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Ding W, Zhang Y, Liu H, Zhou T, Zhao W, Feng Y, An H. Effect of regional block technique on postoperative high-grade complications according to Clavien-Dindo classification in elderly patients with thoracic and abdominal cancer: a retrospective propensity score matching analysis. Front Oncol 2023; 13:1305329. [PMID: 38205136 PMCID: PMC10777742 DOI: 10.3389/fonc.2023.1305329] [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: 10/01/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
Background Postoperative complications have an influence on postoperative rehabilitation, length of hospital stay and hospitalization expenses in elderly patients, especially those with higher Clavien-Dindo (C-D) classification. Patients with cancers often experience more serious postoperative complications after surgery. Different anesthesia methods can affect the postoperative outcomes of cancer patients. Regional block techniques have been recommended in guidelines for enhanced recovery after surgery. However, the relationship between regional blocks and high-grade postoperative complications remains unclear, thus, the study explored the relationship between regional block techniques and high-grade postoperative complications graded by C-D classification in elderly patients with thoracic and abdominal cancer. Method Retrospective enrollment of eligible elderly patients admitted to Peking University People's Hospital between January 2018 and March 2022 was conducted. Propensity score matching (PSM) and univariate and multivariate regression analyses were used to analyze the potential benefits of regional blocks for elderly patients in real world practice. Results A total of 2769 patients were enrolled in this study, including 568 who underwent colorectal resection, 2201 who underwent video-assisted thoracoscopic pneumonectomy. Among them, 2033 patients received regional block, while 736 patients did not. Statistical analysis indicated that regional blocks could reduce the incidence of postoperative complications of C-D classification Grade II or higher, with an Odds ratio (OR) of 0.742, 95% Confidence interval (CI) (0.552 to 0.996) (P = 0.047). Conclusion Regional block is associated with a reduction in the occurrence of postoperative complications graded by C-D classification in elderly patients with thoracic and abdominal cancer. The application of regional blocks can lower the risk of high-risk complications and mortality.
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Affiliation(s)
- Weisi Ding
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yunpeng Zhang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Huixin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
| | - Tianxin Zhou
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Wanlu Zhao
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Haiyan An
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
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Triemstra L, de Jongh C, Tedone F, Brosens LAA, Luyer MDP, Stoot JHMB, Lagarde SM, van Hillegersberg R, Ruurda JP. The Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107095. [PMID: 37913608 DOI: 10.1016/j.ejso.2023.107095] [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: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery. METHODS The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications and cardiovascular, gastrointestinal, infectious, pulmonary, and other complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman's rho-test and compared with standard Fisher's z-transformation. RESULTS Between 2015 and 2018, 211 patients underwent laparoscopic (n = 106) or open (n = 105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p = 0.755) and subgroups of complications (p > 0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs = 0.646 versus rs = 0.628; p = 0.001, difference clinically irrelevant), and reoperations (rs = 0.590 versus rs = 0.599; p = 0.070), and weak correlations for ICU-stay (rs = 0.446 versus rs = 0.440; p = 0.189). CONCLUSIONS The CCI is a composite scoring system based on the CDC and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, following abdominal surgery other than gastrectomy. Implementing CCI showed no clinically relevant benefit and caused additional workload compared to CDC for assessing complication burden. Therefore, using the CCI alongside the CDC after gastric cancer surgery is not recommended.
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Affiliation(s)
- Lianne Triemstra
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | - Cas de Jongh
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | - Fabrizio Tedone
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | | | - Misha D P Luyer
- Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, the Netherlands
| | - Jan H M B Stoot
- Zuyderland Medical Center, Department of Surgery, Sittard, the Netherlands
| | | | | | - Jelle P Ruurda
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands.
