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Wang B, Liang HS, Shen JW, An YZ, Feng Y. A Nomogram for Predicting Postoperative Pulmonary Complications in Critical Patients Transferred to ICU After Abdominal Surgery. J Intensive Care Med 2024:8850666241280900. [PMID: 39262206 DOI: 10.1177/08850666241280900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the risk factors associated with postoperative pulmonary complications(PPCs) in critically ill patients transferred to intensive care unit(ICU) after abdominal surgery and develop a predictive model for this disease. METHODS Data for 3716 patients who were admitted to ICU after abdominal surgery in Peking University People's Hospital between January 2015 and December 2020 were retrospectively collected and analyzed to identify the risk factors and develop a nomogram prediction model. Data for patients admitted to ICU following abdominal surgery at Peking University People's Hospital from March 2021 to December 2022 were prospectively collected as a validation set to validate and assess the model. RESULTS 10 independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model was constructed for PPCs in this group patients, the area under ROC curve was 0.771[95%CI: 0.756,0.786] and 0.759[95%CI: 0.726,0.792] in the training set and validation set, respectively. CONCLUSIONS In this study, independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model for PPCs in critically ill surgical population was constructed using these factors, demonstrating a good predictive value.
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Affiliation(s)
- Bin Wang
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Han Sheng Liang
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
| | - Jia Wei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - You Zhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
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Alrefaei MI, Ahmed RA, Al Thoubaity F. Incidence of postoperative pneumonia in various surgical subspecialties: a retrospective study. Ann Med Surg (Lond) 2024; 86:5043-5048. [PMID: 39238970 PMCID: PMC11374227 DOI: 10.1097/ms9.0000000000002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024] Open
Abstract
Postoperative pneumonia (POP) can be defined as either hospital-acquired pneumonia (HAP, pneumonia developing 48-72 h after admission) or ventilator-associated pneumonia (VAP, pneumonia developing 48-72 h after endotracheal intubation)' or within 30 days in postoperative patients. POP accounts for 2.7-3.4% of postoperative complications. Few studies have evaluated the incidence and the risk factors of POP. This study aimed to estimate the incidence of POP and identify the predictive factors of POP in King Abdul-Aziz University Hospital (KAUH), Jeddah, Saudi Arabia. This retrospective record review included all patients diagnosed with POP at KAUH between 2011 and 2021. Patients younger than 18 years of age and those diagnosed with congenital heart or lung disease were excluded from the study. Data were analyzed using the SPSS program version 26. Of the 2350 patients, 236 met the inclusion criteria. The mean age of patients was 58.12± 17.66 years; 82.6% had comorbidities. ENT (6.4%) and cardiothoracic surgeries associated with POP were the most common surgeries (4.2%). Comorbidities were found as an independent predictor of pneumonia among the studied patients (P = 0.024). The incidence of developing POP was (19.9%). Therefore, Physicians should be aware of POP. Especially when treating patients with comorbidities and patients on corticosteroids.
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Affiliation(s)
| | | | - Fatma Al Thoubaity
- College of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
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Elmaagacli S, Thiele C, Meister F, Menne P, Truhn D, Olde Damink SWM, Bickenbach J, Neumann U, Lang SA, Vondran F, Amygdalos I. Preoperative three-dimensional lung volumetry predicts respiratory complications in patients undergoing major liver resection for colorectal metastases. Sci Rep 2024; 14:10594. [PMID: 38719953 PMCID: PMC11079043 DOI: 10.1038/s41598-024-61386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer and liver resection with complete tumor removal is the best treatment option for these patients. This study examines the predictive ability of three-dimensional lung volumetry (3DLV) based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications in patients undergoing major liver resection for CRLM. Patients undergoing major curative liver resection for CRLM between 2010 and 2021 with a preoperative CT scan of the thorax within 6 weeks of surgery, were included. Total lung volume (TLV) was calculated using volumetry software 3D-Slicer version 4.11.20210226 including Chest Imaging Platform extension ( http://www.slicer.org ). The area under the curve (AUC) of a receiver-operating characteristic analysis was used to define a cut-off value of TLV, for predicting the occurrence of postoperative respiratory complications. Differences between patients with TLV below and above the cut-off were examined with Chi-square or Fisher's exact test and Mann-Whitney U tests and logistic regression was used to determine independent risk factors for the development of respiratory complications. A total of 123 patients were included, of which 35 (29%) developed respiratory complications. A predictive ability of TLV regarding respiratory complications was shown (AUC 0.62, p = 0.036) and a cut-off value of 4500 cm3 was defined. Patients with TLV < 4500 cm3 were shown to suffer from significantly higher rates of respiratory complications (44% vs. 21%, p = 0.007) compared to the rest. Logistic regression analysis identified TLV < 4500 cm3 as an independent predictor for the occurrence of respiratory complications (odds ratio 3.777, 95% confidence intervals 1.488-9.588, p = 0.005). Preoperative 3DLV is a viable technique for prediction of postoperative pulmonary complications in patients undergoing major liver resection for CRLM. More studies in larger cohorts are necessary to further evaluate this technique.
