1
|
Liu XY, Kang B, Lv Q, Wang ZW. Phase angle is a predictor for postoperative complications in colorectal cancer. Front Nutr 2024; 11:1446660. [PMID: 39221167 PMCID: PMC11363711 DOI: 10.3389/fnut.2024.1446660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Aim The aim of this study was to develop a validated nomogram to predict the risk of postoperative complications in colorectal cancer (CRC) patients by analyzing the factors that contribute to these complications. Methods We retrospectively collected clinical information on patients who underwent CRC surgery at a single clinical center from January 2021 to December 2021. Univariate and multivariate logistic regression analysis to identify independent risk factors for postoperative complications and to develop a predictive model. A receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to assess the predicted probability. Calibration curve was drawn to compare the predicted probability of the nomogram with the actual probability, and decision curve analysis (DCA) was employed to evaluate the clinical utility of the nomogram. Results A total of 190 CRC patients were included in this study. We retrospectively collected baseline information, clinical information, surgical information, and nutrition-related indicators for all patients. Through multivariate logistic regression analysis, preoperative albumin (p = 0.041, OR = 0.906, 95% CI = 0.824-0.996), surgical time (p = 0.009, OR = 1.006, 95% CI = 1.001-1.010), waistline (p = 0.049, OR = 1.011, 95% CI = 1.002-1.020) and phase angle (PA) (p = 0.022, OR = 0.615, 95% CI = 0.405-0.933) were identified as independent risk factors for postoperative complications in CRC, and a nomogram prediction model was established using the above four variables. The AUC of 0.706 for the ROC plot and the high agreement between predicted and actual probabilities in the calibration curves suggested that the prediction model has good predictive power. The DCA also confirmed the good clinical performance of the nomogram. Conclusion This study developed a nomogram to predict the risk of postoperative complications in CRC patients, providing surgeons with a reliable reference to personalized patient management in the perioperative period and preoperative nutritional interventions.
Collapse
Affiliation(s)
- Xiao-Yu Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Kang
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Hao J, Du Z, Bo Z, Zhang H, Wang X. Impact of Metabolic Syndrome on Post-Operative Infection in Patients Undergoing Flexible Ureteroscopy Lithotripsy. Surg Infect (Larchmt) 2024; 25:140-146. [PMID: 38265838 DOI: 10.1089/sur.2023.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: To investigate retrospectively whether metabolic syndrome (MetS) of flexible ureteroscopy (fURS) lithotripsy can be used to predict post-operative infection. Patients and Methods: After screening, 1,110 patients who received fURS lithotripsy for upper urinary tract stones in our center between January 2015 and December 2022 were analyzed retrospectively. Patients were divided into MetS-positive group and MetS-negative group. Post-operative infection was divided into fever, urosepsis, and septic shock. Relevant data during the peri-operative period were collected. Univariable and multivariable logistic regression analyses were adopted to estimate the impact of metabolic syndrome on post-operative infection in patients undergoing fURS lithotripsy. Results: Among the 1,110 patients, 427 tested positive for MetS, whereas 683 tested negative. Eighty-eight patients suffered from fever (67 patients in the MetS-positive group and 21 in the MetS-negative group). Forty-nine patients had urosepsis (29 patients in the MetS-positive group and 20 in the MetS-negative group), of whom seven patients developed septic shock. No patient developed multiple organ failure or died because of infection. The prevalence of post-operative infections in the MetS-positive group was higher than that in the MetS-negative group (p < 0.001). Multivariable logistic regression analyses showed that diabetes mellitus, MetS-positive, positive urine culture, and longer operation time were positively correlated with post-operative fever. Positive MetS, positive urine culture, and longer operation time were strongly correlated with post-operative urosepsis. Conclusions: Metabolic syndrome was found to be associated with post-operative infection in patients undergoing fURS lithotripsy, suggesting it can serve as a predictive factor.
