and analyze the course of the postoperative period in obese patients undergoing extended, multi-visceral and multi-stage surgery for cancer of the left half of the colon.

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Ist die Adipositas ein Risikofaktor für postoperative Komplikationen nach Lungenlappenresektion?

Karger Kompass Pneumologie ◽

10.1159/000500586 ◽

2019 ◽

Vol 7 (4) ◽

pp. 200-201

Author(s):

Thomas Lesser

Keyword(s):

Postoperative Complications ◽

Intraoperative Complications ◽

Lung Resection ◽

Postoperative Mortality ◽

Obesity Paradox ◽

P Value ◽

Obese Patients ◽

Short Term ◽

Lung Lobectomy ◽

The Impact

Background: The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. Methods: This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI <30 kg/m2). Results: In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). Conclusions: Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.

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Low preoperative platelets to predict postoperative liver dysfunction in patients with metastatic colorectal cancer undergoing liver resection.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.634 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 634-634

Author(s):

Patrick Starlinger ◽

Beata Herberger ◽

Dietmar Tamandl ◽

Stefan Stremitzer ◽

Christine Brostjan ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

High Risk ◽

Postoperative Complications ◽

Metastatic Colorectal Cancer ◽

Liver Dysfunction ◽

Postoperative Mortality ◽

Platelet Counts ◽

The Impact ◽

Selection Of

634 Background: Despite improving median survival of metastatic colorectal cancer (mCRC) patients, chemotherapy (CTx) compromises liver function. Therefore, selection of patients who are of high risk to develop liver dysfunction (LD) after surgery is important. As platelets are of major importance in liver regeneration, we investigated the impact of preoperative platelet counts on the incidence of postoperative LD and its correlation to postoperative morbidity and mortality. Methods: Patients treated with liver resection for mCRC between January 2000 and December 2010 were eligible. LD was defined as bilirubin > 5 mg/dL or prothrombin time <50% within the first postoperative week. The association of preoperative platelets < 150 x 103/ml with LD, 90 days mortality and surgical complications was analyzed. Results: 518 patients with metastatic CRC cancer underwent liver resection, of whom 68% had received neoadjuvant CTx. 21% of all patients developed LD. Postoperative complications occurred in 13.5%. 10 patients died within 90 days after liver resection (1.9%). The incidence of LD and complications was significantly higher in patients with preoperative platelets < 150 x 103/ml (P=0.010, P=0.047). 90 days mortality was nearly 3 times higher in patients with reduced preoperative platelets (9.8% vs. 3.7%). Neoadjuvant CTx was associated with an increased rate of platelets < 150 x 103/ml (with CTx 25%, without CTx 17%; P=0.051), LD (with CTx 23%, without CTx 15%; P=0.029) and postoperative mortality (with CTx 5.3%, without CTx 2.5%). Conclusions: Patients with platelets < 150 x 103/ml have an increased incidence of postoperative LD, major complications and 90 days mortality. Using this simple routine parameter, it might be possible to select patients that could be better served with alternative treatments such as radiofrequency ablation. Furthermore, reduced platelet counts and the incidence of LD were more frequent in patients after neoadjuvant CTx resulting in an increased 90 days mortality. This suggests that patients after extensive CTx accompanied by low platelets are of high risk to suffer from postoperative complications and surgical treatment should be reconsidered.

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Prediction of Postoperative Mortality in Patients With Organ Failure Following Pancreaticoduodenectomy

The American Surgeon ◽

10.1177/00031348211065104 ◽

2021 ◽

pp. 000313482110651

Author(s):

Vivian Li ◽

Pablo E. Serrano

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Organ Failure ◽

Multivariable Analysis ◽

Significant Proportion ◽

Postoperative Mortality ◽

Failure To Rescue ◽

Renal Complications ◽

The One ◽

The Impact

Background Failure to rescue (FTR) patients with postoperative complications contribute to a significant proportion of postoperative mortality. Our main objective was to determine the risk factors for FTR among patients undergoing pancreaticoduodenectomy who suffered a life-threatening complication requiring intensive care unit (ICU) management. Materials and Methods Consecutive patients undergoing pancreaticoduodenectomy from 2011 to 2020 were reviewed retrospectively. Causes of organ failure were described as the one that most commonly contributed to patient’s transfer to ICU or death. Two groups were created based on whether patients had FTR and risk factors for FTR were compared. The impact of baseline characteristics, operative characteristics, and risk scoring on FTR was analyzed using multiple logistic regression. Results There were 19/58 (33%) FTR patients. Baseline, operative characteristics, postoperative complications, and length of hospital and ICU stay were similar between groups. However, a higher proportion of FTR patients experienced a postoperative pancreatic fistula (POPF) (16% vs 2.6%, P = .062). Among patients who experienced a POPF, the FTR group had a trend in delayed time from diagnosis to treatment (7 vs 23 hours, P=.131). Renal complications (OR 6.12, 95% CI, 1.23 to 38.43, P = .035) and time from POPF diagnosis to treatment (OR 1.05, 95% CI, 1.00 to 1.11, P = .036) were independent predictors of FTR by multivariable analysis. Conclusion The occurrence of certain postoperative complications such as renal complications as well as delayed timing of the management of POPF is predictive of FTR following pancreaticoduodenectomy, especially as delayed timing to treatment is a risk factor for FTR.