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Affiliation(s)
- Suzan Elmaagacli
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christoph Thiele
- Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Franziska Meister
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Menne
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Johannes Bickenbach
- Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Neumann
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sven Arke Lang
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Vondran
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Iakovos Amygdalos
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Sucandy I, Ross S, Patel N, App S, Ignatius J, Syblis C, Crespo K, Butano V, Rosemurgy A. The Impact of Smoking History on Outcomes and Morbidity After Robotic Hepatectomy. Am Surg 2023; 89:3764-3770. [PMID: 37222271 DOI: 10.1177/00031348231173934] [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] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The detrimental effects that smoking has on patient health and postoperative morbidity are well documented. However, literature on the impact that smoking history has on robotic surgery, specifically robotic hepatectomy, is scarce. This study was undertaken to determine whether smoking history impacts the postoperative course of patients undergoing robotic hepatectomy. METHODS We prospectively followed 353 patients that underwent robotic hepatectomy. 125 patients had an apposite history of smoking (ie, smokers) and 228 patients were classified as non-smokers. Data were presented as median (mean ± SD). Patients were then propensity-score matched based on patient and tumor characteristics. RESULTS Prior to the matching, the MELD score and cirrhosis status in patients who smoke were found to be significantly higher when compared to those who do not (mean MELD score 9 vs 8 and cirrhosis in 25% vs 13% of patients, respectively). Both smokers and non-smokers have similar BMIs, number of previous abdominal operations, ASA physical status classifications, and Child-Pugh scores. Six percent smokers vs one percent non-smokers experienced pulmonary complications (pneumonia, pneumothorax, and COPD exacerbation) (P = .02). No differences were found for postoperative complications of Clavien-Dindo score ≥ III, 30-day mortality, or 30-day readmissions. After the matching, no differences were found between the smokers and the non-smokers. CONCLUSION After a propensity-score match analysis, smoking did not appear to negatively affect the intra- and postoperative outcomes after robotic liver resections. We believe that the robotic approach as the most modern minimally invasive technique in liver resection may have the potential to mitigate the known adverse effects of smoking.
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Wang KY, Quan T, Kapoor S, Gu A, Best MJ, Kreulen RT, Srikumaran U. The influence of elevated international normalized ratio on complications following total shoulder arthroplasty. Shoulder Elbow 2023; 15:53-64. [PMID: 37692874 PMCID: PMC10492533 DOI: 10.1177/17585732221088974] [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: 11/06/2021] [Revised: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 09/12/2023]
Abstract
Background Identifying preoperative risk factors for complications following total shoulder arthroplasty (TSA) has both clinical and financial implications. The purpose of this study was to determine the influence of different degrees of preoperative INR elevation on complications following TSA. Methods Patients undergoing primary TSA from 2007 to 2018 were identified in a national database. Patients were stratified into 4 cohorts: INR of <1.0, INR of >1.0 to 1.25, INR of >1.25 to 1.5, and INR of >1.5. Postoperative complications were assessed. Multivariate logistic regressions were performed to adjust for differences in demographics and comorbidities among the INR groups. Results Following adjustment and relative to patients with an INR of <1.0, those with INR of >1.0-1.25, >1.25-1.5, and >1.5 had 1.6-times, 2.4-times, and 2.8-times higher odds of having postoperative bleeding requiring transfusion, respectively (p < 0.05 for all). Relative to patients with INR <1.0, those with INR of > 1.25-1.5 and INR of >1.5 had 7.8-times and 7.0-times higher odds of having pulmonary complications, respectively (p < 0.05 for both). Discussion With increasing INR levels, there is an independent and step-wise increase in odd ratios for postoperative complications. Current guidelines for preoperative INR thresholds may need to be adjusted for more predictive risk-stratification for TSA. Level of Evidence III.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Shrey Kapoor
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | | | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
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Wang B, Liang H, Zhao H, Shen J, An Y, Feng Y. Risk factors and predictive model for pulmonary complications in patients transferred to ICU after hepatectomy. BMC Surg 2023; 23:150. [PMID: 37270566 DOI: 10.1186/s12893-023-02019-1] [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: 06/16/2022] [Accepted: 04/26/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE Postoperative pulmonary complications (PPCs) seriously harm the recovery and prognosis of patients undergoing surgery. However, its related risk factors in critical patients after hepatectomy have been rarely reported. This study aimed at analyzing the factors related to PPCs in critical adult patients after hepatectomy and create a nomogram for prediction of the PPCs. METHODS 503 patients' data were collected form the Peking University People's Hospital. Multivariate logistic regression analysis was used to identify independent risk factors to derive the nomogram. Nomogram's discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curve. RESULTS The independent risk factor for PPCs are advanced age (odds ratio [OR] = 1.026; P = 0.008), higher body mass index (OR = 1.139; P < 0.001), lower preoperative serum albumin level (OR = 0.961; P = 0.037), and intensive care unit first day infusion volume (OR = 1.152; P = 0.040). And based on this, we created a nomogram to predict the occurrence of PPCs. Upon assessing the nomogram's predictive ability, the AUC for the model was 0.713( 95% CI: 0.668-0.758, P<0.001). The Hosmer-Lemeshow test (P = 0.590) and calibration curve showed good calibration for the prediction of PPCs. CONCLUSIONS The prevalence and mortality of postoperative pulmonary complications in critical adult patients after hepatectomy are high. Advanced age, higher body mass index, lower preoperative serum albumin and intensive care unit first day infusion volume were found to be significantly associated with PPCs. And we created a nomogram model which can be used to predict the occurrence of PPCs.