Collapse
Affiliation(s)
- Junxiu Hao
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Zhiyong Du
- Department of Urology Surgery, Dingzhou People's Hospital, Dingzhou, Hebei Province, People's Republic of China
| | - Zhiqiang Bo
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Huimin Zhang
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Xiuyun Wang
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| |
Collapse
|
3
|
Blachman-Braun R, Gurayah AA, Mason MM, Hougen HY, Gonzalgo ML, Nahar B, Punnen S, Parekh DJ, Ritch CR. Incidence and predictors of deep incisional and organ/space surgical site infection following radical cystectomy. Urol Oncol 2023; 41:455.e17-455.e24. [PMID: 37524577 DOI: 10.1016/j.urolonc.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To investigate clinical risk factors associated with postoperative deep incisional or organ/space surgical site infections (SSI) following radical cystectomy (RC) in a well characterized and large contemporary cohort. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to identify adult patients who underwent RC for bladder cancer between 2015 and 2020 (n = 13,081). We conducted multivariable-adjusted logistic regression and Cox adjusted proportional hazards regression analysis to identify clinical predictors of deep incisional or organ/space SSI in the 30-day postoperative-period following RC. RESULTS Deep incisional or organ/space SSI risk increased with continent urinary diversion (HR = 1.61, 95% CI: 1.38-1.88; P < 0.001), obesity (HR = 1.60, 95% CI: 1.35-1.90; P < 0.001), diabetes mellitus (HR = 1.30, 95% CI: 1.13-1.51; P < 0.001), and being functionally dependent before surgery (HR = 2.09, 95% CI: 1.44-3.03; P < 0.001). CONCLUSIONS Postoperative deep incisional or organ/space SSIs following RC occur more frequently in patients who were obese, diabetic, functionally dependent before surgery, and those who underwent continent urinary diversion. These findings may assist urologists in preoperative counseling, medical optimization, and choice of urinary diversion approach, as well as improved patient monitoring and identification of candidates for intervention postoperatively.
Collapse
Affiliation(s)
- Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | | | | | - Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| |
Collapse
|
4
|
Schlager JG, Hartmann D, Kendziora B. [Surgical site infection and perioperative antibiotics in dermatosurgery]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:827-834. [PMID: 37823917 DOI: 10.1007/s00105-023-05233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Postoperative wound infections represent the most common complication in dermatosurgery. Given the low incidence and heterogeneous data, no standards for perioperative antibiotic prophylaxis (PAP) have been established in clinical practice. OBJECTIVES To summarize the current evidence on risk factors for postoperative wound infection in dermatosurgery and the new recommendations on PAP. MATERIALS AND METHODS Relevant study data and current recommendations were summarized descriptively. RESULTS Current evidence suggests that the following factors are associated with an increased risk of wound infection after dermatosurgical procedures: surgery to the lower extremity or the ear, postoperative hemorrhage, defect closure by flap or skin graft, large wound defect, immunosuppression, and male sex. Probably not affecting the risk of infection are diabetes, obesity, age, smoking, use of a blood thinner, multiple surgeries, or wound healing by second intention. Not all risk factors affect the risk of infection equally. They must be weighted differently and only in combination do they increase the risk of wound infection in a clinically relevant way. According to a current position paper of the German Society for Dermatosurgery, the indication for PAP should be made individually and only if multiple factors are present. Furthermore, patients with increased risk for bacterial endocarditis or hematogenic endoprosthesis infection should receive PAP prior to septic skin surgery. CONCLUSION In dermatologic surgery, PAP should be restricted to patients at high risk for wound infection. Further indications are the prevention of bacterial endocarditis and hematogenic endoprosthesis infection in high-risk individuals prior to septic surgery.
Collapse
Affiliation(s)
- Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland.
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Benjamin Kendziora
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude West 38 (W38), Hamburg, Deutschland
| |
Collapse
|
5
|
Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure- and patient-related risk factors. J Dtsch Dermatol Ges 2023; 21:949-956. [PMID: 36892413 DOI: 10.1111/ddg.14947] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 03/10/2023]
Abstract
The aim of perioperative antibiotic prophylaxis (PAP) is to prevent the occurrence of surgical site infections (SSIs) or other infectious complications (especially bacterial endocarditis or septic arthritis). PAP is effective in surgeries where overall infection rates are high even without considering patient-related risk factors (such as orthopedic surgery or fracture repair). Surgery on airways, gastrointestinal, genital, or urinary tract is also considered to be associated with a risk of infection and may require PAP. Overall, SSIs in skin surgery are relatively rare and vary between 1% and 11% depending on the localization, complexity of the wound closure and patient cohort. Therefore, the general surgical recommendations regarding PAP only partially reflect the needs of dermatologic surgery. In contrast to the USA, where recommendations on the use of PAP in skin surgery already exist, there are currently no guidelines for the use of PAP specifically designed for dermatologic surgery in Germany. In the absence of an evidence-based recommendation, the use of PAP is guided by the experience of the surgeons and leads to a heterogeneous use of antimicrobial substances. In this work, we summarize the current scientific literature on the use of PAP and make a recommendation depending on procedure- and patient-related risk factors.
