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Zorrilla-Vaca A, Grant MC, Rehman M, Sarin P, Mendez-Pino L, Urman RD, Varelmann D. Performance Comparison of Pulmonary Risk Scoring Systems in Lung Resection. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00343-9. [PMID: 37330329 DOI: 10.1053/j.jvca.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To validate and compare the performance of different pulmonary risk scoring systems to predict postoperative pulmonary complications (PPCs) in lung resection surgery. DESIGN Retrospective cohort study SETTING: A historic single-center cohort of lung resection surgeries PARTICIPANTS: Adult patients undergoing lung resection surgery under 1-lung ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The accuracy of the following pulmonary risk scoring systems were used to predict pulmonary complications: the ARISCAT (Assess respiratory RIsk in Surgical patients in CATalonia), the LAS VEGAS (Local Assessment of VEntilatory management during General Anesthesia for Surgery), the SPORC (Score for Prediction of Postoperative Respiratory Complications), and a recent thoracic-specific risk score, named CARDOT. Discrimination and calibration were assessed using the concordance (c) index and the intercept of LOESS (locally estimated scatterplot)-smoothed curves, respectively. Additional models were constructed that incorporated predicted postoperative forced expiratory volume (ppoFEV1) into each scoring system. Of the 2,104 patients undergoing lung surgery, 123 developed postoperative pulmonary complications (PPCs; 5.9%). All scoring systems had poor discriminatory power to predict PPCs (ARISCAT c-index 0.60, 95% confidence interval [CI] 0.55-0.65; LAS VEGAS c-index 0.68, 95% CI 0.63-0.73; SPORC c-index 0.63, 95% CI 0.59-0.68; CARDOT c-index 0.64, 95% CI 0.58-0.70), but the inclusion of ppoFEV1 slightly improved the performance of LAS VEGAS (c-index 0.70, 95% CI 0.66-0.75) and CARDOT (c-index 0.68, 95% CI 0.62-0.73). Analysis of calibration showed a slight overestimation when using ARISCAT (intercept -0.28) and LAS VEGAS (intercept -0.27). CONCLUSIONS None of the scoring systems appeared to have adequate discriminatory power to predict PPCs among patients undergoing lung resection. An alternative risk score is necessary to better predict patients at risk of PPCs after thoracic surgery.
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Affiliation(s)
- Andres Zorrilla-Vaca
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Anesthesiology, Universidad del Valle, Hospital Universidad del Valle, Cali, Colombia.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Muhammad Rehman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pankaj Sarin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Laura Mendez-Pino
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, OH
| | - Dirk Varelmann
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Bludevich BM, Emmerick I, Uy K, Maxfield M, Ash AS, Baima J, Lou F. Association Between the Modified Frailty Index and Outcomes Following Lobectomy. J Surg Res 2023; 283:559-571. [PMID: 36442255 DOI: 10.1016/j.jss.2022.11.014] [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: 02/09/2022] [Revised: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Elective thoracic surgery is safe in well-selected elderly patients. The association of frailty with postoperative morbidity in elective-lobectomy patients is understudied. We examined frailty as defined by abbreviated modified frailty index (mFI-5), mFI-11 in the thoracic surgery population, and the correlation between frailty and postoperative complications. METHODS We studied outcomes of patients in two cohorts, 2010-2012 and 2013-2019, from the National Surgical Quality Improvement Program (NSQIP) database and used multivariable logistic regression models to predict all postoperative morbidity, mortality, and major morbidity. The mFI-5 could be calculated for all subjects (both 2010-2012, and 2013-2019); the mFI-11 could only be calculated for the 2010-2012 cohort. Patient frailty was defined as mFI≥3 (with either index). We used odds ratios (ORs) to examine associations of preoperative characteristics with postoperative complications and C-statistics to assess overall predictive power. RESULTS Complications were less prevalent in the 2013-2019 cohort (17.9% versus 19.5%, P = 0.008). Open lobectomies were more common in the 2010-2012 cohort (53.9% versus 34.6%) and were strongly associated with postoperative morbidity and mortality (ORs >1.5) in both cohorts. Each frailty measure was associated with morbidity and mortality (ORs >1.4) after adjusting for other significant preoperative factors. Models on the 2010-2012 cohort had nearly identical C-statistics using the mFI-11 versus mFI-5 frailty indices (0.6142 versus 0.6139; P > 0.8). CONCLUSIONS Frailty, as captured in the mFI-5, is a significant associated factor of postoperative morbidity and mortality following elective lobectomies. As a modifiable risk factor, frailty should be considered in surgical decision-making and when counseling patients regarding perioperative risks.