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Donnelly M, Driever D, Ryan ÉJ, Elliott JA, Finnegan J, McNamara D, Murphy I, Conlon KC, Neary PC, Kavanagh DO, O'Riordan JM. Obesity, Sarcopenia and Myosteatosis: Impact on Clinical Outcomes in the Operative Management of Crohn's Disease. Inflamm Bowel Dis 2023:izad225. [PMID: 37861366 DOI: 10.1093/ibd/izad225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Obesity, sarcopenia, and myosteatosis in inflammatory bowel disease may confer negative outcomes, but their prevalence and impact among patients with Crohn's disease (CD) have not been systematically studied. The aim of this study was to assess nutritional status and body composition among patients undergoing resectional surgery for CD and determine impact on operative outcomes. METHODS Consecutive patients with CD undergoing resection from 2000 to 2018 were studied. Total, subcutaneous, and visceral fat areas and lean tissue area (LTA) and intramuscular adipose tissue (IMAT) were determined preoperatively by computed tomography at L3 using SliceOmatic (Tomovision, Canada). Univariable and multivariable linear, logistic, and Cox proportional hazards regression were performed. RESULTS One hundred twenty-four consecutive patients were studied (ileocolonic disease 53%, n = 62, biologic therapy 34.4% n = 43). Mean fat mass was 22.7 kg, with visceral obesity evident in 23.9% (n = 27). Increased fat stores were associated with reduced risk of emergency presentation but increased corticosteroid use (β 9.09, standard error 3.49; P = .011). Mean LBM was 9.9 kg. Sarcopenia and myosteatosis were associated with impaired baseline nutritional markers. Myosteatosis markers IMAT (P = .002) and muscle attenuation (P = .0003) were associated with increased grade of complication. On multivariable analysis, IMAT was independently associated with increased postoperative morbidity (odds ratio [OR], 1.08; 95% confidence interval (CI), 1.01-1.16; P = .037) and comprehensive complications index (P = .029). Measures of adiposity were not associated with overall morbidity; however, increased visceral fat area independently predicted venous thromboembolism (OR, 1.02; 95% CI, 1.00-1.05; P = .028), and TFA was associated with increased wound infection (OR, 1.00; 95% CI, 1.00-1.01; P = .042) on multivariable analysis. CONCLUSION Myosteatosis is associated with nutritional impairment and predicts increased overall postoperative morbidity following resection for CD. Despite its association with specific increased postoperative risks, increased adiposity does not increase overall morbidity, reflecting preservation of nutritional status and relatively more quiescent disease phenotype. Impaired muscle mass and function represent an appealing target for patient optimization to improve outcomes in the surgical management of CD.
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Affiliation(s)
- Mark Donnelly
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Dorothee Driever
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - John Finnegan
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin Ireland
| | - Ian Murphy
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Kevin C Conlon
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin Ireland
| | - Paul C Neary
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin Ireland
| | - Dara O Kavanagh
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Department of Surgical Affairs, Dublin, Ireland
| | - James M O'Riordan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin Ireland
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Metzemaekers J, Bouwman L, de Vos M, van Nieuwenhuizen K, Twijnstra ARH, Smeets M, Jansen FW, Blikkendaal M. Clavien-Dindo, comprehensive complication index and classification of intraoperative adverse events: a uniform and holistic approach in adverse event registration for (deep) endometriosis surgery. Hum Reprod Open 2023; 2023:hoad019. [PMID: 37250430 PMCID: PMC10224795 DOI: 10.1093/hropen/hoad019] [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: 01/07/2023] [Revised: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
STUDY QUESTION What is the additional value of the comprehensive complication index (CCI) and ClassIntra system (classification for intraoperative adverse events (ioAEs)) in adverse event (AE) reporting in (deep) endometriosis (DE) surgery compared to only using the Clavien-Dindo (CD) system? SUMMARY ANSWER The CCI and ClassIntra are useful additional tools alongside the CD system for a complete and uniform overview of the total AE burden in patients with extensive surgery (such as DE), and with this uniform data registration, it is possible to provide greater insight into the quality of care. WHAT IS KNOWN ALREADY Uniform comparison of AEs reported in the literature is hampered by scattered registration. In endometriosis surgery, the usage of the CD complication system and the CCI is internationally recommended; however, the CCI is not routinely adapted in endometriosis care and research. Furthermore, a recommendation for ioAEs registration in endometriosis surgery is lacking, although this is vital information in surgical quality assessments. STUDY DESIGN SIZE DURATION A prospective mono-center study was conducted with 870 surgical DE cases from a non-university DE expertise center between February 2019 and December 2021. PARTICIPANTS/MATERIALS SETTING METHODS Endometriosis cases were collected with the EQUSUM system, a publicly available web-based application for registration of surgical procedures for endometriosis. Postoperative adverse events (poAEs) were classified with the CD complication system and CCI. Differences in reporting and classifying AEs between the CCI and the CD were assessed. ioAEs were assessed with the ClassIntra. The primary outcome measure was to assess the additional value toward the CD classification with the introduction of the CCI and ClassIntra. In addition, we report a benchmark for the CCI in DE surgery. MAIN RESULTS AND THE ROLE OF CHANCE A total of 870 DE procedures were registered, of which 145 procedures with one or more poAEs, resulting in a poAE rate of 16.7% (145/870), of which in 36 cases (4.1%), the poAE was classified as severe (≥Grade 3b). The median CCI (interquartile range) of patients with poAEs was 20.9 (20.9-31.7) and 33.7 (33.7-39.7) in the group of patients with