Collapse
Affiliation(s)
- Christoph R Löser
- Department of Dermatolgogy, Ludwigshafen City Hospital, Ludwigshafen
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Lukas Kofler
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tübingen, Tübingen
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal
| |
Collapse
|
6
|
Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 1: Eingriffs- und patientenbezogene Risikofaktoren. J Dtsch Dermatol Ges 2023; 21:949-957. [PMID: 37700414 DOI: 10.1111/ddg.14947_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie perioperative Antibiotikaprophylaxe (PAP) hat das Ziel, postoperative Wundinfektionen und Infektionskomplikationen (insbesondere bakterielle Endokarditis oder septische Arthritis) bei chirurgischen Eingriffen zu vermeiden. Die PAP hat sich besonders bei Eingriffen bewährt, bei denen die Infektionsraten auch ohne Berücksichtigung der patientenbezogenen Risikofaktoren insgesamt hoch sind (wie für orthopädische Eingriffe oder die Versorgung von Frakturen). Auch Operationen mit Eröffnung der Atemwege, des Verdauungs‐, Genital‐ oder Harntrakts gelten als mit Infektionsrisiko behaftet und können eine PAP erfordern. In der Dermatochirurgie sind Infektionskomplikationen insgesamt verhältnismäßig selten und variieren in Abhängigkeit von der Lokalisation, Komplexität des Eingriffes und der Patientenkohorte zwischen 1% und 11%. Daher spiegeln die allgemeinchirurgischen Empfehlungen bezüglich der PAP die Bedürfnisse der Dermatochirurgie nur begrenzt wider. Im Gegensatz zu den USA, wo eine entsprechende Empfehlung vorliegt, existiert in Deutschland zurzeit keine speziell für dermatochirurgische Eingriffe konzipierte Leitlinie zur Anwendung von PAP. In Abwesenheit evidenzbasierter Empfehlungen wird die PAP durch die Erfahrung der einzelnen Operateure geprägt, was zu einer heterogenen Anwendung antimikrobieller Substanzen führt. In der vorliegenden Arbeit wird die aktuelle wissenschaftliche Literatur zu dem Thema zusammengefasst und die daraus resultierende Empfehlung zur Anwendung der PAP in Abhängigkeit von eingriffs‐ und patientenbezogenen Risikofaktoren formuliert.
Collapse
Affiliation(s)
- Christoph R Löser
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
| |
Collapse
|
7
|
Khachfe HH, Hammad AY, AlMasri S, deSilva A, Kraftician J, Lee KK, Zureikat AH, Paniccia A. Obesity Is Associated With Increased Risk for Adverse Postoperative Outcomes After Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma. J Surg Res 2023; 284:164-172. [PMID: 36577229 PMCID: PMC11200326 DOI: 10.1016/j.jss.2022.11.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Conflicting reports exist about the effect obesity has on adverse postoperative surgical outcomes after distal pancreatectomy (DP). The aim of this study is to explore the role of obesity in terms of morbidity and pancreas-specific complications following DP for pancreatic ductal adenocarcinoma (PDAC). METHODS All patients who underwent DP at a single institution over 10 y were analyzed (2009-2020). Patients were categorized as nonobese (body mass index [BMI] < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). Independent predictors of adverse postoperative outcomes were calculated using multivariate logistic regression models. Overall survival was assessed using Kaplan-Meier survival analysis. RESULTS Of the 178 patients included, 58 (32.5%) were obese. Clinically relevant postoperative pancreatic fistula (CR-POPF) formation rate was significantly higher in the obese group (20.6% versus 7.5%, P value = 0.011). We did not identify any significant difference between obese and nonobese patients in median overall survival (30.2 mon versus 28.9 mon, P value = 0.811). On multivariate binary logistic regression analysis, BMI ≥ 30 was an independent predictor of morbidity (any complication) and CR-POPF formation after DP for PDAC. CONCLUSIONS Obesity is associated with a significantly increased risk for CR-POPF in patients undergoing DP for PDAC. Obesity should be considered as a variable in fistula risk calculators for DP.
