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Zhang Q, Zhu L, Yuan S, Lu S, Zhang X. Identifying risk factors for hypoxemia during emergence from anesthesia in patients undergoing robot-assisted laparoscopic radical prostatectomy. J Robot Surg 2024; 18:200. [PMID: 38713381 DOI: 10.1007/s11701-024-01964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024]
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALP) has emerged as an effective treatment for prostate cancer with obvious advantages. This study aims to identify risk factors related to hypoxemia during the emergence from anesthesia in patients undergoing RALP. A cohort of 316 patients undergoing RALP was divided into two groups: the hypoxemia group (N = 134) and the non-hypoxemia group (N = 182), based on their postoperative oxygen fraction. Comprehensive data were collected from the hospital information system, including preoperative baseline parameters, intraoperative data, and postoperative recovery profiles. Risk factors were examined using multiple logistic regression analysis. The study showed that 38.9% of patients had low preoperative partial pressure of oxygen (PaO2) levels. Several clinical parameters showed significant differences between the hypoxemia group and the non-hypoxemia group, including weight (P < 0.0001), BMI (P < 0.0001), diabetes mellitus (P = 0.044), history of emphysema and pulmonary alveoli (P < 0.0001), low preoperative PaO2 (P < 0.0001), preoperative white blood cell count (P = 0.012), preoperative albumin (P = 0.048), intraoperative bleeding (P = 0.043), intraoperative CO2 accumulation (P = 0.001), duration of surgery (P = 0.046), postoperative hemoglobin level (P = 0.002), postoperative hypoxemia (P = 0.002), and early postoperative fever (P = 0.006). Multiple logistic regression analysis revealed BMI (adjusted odds ratio = 0.696, 95% confidence interval 0.612-0.719), low preoperative PaO2 (adjusted odds ratio = 9.119, 95% confidence interval 4.834-17.203), and history of emphysema and pulmonary alveoli (adjusted odds ratio = 2.804, 95% confidence interval 1.432-5.491) as independent factors significantly associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. Our results demonstrate that BMI, lower preoperative PaO2, and a history of emphysema and pulmonary alveolar disease are independent risk factors associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. These findings provide a theoretical framework for surgeons and anesthesiologists to facilitate strategies to mitigate postoperative hypoxemia in this unique patient population.
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Affiliation(s)
- Qiyao Zhang
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Leilei Zhu
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Shengjie Yuan
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Shunmei Lu
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Xin Zhang
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China.
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Li W, Wang Y, Zhou S, Liu S, Di L, Chen W, Lv H. Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture. Sci Rep 2024; 14:3543. [PMID: 38347044 PMCID: PMC10861573 DOI: 10.1038/s41598-024-53356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Closed femoral shaft fracture is caused by high-energy injuries, and non-union exists after operation, which can significantly damage patients' body and mind. This study aimed to explore the factors influencing postoperative non-union of closed femoral shaft fractures and establish a predictive nomogram. Patients with closed femoral shaft fractures treated at Hebei Medical University Third Hospital between January 2015 and December 2021 were retrospectively enrolled. A total of 729 patients met the inclusion criteria; of them, those treated in 2015-2019 comprised the training cohort (n = 617), while those treated in 2020-2021 comprised the external validation cohort (n = 112). According to multivariate logistic regression analysis, complex fractures, bone defects, smoking, and postoperative infection were independent risk factors. Based on the factors, a predictive nomogram was constructed and validated. The C-indices in training and external validation cohorts were 0.818 and 0.781, respectively; and the C-index of internal validation via bootstrap resampling was 0.804. The Hosmer-Lemeshow test showed good fit of the nomogram (P > 0.05) consistent with the calibration plot results. The clinical effectiveness was best at a threshold probability of 0.10-0.40 in decision curve analysis. The risk prediction for patients with fractures using this nomogram may aid targeted prevention and rehabilitation programs.
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Affiliation(s)
- Wenjing Li
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yan Wang
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shuai Zhou
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shihang Liu
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Luqin Di
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wei Chen
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Hongzhi Lv
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China.
