Preoperative hypokalemia can increase complications after colorectal cancer surgery: a propensity score matching analysis

Diuretic long-term medication is an independent predictor of posthepatectomy liver failure

BACKGROUND

Posthepatectomy liver failure (PHLF) is the most fatal complication following liver resection, particularly, in patients with comorbidities. This study aimed to assess the impact of long-term medication on PHLF incidence after open liver resections.

METHODS

A retrospective analysis of 682 patients who underwent elective open hepatectomies between 2008 and 2015 at two academic centers was performed. Preoperative, intraoperative, and postoperative data were collected, including long-term medication. Risk factors for the development of PHLF and other postoperative complications were evaluated using univariate and multivariable logistic regression analyses.

RESULTS

PHLF occurred in 11.9% (n=81) of patients, with a higher incidence in those taking diuretics as long-term medication (17.7% vs. 5.3%, P < 0.001). Diuretic use was identified as a strong independent risk factor for PHLF (OR 3.8, 95%CI 2.1 - 7.0, P < 0.001), alongside liver cirrhosis (OR 3.8, 95%CI 1.9 - 7.6, P < 0.001), primary liver malignancies (OR 3.8, 95%CI 1.6 - 9.3, P < 0.001), major hepatectomies (OR 3.1, 95%CI 1.7 - 5.7, P < 0.001) and long operating time (OR 4.2, 95% CI 2.4 - 7.2, P < 0.001). Patients with long-term diuretic intake were older, had higher BMIs, and more comorbidities, including liver cirrhosis.

CONCLUSION

Long-term diuretic use is associated with a significantly increased risk of PHLF after open hepatectomy.

Nomogram for predicting the development of pneumonia after colorectal cancer surgery

The aim of this study was to analyze the factors contributing to the development of pneumonia after colorectal cancer (CRC) surgery and to develop a validated nomogram to predict the risk. We retrospectively collected information on patients who underwent radical CRC resection at a single clinical center from January 2011 to December 2021. The information was then randomly assigned to a training cohort and a validation cohort in a 7:3 ratio. Univariate and multivariate logistic regression analysis were performed on the training cohort to identify independent risk factors for the development of pneumonias, which were then included in the nomogram. Validation was performed in a validation cohort, area under the curve (AUC) and calibration curves were used to determine the predictive accuracy and discriminative power of the graphs, and decision curve analysis (DCA) was used to further substantiate the clinical efficacy of the nomogram. A total of 7130 patients were included in the study. Based on multivariate logistic regression analysis of the training cohort, age, sex, preoperative albumin, surgical methods, and surgical time were identified as independent risk factors for the development of pneumonia after CRC surgery, and a nomogram prediction model was established using the above five variables. The AUC was 0.745 in training cohort and 0.773 in validation cohort. This study established a nomogram that is a good predictor of the risk of developing pneumonia after CRC surgery and provided surgeons with a reference for personalized management of patients in the perioperative period.

Preoperative hemoglobin to albumin ratio as a prognostic predictor for patients with colorectal cancer surgery

The purpose of this study was to identify whether the preoperative hemoglobin to albumin ratio (HAR) could predict the prognosis of patients who underwent colorectal cancer (CRC) radical resection. This study enrolled 4018 consecutive CRC patients, calculating HAR as the hemoglobin count divided by albumin count. Patients were divided into the high and low HAR groups based on a cut-off value (0.36). Baseline information and short-term outcomes were compared between the two groups. Logistic and Cox regression analyses were conducted to determine whether HAR was an independent risk factor for CRC. A total of 4018 patients were divided into the high HAR group (3295) and the low HAR group (723). It was found that the high HAR group had more females (P < 0.01), less BMI (P = 0.027), less smoking (P < 0.01), less drinking (P < 0.01), less T2DM (P = 0.027), lower albumin (P < 0.01), higher hemoglobin (P < 0.01) and more rectal cancer (P = 0.026). We found that HAR was an independent risk factor for overall complications (P = 0.012, OR = 1.279, 95% CI 1.055-1.550). Moreover, we found that HAR was an independent risk factor for overall survival (OS) (P = 0.012, HR = 1.300, 95% CI 1.059-1.597) and disease-free survival (DFS) (P = 0.030, HR = 1.231, 95% CI 1.021-1.484). We found that the low HAR group had worse OS in stage III (P = 0.012) CRC than the high HAR group. In terms of DFS, the low HAR group also had worse DFS in stage III (P = 0.01) CRC than the high HAR group. HAR was an independent predictive factor for the prognosis of CRC. Therefore, surgeons should pay attention to hemoglobin and albumin values before surgery.

Association of Preoperative Serum Potassium With Postoperative Seizures in Patients Undergoing Elective Craniotomy

BACKGROUND AND OBJECTIVES

Patients who undergo craniotomy are at risk of developing seizures during the postoperative period. Preoperative serum potassium as an important potential risk factor has not been investigated yet.

METHODS

We conducted a retrospective cohort study involving adults undergoing elective craniotomy at West China Hospital, from January 2011 and March 2021. The main outcome of this study was postoperative seizures in patients undergoing elective craniotomy during hospitalization. We performed univariable and multivariable logistic regression to investigate the association of preoperative serum potassium with postoperative seizures.

RESULTS

A total of 15 041 patients were collected after filtering by excluded criteria. The incidence of postoperative seizures was 4.87%. We identified a linear relationship between preoperative serum potassium and postoperative seizures (P for nonlinearity =.87). Compared with patients with serum potassium 3.5 to 4.5 mmol/L, the odds of postoperative seizures increased in patients with serum potassium ≥4.5 mmol/L (the adjusted odds ratios 1.46, 95% CI 1.10-1.93), and the odds of postoperative seizures decreased in patients with serum potassium ≤3.5 mmol/L (the adjusted odds ratios 0.73, 95% CI 0.53-1.01).

CONCLUSION

We found that high preoperative serum potassium level was associated with the high risk of postoperative seizures in patients undergoing craniotomy. We demonstrated that preoperative serum potassium level was the independent risk factor of postoperative seizures.

Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients: A Propensity Score Matching Study

OBJECTIVE

This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.

METHODS

This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022. Data were collected for each patient, including demographics, disease status, surgical data, and clinical information. Preoperative bowel preparation, postoperative gastrointestinal function, and electrolyte levels were compared between the two groups using propensity score matching (PSM).

RESULTS

The incidence of hypokalemia (serum potassium level <3.5 mmol/L) during the recovery period from anesthesia was approximately 43.75%. After PSM, oral laxative use (96.4% vs. 82.4%, P=0.005), the number of general enemas (P=0.014), and the rate of ≥2 general enemas (92.9% vs. 77.8%, P=0.004) were identified as risk factors for hypokalemia, which was accompanied by decreased PaCO2 and hypocalcemia. There were no significant differences in postoperative gastrointestinal outcomes, such as the time to first flatus or feces, the I-FEED score (a scoring system was created to evaluate impaired postoperative gastrointestinal function), or postoperative recovery outcomes, between the hypokalemia group and the normal serum potassium group.

CONCLUSION

Hypokalemia during postanesthesia recovery period occurred in 43.75% of gynecological patients, which resulted from preoperative mechanical bowel preparation; however, it did not directly affect clinical outcomes, including postoperative gastrointestinal function, postoperative complications, and length of hospital stay.