Collapse
Affiliation(s)
- Hussein H Khachfe
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Abdulrahman Y Hammad
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Samer AlMasri
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Annissa deSilva
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Jasmine Kraftician
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, Pennsylvania.
| |
Collapse
|
8
|
Kudsi OY, Kaoukabani G, Friedman A, Bahadir J, Gokcal F. Obesity and mid-term outcomes following robotic cholecystectomy. Am J Surg 2023:S0002-9610(23)00104-6. [PMID: 36922324 DOI: 10.1016/j.amjsurg.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND As obese adults often suffer from gallbladder disease, more data on postoperative outcomes following robotic cholecystectomy(RC) is needed. METHODS RC candidates with a body mass index(BMI) > 30 kg/m2 were included. Postoperative course was documented and analyzed. A logistic regression analysis was performed to determine possible risk factors associated with complications. RESULTS 617 patients with a BMI of 35.9 ± 6.4 kg/m2 were included of which 65 had complicated gallbladders (gangrenous, fistulated, or abscessed). Eight cases were converted to open. Sixty-five(10.5%) patients revisited the emergency department within 30 days, and 35(5.7%) were readmitted to the hospital. Average follow-up time was 35 months. Fifty(9.1%) patients experienced complications, eight(1.5%) underwent reoperation. Postoperative complications were associated with chronic obstructive pulmonary disease[p < 0.001, Odds-Ratio(OR):8.418, 95%-Confidence-interval(CI):4.029-17.585], BMI(p < 0.024, OR:1.045, 95%-CI:[1.006-1.086]), class-III obesity (p < 0.021, OR:2.221, 95%-CI:[1.126-4.379], and complicated gallbladders (p < 0.001, OR:3.659, 95%CI:[1.665-8.041]). CONCLUSION This is the first study to establish a link between higher obesity classes and postoperative complications following RC.
Collapse
Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Brockton, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
| | | | | | - Jenna Bahadir
- Department of Surgery, Good Samaritan Medical Center, Brockton, MA, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Brockton, MA, USA
| |
Collapse
|
9
|
Cohen NS, Bock JM, May AK. Sepsis and postoperative surgical site infections. Surgery 2023:S0039-6060(23)00006-5. [PMID: 36775759 DOI: 10.1016/j.surg.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
Surgical site infections remain a significant cause of morbidity and mortality. High-quality evidence supports several measures to prevent surgical site infections that should be applied with high compliance, although effective application remains suboptimal. Recognizing high-risk patients and avoiding potential pitfalls in the diagnosis of surgical site infections is paramount in preventing progression to sepsis, particularly in emergency surgical patients with physiologic derangement. A high index of suspicion postoperatively is critical to identify patients with surgical site infections and to prevent failure to rescue.
Collapse
Affiliation(s)
- Nina S Cohen
- Division of Acute Care Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC
| | - Jiselle M Bock
- Department of Surgery, Atrium Health - Cleveland, Shelby, NC. http://www.twitter.com/jisellebockmd
| | - Addison K May
- Acute Care Surgery, Department of Surgery, Atrium Health, Wake Forest School of Medicine, Charlotte, NC.
| |
Collapse
|
10
|
Towards interpretable, medically grounded, EMR-based risk prediction models. Sci Rep 2022; 12:9990. [PMID: 35705550 PMCID: PMC9200841 DOI: 10.1038/s41598-022-13504-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022] Open
Abstract
Machine-learning based risk prediction models have the potential to improve patient outcomes by assessing risk more accurately than clinicians. Significant additional value lies in these models providing feedback about the factors that amplify an individual patient's risk. Identification of risk factors enables more informed decisions on interventions to mitigate or ameliorate modifiable factors. For these reasons, risk prediction models must be explainable and grounded on medical knowledge. Current machine learning-based risk prediction models are frequently 'black-box' models whose inner workings cannot be understood easily, making it difficult to define risk drivers. Since machine learning models follow patterns in the data rather than looking for medically relevant relationships, possible risk factors identified by these models do not necessarily translate into actionable insights for clinicians. Here, we use the example of risk assessment for postoperative complications to demonstrate how explainable and medically grounded risk prediction models can be developed. Pre- and postoperative risk prediction models are trained based on clinically relevant inputs extracted from electronic medical record data. We show that these models have similar predictive performance as models that incorporate a wider range of inputs and explain the models' decision-making process by visualizing how different model inputs and their values affect the models' predictions.