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Affiliation(s)
- Bryce M Bludevich
- Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Isabel Emmerick
- Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karl Uy
- Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mark Maxfield
- Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Arlene S Ash
- Department of Quantitative Health Services, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer Baima
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Feiran Lou
- Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
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Eldaabossi S, Al-Ghoneimy Y, Ghoneim A, Awad A, Mahdi W, Farouk A, Soliman H, Kanany H, Antar A, Gaber Y, Shaarawy A, Nabawy O, Atef M, Nour SO, Kabil A. The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia. J Multidiscip Healthc 2023; 16:625-634. [PMID: 36910018 PMCID: PMC9999721 DOI: 10.2147/jmdh.s404124] [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: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.
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Affiliation(s)
- Safwat Eldaabossi
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt.,Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Al-Ghoneimy
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ayman Ghoneim
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt
| | - Amgad Awad
- Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Waheed Mahdi
- Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt.,Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.,Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Abdallah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hesham Soliman
- Consultant and Chief of Anesthesia, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hatem Kanany
- Department of Critical Care and Anesthesia, Al-Azhar University, Cairo, Egypt
| | - Ahmad Antar
- Department of Internal Medicine, Hematology-Oncology Section, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Gaber
- Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Radiology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shaarawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Osama Nabawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Moaz Atef
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Sameh O Nour
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
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Kirillov AY, Yavorovskiy AG, Vyzhigina MA, Komаrov RN, Aliev VA, Bаgdаsаrov PS, Yavorovskаya DA, Kushanov RS, Laricheva EA. Experience of Using High-Frequency Lung Ventilation during Cardiopulmonary Bypass in Cardiac Surgery. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-6-41-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A. Yu. Kirillov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. G. Yavorovskiy
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M. A. Vyzhigina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - R. N. Komаrov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V. A. Aliev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - P. S. Bаgdаsаrov
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - R. S. Kushanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E. A. Laricheva
- Sechenov First Moscow State Medical University (Sechenov University)
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Liu W, Jin F, Wang HM, Yong FF, Wu Z, Jia HQ. The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery. Front Oncol 2022; 12:1011849. [PMID: 36237329 PMCID: PMC9552823 DOI: 10.3389/fonc.2022.1011849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both double-lumen tube (DLT) and bronchial blocker (BB) are used for lung isolation in patients undergoing lung cancer surgery. However, the effects of different devices for lung isolation remain inconclusive. Present study was designed to investigate the association between the choice of the two devices and postoperative pulmonary complications (PPCs) in patients with lung cancer. Methods In this retrospective cohort study, patients who underwent lung cancer surgery between January 1, 2020 and October 31, 2020 were screened. Patients were divided into two groups according to different devices for lung isolation: DLT group and BB group. Primary outcome was the incidence of a composite of PPCs during postoperative in-hospital stay. Results A total of 1721 were enrolled for analysis, of them, 868 received DLT and 853 BB. A composite of PPCs was less common in patients with BB (25.1%, [214/853]) than those received DLT (37.9% [329/868] OR 0.582 95% CI 0.461-0.735 P < 0.001). Respiratory infection was less common in BB group (14.4%, [123/853]) than DLT group (30.3%, [263/868], P<0.001). The incidence of non-PPCs complications was not statistically significant between the 2 groups. Conclusions For patients undergoing surgery for lung cancer, the use of BB for lung isolation was associated with a reduced risk of PPCs when compared with DLT.
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Affiliation(s)
- Wei Liu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fan Jin
- Department of Anesthesiology, Zhuji People’s Hospital, Shaoxing, China
| | - He-Mei Wang
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang-Fang Yong
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen Wu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Qun Jia
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Hui-Qun Jia,
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Chiappetta M, Sassorossi C, Lococo F, Lorusso R, Nachira D, Margaritora S. Intrapleural Foreign Body in a Critically Ill Patient. Chest 2022; 161:e51-e53. [DOI: 10.1016/j.chest.2021.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/25/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022] Open
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7
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Nithiuthai J, Siriussawakul A, Junkai R, Horugsa N, Jarungjitaree S, Triyasunant N. Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital. Perioper Med (Lond) 2021; 10:43. [PMID: 34876228 PMCID: PMC8653534 DOI: 10.1186/s13741-021-00214-3] [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] [Received: 02/25/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023] Open
Abstract
Background The incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais. Methods A retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores. Results In all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001). Conclusions PPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.
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Affiliation(s)
- Jitsupa Nithiuthai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rangsinee Junkai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutthakorn Horugsa
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunit Jarungjitaree
- Siriraj Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Namtip Triyasunant
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Yamamoto N, Anzai A, Okamura K, Gamo M, Goto T. Risk factors for prolonged postoperative oxygen supplementation dependence after surgical lung biopsy in patients with interstitial pneumonia: A single-center, retrospective, observational study. J Clin Anesth 2020; 65:109878. [PMID: 32464478 DOI: 10.1016/j.jclinane.2020.109878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Natsuhiro Yamamoto
- Department of Anesthesiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka higashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan.
| | - Akiko Anzai
- Department of Anesthesiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka higashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Kenta Okamura
- Department of Anesthesiology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Masahiro Gamo
- Department of Anesthesiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka higashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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