scholarly journals Risk Factors Related to Operative Duration and Their Relationship With Clinical Outcomes in Pediatric Patients Undergoing Roux-en-Y Hepaticojejunostomy

2020 ◽  
Vol 8 ◽  
Author(s):  
Yongjun Zhou ◽  
Yunfei Zhang ◽  
Hongjie Guo ◽  
Chao Zheng ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Operative Time ◽  
Short Operative Time ◽  
Perioperative Morbidity ◽  
Operative Duration ◽  
Independent Risk Factors ◽  
Surgical Duration ◽  
Median Operative Time

Background: Operative duration might be important for perioperative morbidity, and its involvement has not been fully characterized in pediatric patients. We identified perioperative variables associated with operative duration and determined their influence on clinical outcomes in pediatric patients.Methods: We retrospectively reviewed 701 patients who underwent elective removal of choledochal cysts followed by Roux-en-Y hepaticojejunostomy. The patients were separated into the long operative time group (>165 min) and short operative time group (<165 min) based on the median operative time (165 min). Propensity score matching was performed to adjust for any potential selection bias. The independent risk factors for operative time were determined using multivariable logistic regression analyses.Results: The operative time was often increased by excision difficulty caused by a larger choledochal cyst size (OR = 1.56; 95% CI, 1.09–2.23; p < 0.001), a greater BMI (OR = 1.02; 95% CI, 1.00–1.15; p = 0.018), and older age (OR = 1.17; 95% CI, 1.02–1.39; p = 0.012) in the multivariate analysis. A long surgical duration was associated with delayed gastrointestinal functional recovery, as measured using the time to first defecation (p = 0.027) and first bowel movement (p = 0.019). Significantly lower levels of serum albumin were found in the long operative time group than in the short operative time group (p = 0.0035). The total length of postoperative hospital stay was longer in patients in the long operative time group (7.51 ± 2.03 days) than in those in the short operative time group (6.72 ± 1.54 days, p = 0.006).Conclusions: Our data demonstrated that a short operative time was associated with favorable postoperative results. The influencing factors of operative time should be ameliorated to achieve better outcomes.

scholarly journals Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases

2018 ◽  
Vol 7 (12) ◽  
pp. 547
Author(s):  
Michał Wysocki ◽  
Dorota Radkowiak ◽  
Anna Zychowicz ◽  
Mateusz Rubinkiewicz ◽  
Jan Kulawik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Perioperative Complications ◽  
Perioperative Morbidity ◽  
Group 12 ◽  
Independent Risk Factors ◽  
Male Sex ◽  
And Control

Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications.

Ventricular Fibrillation After Release of an Aortic Cross-Clamp in Valvular Surgery: Independent Risk Factors, Outcomes, and Incidence from Access Routes

2021 ◽  
Author(s):  
Weichao LI ◽  
heng li ◽  
Jianping Gong ◽  
Weihua Liu ◽  
BaoJun Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Fibrillation ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Smoking Status ◽  
Left Ventricular ◽  
Aortic Cross Clamp ◽  
Valvular Surgery ◽  
Htk Solution ◽  
Independent Risk Factors

Abstract Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.

scholarly journals 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Dong Hoon Shin ◽  
Kang Il Jun ◽  
Song Mi Moon ◽  
Wan Beom Park ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Resistant Organism ◽  
Time Interval ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Acute Myelogenous ◽  
Independent Risk Factors

Abstract Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.

scholarly journals The Risk Factors for Perioperative Serum Albumin Variation in Pediatric Patients Undergoing Major Gastroenterology Surgery

2021 ◽  
Vol 7 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Chao Zheng ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Patients ◽  
Operating Time ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Perioperative Outcomes ◽  
Multivariable Logistic Regression Model ◽  
Perioperative Morbidity ◽  
Charcot’S Triad

Background: The albumin, a negative acute-phase protein, is important for perioperative morbidity, even in patients with normal preoperative levels. This study intend to determine the perioperative factors related with the postoperative reduction in serum albumin (ΔALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 pediatric patients who underwent major gastroenterology surgery from August 2010 to August 2019. The patients were dichotomized into a high ΔALB group (≥14.6%) and a low ΔALB group (&lt;14.6%) based on the mean value of ΔALB (14.6%). the independent risk factors for ΔALB, were explored using the propensity score matching to minimize potential selection bias and subjected to method multivariable logistic regression model. Furthermore, in 366 matched patients, the influences of operating time on perioperative outcomes were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 [odds ratio (OR) = 2.36 (95% CI, 1.51–3.86); p = 0.007], a longer operating time [OR = 1.18 (95% CI, 1.00–1.53); p = 0.014), and the presence of Charcot's triad [OR = 1.73 (95% CI, 1.05–2.83); p = 0.031] were factors that predicted a high ΔALB level. A high ΔALB level was also related with gastrointestinal functional recovery delay, reflected by the postoperative defecation (p = 0.013) and bowel movement (p = 0.019) delay and the high occurrence of postoperative complications (16.1 vs. 10.9%, OR, 1.57; 95% CI, 1.02–2.41, P = 0.0026).Conclusions: The high ΔALB level was correlated with postoperative outcome. To obtain a safe recovery and discharge after a major abdominal operation, the above risk factors for ΔALB could be addressed in the perioperative period.

Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

2012 ◽  
Vol 33 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Eman Shaban ◽  
Cecile Letourneau ◽  
Angel Pechie
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prolonged Exposure ◽  
Adverse Outcomes ◽  
Concurrent Use ◽  
Independent Risk Factors ◽  
The Impact

Objective.To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.Design.Retrospective cohort study.Setting.University-affiliated community hospital.Methods.We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.Results.Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.Conclusions.Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

scholarly journals Prognostic death factors in SHLH children with MODS receiving CRRT: a multicenter prospective nested case-control study

2020 ◽  
Author(s):  
Yun Cui ◽  
Jingyi Shi ◽  
Yijun Shan ◽  
Chunxia Wang ◽  
Yuqian Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Dysfunction ◽  
Pediatric Patients ◽  
Case Control Study ◽  
Case Control ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Independent Risk Factors ◽  
Nested Case Control ◽  
Control Study

Abstract Background: Multiple organ dysfunction syndrome (MODS) with secondary hemophagocytic lymphohistiocytosis (SHLH) causes significant mortality, while continuous renal replacement therapy (CRRT) is commonly conducted. The objective is to identify the predictor factors associated with poor outcomes in pediatric patients with SHLH -associated MODS who received CRRT. Methods: A multicenter prospective nested case-control study in four PICUs of tertiary university children’s hospital in Shanghai from September 2013 to August 2018.We prospectively studied 52 SHLH-associated MODS pediatric patients receiving CRRT. Results: Overall PICU mortality rate was 46.15%(24/52). Less respiratory (28.6% vs. 87.5%, P <0.001) or cardiovascular dysfunction (25% vs. 83.3%, P <0.001) caused in survivors at CRRT initiation, as well as reduced demands of mechanical ventilation and vasoactive agents (28.6% vs. 87.5%,17.9 % vs. 66.7 %, both P <0.001). Non-survivors had higher levels of serum lactate dehydrogenase (1404.5 (713.25, 2793) vs. 982.7 (692, 1461) (U/L), P = 0.037), lactic acid (1.9 (1.3, 4.53) (mmol/L) vs. 1.65 (0.8, 2.45) , P=0.034), triglyceride (2.88 (1.94, 5.08) (mmol/L) vs. 2.41 (1.63, 3.32), P=0.032) and IL-6 (28.66 (17.77, 113.63) (pg/ml) vs.0.98 (0.1, 4.63) P=0.000). More than 3 organ dysfunction (Odd ratio [ OR ] : 3.464; 95% confidence interval [ CI ] [1.018-11.788], P = 0.047), and the serum IL-6 level higher than 13.12 pg/mL ( OR :1.388; 95% CI [1.058-1.821], P = 0.018 ) were two independent risk factors for mortality. Conclusions: The number of organ dysfunction and IL-6 levels at CRRT initiation are the independent risk factors for mortality in SHLH-associated MODS patients.

scholarly journals Early tracheostomy in severely burned pediatric patients: 16-year experience at a tertiary burn center in China

2020 ◽  
Author(s):  
Bin Chen ◽  
Fang Kuang ◽  
Zhi Zhang ◽  
Liying Chen ◽  
Zhihe Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Airway Management ◽  
Pediatric Patients ◽  
Linear Regression Analysis ◽  
Late Complications ◽  
Inhalation Injury ◽  
Multivariate Linear Regression Analysis ◽  
Early Tracheostomy ◽  
Ventilation Time ◽  
Independent Risk Factors

Abstract Background: A tracheostomy is a lifesaving procedure in severely burned pediatric patients. Because of the complex operative procedures, higher incidence of complications, pulmonary infections and mortality, tracheostomy in pediatric patients has always been controversial, especially for children < 3 years of age. Our study aimed to describe the characteristics of severely burned pediatric patients who had a tracheostomy and to identify the risk factors associated with complications related to tracheostomies, so as to provide assistance and suggestions for the airway management of such patients.Method: Severely burned pediatric patients (aged ≤15 years of age) who had a tracheostomy between 1 January, 2004 and 31 December, 2019 were retrospectively reviewed. The following data were collected: age; gender; total burn surface area (TBSA); burn mechanism; inhalation injury; indication for tracheostomy; time from injury to tracheotomy; duration of ventilation; duration of tracheostomy, tracheotomy-related complications; and prognosis.Results: Sixty-five severely burned pediatric patients with tracheostomies were reviewed in this study, 70.6% were < 3 years of age. The 0-3 year age group had the largest number of tracheotomies and the highest incidence of tracheostomy-related complications. Tracheotomy-related complications occurred in 15 patients (23.1%); seven, and eight were early and late complications, respectively. There was no significant relationship between the risk factors that were analyzed and early complications, but TBSA%, ventilation time, and duration of tracheostomy were significantly related to late complications. Multivariate linear regression analysis indicated that age, TBSA%, inhalation injury, and ventilation time were independent variables influencing the duration of tracheostomy. Decannulation was carried out successfully in 96.7% (58/60) of surviving patients. Age (B = −0.011, p = 0.008), TBSA (B = 1.5, p = 0.006), inhalation injury (B = 1.07, p = 0.004), and ventilation time (B = 1.081, p = 0.000) were independent risk factors influencing the duration of tracheostomy. Five patients died (7.7%); no children died from tracheotomy-related complications.Conclusion: Early tracheostomy is a relatively safe and effective method for airway management in severely burned children; however, patients < 3 years of age should be evaluated for tracheostomy with greater caution due to the severity of the complications.

scholarly journals Risk factors Affecting the 1-year Outcomes of Minor Ischemic Stroke: Results from Xi’an Stroke Registry Study of China

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Clinical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year rates of stroke recurrence, disability, and all-cause mortality were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the rates of stroke recurrence, disability, and all-cause mortality at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause mortality. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China. Early identification of risk factors for poor clinical outcomes, attention to high risk populations, and targeted interventions contribute to reducing the risk for poor clinical outcomes of patients at 1 year after onset of MIS.

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