Collapse
|
11
|
Lameka M, Mabry S, Montgomery T, Wilson AL, Fellows K, McGwin G, Spitler CA. Systemic Complications of Obesity in Operative Acetabular Fractures. J Orthop Trauma 2022; 36:184-188. [PMID: 34456314 DOI: 10.1097/bot.0000000000002253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of obesity on rates of systemic complications in operatively treated acetabular fractures. DESIGN Retrospective Case-Control study. SETTING Level 1 Trauma Center. PATIENTS/PARTICIPANTS All patients with acetabular fractures managed operatively from January 2015 to December 2019. Patients were divided into groups based on their body mass index (BMI) (normal weight = BMI <25 kg/m2, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese = BMI >40). INTERVENTION Operative management of an acetabular fracture. MAIN OUTCOME MEASUREMENT Systemic complications, including mortality, sepsis, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, or venous thrombotic event. RESULTS A total of 428 patients were identified. One hundred nine patients (25.4%) were in normal weight, 133 (31.1%) were overweight, 133 (31.1%) were obese, and 53 (12.4%) were morbidly obese. The rate of systemic complications was 17.5%, and overall mortality rate was 0.005%. There were no significant differences between the different BMI groups in all-cause complications or any individual complications. When the morbidly obese group was compared with all other patients, there were also no significant differences in all-cause complications or any individual complications. CONCLUSION In conclusion, in this study, there was no association with increasing BMI and inpatient systemic complications after operative management of acetabular fractures. As we continue to refine our understanding of how obesity affects outcomes after acetabular fracture surgery, other indices of obesity might prove more useful in predicting complications. In the obese population, there are well-documented risks of postoperative infections and challenges in obtaining an anatomic reduction, but the fear of postoperative systemic complications should not deter surgeons from undertaking operative management of acetabular fractures in the obese population. Because the prevalence of obesity in trauma patients continues to increase, it is incumbent on us to continue to improve our understanding of optimal treatment for our patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Megan Lameka
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Scott Mabry
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Tyler Montgomery
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Anthony L Wilson
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Kenneth Fellows
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| |
Collapse
|
12
|
Smith NA, Batterham M, Shulman MA. Predicting recovery and disability after surgery in patients with severe obesity: The role of the six-minute walk test. Anaesth Intensive Care 2022; 50:159-168. [PMID: 35171060 DOI: 10.1177/0310057x20981969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most appropriate method to predict postoperative outcomes in patients with severe obesity undergoing elective non-bariatric surgery is not known. We conducted a single-centre prospective cohort study in patients with a body mass index of at least 35 kg/m2 undergoing non-bariatric, non-cardiac surgery. Patients completed the six-minute walk test prior to surgery. Disability was measured before and six months after surgery using the World Health Organization disability assessment schedule. Primary outcome measures included quality of recovery at one month and significantly increased disability at six months after surgery. A total of 293 patients participated. The median body mass index was 41 kg/m2. Patients generally recovered well. Following surgery, 9% of patients experienced a poor quality of recovery and 7% developed a significant increase in disability. The proportion of patients free from clinically significant disability increased from 66% prior to surgery to 90% at six months after surgery. The distance walked in six minutes was weakly predictive of poor recovery at one month and significantly increased disability at six months; weight and body mass index were not. The area under the receiver operating characteristic curve was 0.65 (95% confidence intervals 0.51 to 0.78) for poor recovery and 0.64 (95% confidence intervals 0.51 to 0.77) for increased disability. A preoperative six-minute walk test distance of 308 m was the best cut-off value for predicting increased postoperative disability (sensitivity 0.68, specificity 0.63). The six-minute walk test was most discriminatory at shorter distances. This population of patients with severe obesity appeared to recover well and had few adverse outcomes. The degree of functional capacity was more important than the degree of obesity in predicting postoperative outcomes.
