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Khoury MK, Anjorin AC, Demsas F, Mulaney B, Bellomo TR, Dua A, Mohapatra A, Mohebali J, Srivastava SD, Eagleton MJ, Zacharias N. Identifying risk factors for postoperative ileus following open abdominal aortic aneurysm repair. J Vasc Surg 2024:S0741-5214(24)01665-3. [PMID: 39096979 DOI: 10.1016/j.jvs.2024.07.094] [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: 05/04/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Postoperative ileus (POI) is a common complication following major abdominal surgery. The majority of the data available regarding POI following abdominal surgery is from the gastrointestinal and urologic literature. These data have been extrapolated to vascular surgery, especially with regards to enhanced recovery programs for open abdominal aortic aneurysm (AAA) surgery. However, vascular patients are a unique patient population and extrapolation of gastrointestinal and urological data may not necessarily be appropriate. Therefore, the purpose of this study was to delineate the prevalence and risk factors of POI in patients undergoing open AAA surgery. METHODS This was a retrospective, single-institution study of patients who underwent open AAA surgery from January 2016 to July 2023. Patients were excluded if they had undergone non-elective repairs or had expired within 72 hours of their index operation. The primary outcome was rates of POI, which was defined as the presence of two or more of the following after the third postoperative day: nausea and/or vomiting, inability to tolerate oral food intake, absence of flatus, abdominal distension, or radiological evidence of ileus. RESULTS A total of 123 patients met study criteria with an overall POI rate of 8.9% (n=11). Patients who developed a POI had significantly lower BMIs (24.3 kg/m2 versus 27.1 kg/m2, P=.003), were more likely to undergo a transperitoneal approach (81.8% versus 42.0%, P=.022), midline laparotomy (81.8% versus 37.5%, P=.008), longer total clamp times (151.6 minutes versus 97.7 minutes, P=.018), larger amounts of intraoperative crystalloid infusion (3495 mL versus 2628 mL, P=.029), and were more likely to return to the operating room (27.3% versus 3.6%, P=.016). Proximal clamp site was not associated with POI (P=.463). POI patients also had higher rates of post-operative vasopressor use (100% versus 61.1%, P=.014) and larger amounts of oral morphine equivalents in the first 3 post-operative days (488.0 mg + 216.0 versus 203.8 mg + 29.6 P=.016). Patients who developed POI had longer lengths of stay (12.5 days versus 7.6 days, P<.001), longer duration of NGT decompression (5.9 days versus 2.2 days, P<.001), and a longer period of time before diet tolerance (9.1 days versus 3.7 days, P<.001). Of those that developed a POI (n=11), 4 (36.4%) required total parental nutrition during the admission. CONCLUSION POI is a morbid complication amongst patients undergoing elective open AAA surgery that significantly prolongs hospital stay. Patients at risk for developing a POI are those with lower BMIs, had an operative repair via a transperitoneal approach, midline laparotomy, longer clamp times, larger amounts of intraoperative crystalloid infusion, a return to the operating room, post-operative vasopressor use, and higher amounts of oral morphine equivalents. These data highlight important peri-operative opportunities to reduce the prevalence of POI.
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Affiliation(s)
- Mitri K Khoury
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA; HonorHealth Heart Care; Scottsdale, AZ.
| | - Aderike C Anjorin
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Falen Demsas
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Bianca Mulaney
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Tiffany R Bellomo
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Anahita Dua
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Abhikesh Mohapatra
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Jahan Mohebali
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Sunita D Srivastava
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Matthew J Eagleton
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
| | - Nikolaos Zacharias
- Massachusetts General Hospital; Division of Vascular and Endovascular Surgery; Boston, MA
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You C, Cheng L, Fang Q, Qing L, Li Q, Liu S, Wang Y, Li R, Dong Z. Comparative evaluation of reproductive organ-preserving versus standard radical cystectomy in female: a meta-analysis and systematic review of perioperative, oncological, and functional outcomes. Surg Endosc 2024:10.1007/s00464-024-11074-5. [PMID: 39009729 DOI: 10.1007/s00464-024-11074-5] [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: 04/05/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer. METHODS A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522). RESULTS The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival. CONCLUSIONS ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.
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Affiliation(s)
- Chengyu You
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Long Cheng
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Qixiang Fang
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Liangliang Qing
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Qingchao Li
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Shuai Liu
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Yanan Wang
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Rongxin Li
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Zhilong Dong
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China.
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China.
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