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Li H, Zhang Y, Cai J, Wang H, Wei R. Risk Factors of Hypoxemia in the Postanesthesia Care Unit After General Anesthesia in Children. J Perianesth Nurs 2023; 38:799-803. [PMID: 37330722 DOI: 10.1016/j.jopan.2023.02.003] [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: 08/18/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To investigate the incidence and risk factors of hypoxemia in the postanesthesia care unit (PACU) after general anesthesia in children. DESIGN A retrospective observational study. METHODS Elective surgical patients (N = 3,840 patients) treated in a pediatric hospital were divided into a hypoxemia group and a nonhypoxemia group according to the presence of hypoxemia following transport to the PACU. The clinical data of the 3,840 patients were compared between these two groups to evaluate factors that were linked to the development of postoperative hypoxemia. Factors that showed a statistically significant difference (P < .05) in single-factor tests were then examined in multivariate regression analyses to identify hypoxemia risk factors. FINDINGS In our study group of 3,840 patients, 167 (4.35%) patients developed hypoxemia, with an incidence of 4.35%. Univariate analysis indicated that age, weight, anesthesia method, and operation type were significantly associated with hypoxemia. Logistic regression analysis indicated that operation type was associated with hypoxemia. CONCLUSIONS Surgery type is a primary risk factor for pediatric hypoxemia in the PACU following general anesthesia. Patients undergoing oral surgery are more prone to hypoxemia and should be more intensively monitored to ensure timely treatment if required.
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Affiliation(s)
- Hongyun Li
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuting Zhang
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingjie Cai
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wang
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Wei
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Chi W, Pang P, Luo Z, Liu X, Cai W, Li W, Hao J. Risk factors for hypoxaemia following hip fracture surgery in elderly patients who recovered from COVID-19: a multicentre retrospective study. Front Med (Lausanne) 2023; 10:1219222. [PMID: 37497272 PMCID: PMC10366448 DOI: 10.3389/fmed.2023.1219222] [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: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Objectives To explore the risk factors associated with postoperative hypoxaemia in elderly patients who have recovered from coronavirus disease (COVID-19) and underwent hip fracture surgery in the short term. Design Multicentre retrospective study. Setting The study was performed in three first 3A-grade hospitals in China. Participants A sequential sampling method was applied to select study participants. Medical records of 392 patients aged ≥65 years who had recovered from COVID-19 and underwent hip fracture surgery at three hospitals in China between 1 November, 2022, and 15 February, 2023, were reviewed. Interventions Patients were assigned to hypoxaemia or non-hypoxaemia groups, according to whether hypoxaemia occurred after surgery. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative hypoxaemia. Results The incidence of postoperative hypoxaemia was 38.01%. Statistically significant differences were found between the two groups in terms of age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, presence of expectoration symptoms, preoperative hypoxaemia, chronic obstructive pulmonary disease, pulmonary inflammation, time between recovery from COVID-19 and surgery, anaesthetic mode, surgical procedure, intraoperative blood loss, intraoperative infusion, duration of surgery, and length of hospital stay (p < 0.05). Furthermore, patients with BMI ≥28.0 kg/m2, expectoration symptoms, presence of preoperative hypoxaemia, ASA classification III, time between recovery from COVID-19 and surgery ≤2 weeks, and general anaesthesia were potential risk factors for postoperative hypoxaemia. Conclusion Obesity, expectoration symptoms, preoperative hypoxaemia, ASA classification III, time between recovery from COVID-19 and surgery ≤2 weeks, and general anaesthesia were potential risk factors for postoperative hypoxaemia in elderly patients who recovered from COVID-19 and underwent hip fracture surgery in the short term.
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Affiliation(s)
- Wen Chi
- Department of Operating Room, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Peng Pang
- Department of Anaesthesiology, Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Zhenguo Luo
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Xiaobing Liu
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Wenbo Cai
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Wangyang Li
- Department of Orthopedic, Linfen Hospital Affiliated to Shanxi Medical University, Linfen, China
| | - Jianhong Hao
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
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