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Elective hip arthroplasty rates and related complications in people with diabetes mellitus

Hip International ◽

10.1177/1120700020981573 ◽

2020 ◽

pp. 112070002098157

Author(s):

Lindsey C McVey ◽

Nicholas Kane ◽

Helen Murray ◽

RM Dominic Meek ◽

S Faisal Ahmed

Keyword(s):

Diabetes Mellitus ◽

Postoperative Complications ◽

Glycaemic Control ◽

Hip Arthroplasty ◽

Surgical Complications ◽

Complication Rates ◽

Obese Patients ◽

Poor Glycaemic Control ◽

Increased Risk ◽

The Impact

Background and Aims: Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. Methods: We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). Results: Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls ( p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls ( p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls ( p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control ( p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients ( p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI ( p = 0.587). Conclusions: DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.

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Clinical and Economic Impact of Previous Bariatric Surgery on Liver Transplantation: a Nationwide, Population-Based Retrospective Study

Obesity Surgery ◽

10.1007/s11695-021-05684-4 ◽

2021 ◽

Author(s):

Antonio Iannelli ◽

Julie Bulsei ◽

Tarek Debs ◽

Albert Tran ◽

Andrea Lazzati ◽

...

Keyword(s):

Bariatric Surgery ◽

Hospital Stay ◽

Group Versus ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Control Group ◽

Study Group ◽

Obese Patients ◽

History Of ◽

The Impact

Abstract Purpose The present study aims to determine the impact of previous bariatric surgery (BS) on the length of hospital stay; the incidence of mortality, re-transplantation, and re-hospitalization after LT; and the related economic costs, through the analysis of the French National Health Insurance Information System. Materials and Methods All patients aged > 18 years who underwent LT in France in the period from 2010 to 2019 were included. Thirty-nine patients with a history of BS (study group) were compared with 1798 obese patients without previous BS (control group). Results At the time of LT, patients with a history of BS were significantly younger than those of the control group and had lower Charlson comorbidity index. Female sex was significantly more represented in the study group. No significant differences were detected between the two groups regarding the postoperative mortality rate after LT (10.3% in the study group versus 8.0% in the control group), long-term mortality (0.038 versus 0.029 person-year of follow-up, respectively), re-transplantation (adjusted hazard ratio (HR) = 2.15, p = 0.2437), re-hospitalization (adjusted analysis, IRR = 0.93, p = 0.7517), and costs of LT hospitalization (73,515 € in the study group versus 65,878 € in the control group). After 1:2 propensity score matching, the duration of the LT hospital stay was significantly longer in the study group (58.3 versus 33.4 days, p = 0.0172). Conclusion No significant differences were detected between patients with previous BS versus obese patients without history of BS undergoing LT concerning the rates of mortality, re-LT, re-hospitalization after LT, and costs of hospitalization and re-hospitalizations. Graphical abstract

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Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9113526 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3526

Author(s):

Patrick Téoule ◽

Erik Rasbach ◽

Hani Oweira ◽

Mirko Otto ◽

Nuh N. Rahbari ◽

...

Keyword(s):

Overall Survival ◽

Postoperative Complications ◽

Pancreatic Surgery ◽

Study Groups ◽

Ductal Adenocarcinoma ◽

Matched Pair ◽

Matched Pairs ◽

Obese Patients ◽

Curative Intent ◽

The Impact

Background: Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic. Methods: Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m2. The primary endpoint was the difference in overall survival between patients with and without obesity. Results: Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m2 in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery. Conclusions: Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.