Collapse
Affiliation(s)
- Natalie A Smith
- Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia.,School of Medicine, University of Wollongong, Wollongong, Australia
| | - Marijka Batterham
- Statistical Consulting Centre, University of Wollongong, Wollongong, Australia
| | - Mark A Shulman
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia.,Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
13
|
Patel BM, Samsonov AP, Patel JR, Onursal E, Jung MK, Talty N, Baltazar GA. Obesity and Anterior Abdominal Gunshot Wounds: A Cushion Effect. Cureus 2021; 13:e19838. [PMID: 34963852 PMCID: PMC8698236 DOI: 10.7759/cureus.19838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/07/2022] Open
Abstract
Background Although the standard of care for anterior abdominal gunshot wounds (AAGSWs) is immediate laparotomy, these operations are associated with a high rate of negativity and potentially serious complications. Recent data suggest the possibility of selective non-operative management (SNOM) of AAGSWs, but none implicate body mass index (BMI) as a factor in patient selection. Anecdotal experience at our trauma center suggested a protective effect of obesity among patients with AAGSWs, and given the exceptionally high rate of obesity in the Bronx, we sought to analyze the associations of AAGSWs and BMI to inform future trauma research and management. In this study, we aimed to evaluate whether BMI is associated with injury severity, resource utilization, and clinical outcomes of AAGSWs. Methodology From our prospectively accrued trauma registry, we retrospectively abstracted all patients greater than 16 years old with Current Procedural Terminology codes associated with gunshot wounds from 2008 to 2016. The electronic medical record was reviewed to define a cohort of patients with at least one AAGSW. Patients were divided into the following cohorts based on BMI: underweight (UW, BMI: <18.5), normal weight (NW, BMI: 18.5-24.9), overweight (OW, BMI: 25-29.9), and obese (OB, BMI: ≥30). Among these cohorts, we analyzed data regarding injury severity, resource utilization, and clinical outcomes. Results In this study, none of the patients were UW, 17 (42.5%) patients were NW, 15 (37.5%) patients were OW, and eight (20%) patients were OB. One patient each in the NW and OB cohorts was successfully managed non-operatively, while all others underwent immediate exploratory laparotomy. The mean new injury severity score was significantly lower as BMI increased (NW = 30.9 ± 17.0, OW = 22.9 ± 16.1, and OB = 12.8 ± 13.7; p = 0.039). Patients in the OB cohort were less likely to have abdominal fascial penetration compared to the OW and NW cohorts (p = 0.027 and 0.004, respectively) and sustained fewer mean visceral injuries compared to the OW and NW cohorts (p = 0.027 and 0.045, respectively). OB patients were significantly more likely to have sustained two or more AAGSWs (OB = 27.5%, OW = 6.7%, and NW = 5.9%; p = 0.033), suggesting higher rates of tangential soft tissue injuries. The mean hospital length of stay down-trended as BMI increased but did not achieve statistical significance (NW = 7.4 ± 5.3, OW = 6.6 ± 6.7, and OB = 3.1 ± 2.3; p = 0.19). The OB cohort had the lowest mean hospital charges. Conclusions Obesity may yield a protective effect among AAGSW victims, and BMI may provide trauma surgeons another tool to triage patients for SNOM of AAGSWs, potentially diminishing the risks associated with negative laparotomy. Our data serve as the basis for the analysis of a larger patient cohort.
Collapse
Affiliation(s)
- Bharvi Marsha Patel
- Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Alan P Samsonov
- Department of General Surgery, City University of New York, School of Medicine, New York, USA
| | - Joy R Patel
- Department of Anesthesiology, Penn State College of Medicine, Pennsylvania, USA
| | - Elif Onursal
- Department of General Surgery, St. Barnabas Hospital Health System, Bronx, USA
| | - Min-Kyung Jung
- Statistics, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Nanette Talty
- Department of General Surgery, St. Barnabas Hospital Health System, Bronx, USA
| | - Gerard A Baltazar
- Surgery, New York University Langone Health/New York University Winthrop Hospital, Mineola, USA
| |
Collapse
|