severe poAEs. In 20 patients (13.8%), the CCI was higher than the CD because of multiple poAEs. There were 11 ioAEs reported (11/870, 1.3%) in all procedures, mostly minor and directly repaired serosa injuries. LIMITATIONS REASONS FOR CAUTION This study was conducted at a single center; thus, trends in AE rates and type of AEs could differ from other centers. Furthermore, no conclusion could be drawn on ioAEs in relation to the postoperative course because the power of this database is not robust enough for that purpose. WIDER IMPLICATIONS OF THE FINDINGS From our data, we would advise to use the Clavien-Dindo classification system together with the CCI and ClassIntra for a complete overview of AE registration. The CCI appeared to provide a more complete overview of the total burden of poAEs compared to only reporting the most severe poAEs (as with CD). If the use of the CD, CCI, and ClassIntra is widely adapted, uniform data comparison will be possible at (inter)national level, providing better insight into the quality of care. Our data could be used as a first benchmark for other DE centers to optimize information provision in the shared decision-making process. STUDY FUNDING/COMPETING INTERESTS No funding was received for this study. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jeroen Metzemaekers
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte Bouwman
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Marit de Vos
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim van Nieuwenhuizen
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maddy Smeets
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mathijs Blikkendaal
- Correspondence address. Department of Gynecology/Endometriosis, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:
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朱 易, 王 飞, 赵 怡, 朱 涛. [Research Updates: Standardized Reporting and Evaluation Instruments for Postoperative Complications]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:342-348. [PMID: 35332740 PMCID: PMC10409346 DOI: 10.12182/20220360506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 06/14/2023]
Abstract
Postoperative complications are important indicators for evaluating surgical outcomes, and mortality and the incidence of various specific complications are often used to measure the efficacy of surgical and perioperative management strategies. With the progress of medical technology, there has been a dramatic decline in mortality and the incidence of complications. As a result, reporting and evaluation in the traditional methods no longer meets the actual needs of the world. There has arisen an urgent need for an instrument of standardized reporting and evaluation. The instrument should be aligned with the actual circumstances and should represent the patient's overall burden of postoperative complications. We herein reviewed the latest research findings on Clavien-Dindo Classification (CDC) system and comprehensive complication index (CCI), two instruments of standardized reporting and evaluation of postoperative complications, and discussed the space for improvement and prospects of application of CDC and CCI.
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Affiliation(s)
- 易豪 朱
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 飞 王
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- 电子科技大学 四川省医学科学院·四川省人民医院 麻醉科 (成都 610041)Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - 怡 赵
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 涛 朱
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Ding Y, Zhang X, Qiu J, Zhang J, Hua K. Assessment of ESGO Quality Indicators in Cervical Cancer Surgery: A Real-World Study in a High-Volume Chinese Hospital. Front Oncol 2022; 12:802433. [PMID: 35145915 PMCID: PMC8821940 DOI: 10.3389/fonc.2022.802433] [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: 10/26/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
The ESGO developed a list of fifteen quality indicators for cervical cancer surgery in order to audit and improve clinical practice in 2020. However, data from the developing countries with high incidence rates of cervical cancer is still lacking. Therefore, we conducted a retrospective study of 7081 cases diagnosed as cervical cancer between 2014 and 2019 in a Chinese single center according to the quality indicators proposed by ESGO. A total of 5952 patients underwent radical procedures, with an average of 992.0 per year. All surgeries were performed or supervised by a certified gynecologic oncologist as surgical qualification grading system has been established. Compared with the low-volume group, patients in the high-volume group (≥15 cases/year) had a shorter hospital stay (P<0.001), more free surgical margins (P=0.031), and less complications (P<0.001), but the 5-year recurrence-free survival and overall survival rates were similar (P>0.05). Treatment was not planned at a multidisciplinary team meeting but with the consultation system. The required preoperative workup was incomplete in 19.7% of patients with pelvic MRI and 45.7% of patients with PET-CT. A total of 1459 (20.6%) patients experienced at least one complication after surgery. The CDC grade IIIb or higher complications occurred in 80 patients, accounting for 5.5% complications. The urological fistula rate within 30 postoperative days were 0.3%. After primary surgical treatment, 97.4% patients had clear vaginal and parametrial margins. After restaging FIGO 2009 to FIGO 2018 system, 14.7% patients with a stage T1b disease were T-upstaged. After a median follow-up of 42 months, recurrence occurred in 448 patients, and 82.1% patients recurred within 2 years. The 2-year RFS rate of patients with pT1b1N0 was 97.3% in 2009 FIGO staging system. Lymph node staging was performed in 99.0% patients with a stage T1 disease. After a primary surgical treatment for a stage pT1b1N0 disease, 28.3% patients received adjuvant chemoradiotherapy. Above all, most of quality indicators reached the targets, except four quality indicators. The quality indicators of ESGO should be popularized and applied in China to guarantee quality of surgery.
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Affiliation(s)
- Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jianfeng Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
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