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Radiofrequency ablation of colorectal liver metastases

Perspectives in Surgery ◽

10.33699/pis.2019.98.10.399-403 ◽

2019 ◽

Vol 98 (10) ◽

Keyword(s):

Radiofrequency Ablation ◽

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Postoperative Mortality ◽

Disease Free Survival ◽

Female Ratio ◽

Liver Resections ◽

Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

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Working of an oncological surgical nurse in the prevention of postoperative complications after undergoing radical mastectomy

Medsestra (Nurse) ◽

10.33920/med-05-2007-01 ◽

2020 ◽

pp. 10-14

Author(s):

Natalya Fedosova ◽

Anatoly Volodin

Keyword(s):

Postoperative Complications ◽

Nursing Care ◽

Postoperative Period ◽

Radical Mastectomy

The article presents the results of a study conducted to determine the effect of the organization of nursing care on reducing the duration of the postoperative period in women who underwent radical mastectomy.

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Study of Biochemical and Clinical Markers in Steatohepatitis Related to Obesity

Revista de Chimie ◽

10.37358/rc.18.6.6355 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1501-1505

Author(s):

Roxana Maria Livadariu ◽

Radu Danila ◽

Lidia Ionescu ◽

Delia Ciobanu ◽

Daniel Timofte

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Large Scale ◽

Biological Data ◽

Obese Patients ◽

Clinical Markers ◽

Mean Values ◽

Nonalcoholic Fatty Liver ◽

Obstructive Sleep ◽

Increased Risk

Nonalcoholic fatty liver disease (NAFLD) is highly associated to obesity and comprises several liver diseases, from simple steatosis to steatohepatitis (NASH) with increased risk of developing progressive liver fibrosis, cirrhosis and hepatocellular carcinoma. Liver biopsy is the gold standard in diagnosing the disease, but it cannot be used in a large scale. The aim of the study was the assessment of some non-invasive clinical and biological markers in relation to the progressive forms of NAFLD. We performed a prospective study on 64 obese patients successively hospitalised for bariatric surgery in our Surgical Unit. Patients with history of alcohol consumption, chronic hepatitis B or C, other chronic liver disease or patients undergoing hepatotoxic drug use were excluded. All patients underwent liver biopsy during sleeve gastrectomy. NAFLD was present in 100% of the patients: hepatic steatosis (38%), NASH with the two forms: with fibrosis (31%) and without fibrosis (20%), cumulating 51%; 7 patients had NASH with vanished steatosis. NASH with fibrosis statistically correlated with metabolic syndrome (p = 0.036), DM II (p = 0.01) and obstructive sleep apnea (p = 0.02). Waist circumference was significantly higher in the steatohepatitis groups (both with and without fibrosis), each 10 cm increase increasing the risk of steatohepatitis (p = 0.007). The mean values of serum fibrinogen and CRP were significantly higher in patients having the progressive forms of NAFLD. Simple clinical and biological data available to the practitioner in medicine can be used to identify obese patients at high risk of NASH, aiming to direct them to specialized medical centers.

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Determining the impact of postoperative complications in neurosurgery based on simulated longitudinal smartphone app-based assessment

Acta Neurochirurgica ◽

10.1007/s00701-021-04967-0 ◽

2021 ◽

Author(s):

Lion D. Comfort ◽

Marian C. Neidert ◽

Oliver Bozinov ◽

Luca Regli ◽

Martin N. Stienen

Keyword(s):

Postoperative Complications ◽

Feasibility Study ◽

Well Being ◽

Smartphone Application ◽

Simulated Patients ◽

Subjective Well Being ◽

Longitudinal Assessment ◽

User Friendliness ◽

User Friendly ◽

The Impact

Abstract Background Complications after neurosurgical operations can have severe impact on patient well-being, which is poorly reflected by current grading systems. The objective of this work was to develop and conduct a feasibility study of a new smartphone application that allows for the longitudinal assessment of postoperative well-being and complications. Methods We developed a smartphone application “Post OP Tracker” according to requirements from clinical experience and tested it on simulated patients. Participants received regular notifications through the app, inquiring them about their well-being and complications that had to be answered according to their assigned scenarios. After a 12-week period, subjects answered a questionnaire about the app’s functionality, user-friendliness, and acceptability. Results A total of 13 participants (mean age 34.8, range 24–68 years, 4 (30.8%) female) volunteered in this feasibility study. Most of them had a professional background in either health care or software development. All participants downloaded, installed, and applied the app for an average of 12.9 weeks. On a scale of 1 (worst) to 4 (best), the app was rated on average 3.6 in overall satisfaction and 3.8 in acceptance. The design achieved a somewhat favorable score of 3.1. One participant (7.7%) reported major technical issues. The gathered patient data can be used to graphically display the simulated outcome and assess the impact of postoperative complications. Conclusions This study suggests the feasibility to longitudinally gather postoperative data on subjective well-being through a smartphone application. Among potential patients, our application indicated to be functional, user-friendly, and well accepted. Using this app-based approach, further studies will enable us to classify postoperative complications according to their impact on the patient’s well-being.

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