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Affiliation(s)
- Bin Wang
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HanSheng Liang
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HuiYing Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - JiaWei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - YouZhong An
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
| | - Yi Feng
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
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Lee DU, Fan GH, Chang K, Lee KJ, Han J, Jung D, Kwon J, Karagozian R. The Clinical Impact of Advanced Age on the Postoperative Outcomes of Patients Undergoing Gastrectomy for Gastric Cancer: Analysis Across US Hospitals Between 2011–2017. J Gastric Cancer 2022; 22:197-209. [PMID: 35938366 PMCID: PMC9359884 DOI: 10.5230/jgc.2022.22.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose This study systematically evaluated the implications of advanced age on post-surgical outcomes following gastrectomy for gastric cancer using a national database. Materials and Methods The 2011–2017 National Inpatient Sample was used to isolate patients who underwent gastrectomy for gastric cancer. From this, the population was stratified into those belonging to the younger age cohort (18–59 years), sexagenarians, septuagenarians, and octogenarians. The younger cohort and each advanced age category were compared in terms of the following endpoints: mortality following surgery, length of hospital stay, charges, and surgical complications. Results This study included a total of 5,213 patients: 1,366 sexagenarians, 1,490 septuagenarians, 743 octogenarians, and 1,614 under 60 years of age. Between the younger cohort and sexagenarians, there was no difference in mortality (2.27 vs. 1.67%; P=0.30; odds ratio [OR], 1.36; 95% confidence interval [CI], 0.81–2.30), length of stay (11.0 vs. 11.1 days; P=0.86), or charges ($123,557 vs. $124,425; P=0.79). Compared to the younger cohort, septuagenarians had higher rates of in-hospital mortality (4.30% vs. 1.67%; P<0.01; OR, 2.64; 95% CI, 1.67–4.16), length of stay (12.1 vs. 11.1 days; P<0.01), and charges ($139,200 vs. $124,425; P<0.01). In the multivariate analysis, septuagenarians had higher mortality (P=0.01; adjusted odds ratio [aOR], 2.01; 95% CI, 1.18–3.43). Similarly, compared to the younger cohort, octogenarians had a higher rate of mortality (7.67% vs. 1.67%; P<0.001; OR, 4.88; 95% CI, 3.06–7.79), length of stay (12.3 vs. 11.1 days; P<0.01), and charges ($131,330 vs. $124,425; P<0.01). In the multivariate analysis, octogenarians had higher mortality (P<0.001; aOR, 4.03; 95% CI, 2.28–7.11). Conclusions Advanced age (>70 years) is an independent risk factor for postoperative death in patients with gastric cancer undergoing gastrectomy.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Kevin Chang
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Daniel Jung
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Jean Kwon
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
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Chan KS, Wang B, Tan YP, Chow JJL, Ong EL, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study. JMIR Perioper Med 2021; 4:e30473. [PMID: 34559668 PMCID: PMC8496752 DOI: 10.2196/30473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. OBJECTIVE We report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. METHODS We divided our study into 4 phases-phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post-CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post-CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. RESULTS A total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre-CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). CONCLUSIONS This follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bei Wang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee Ling Ong
- Office of Clinical Governance, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Ally SA, Foy M, Sood A, Gonzalez M. Preoperative risk factors for postoperative pneumonia following primary Total Hip and Knee Arthroplasty. J Orthop 2021; 27:17-22. [PMID: 34456526 PMCID: PMC8379351 DOI: 10.1016/j.jor.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/15/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate risk factors for pneumonia following THA and TKA. METHODS Patients were identified from the American College of Surgeons National Quality Improvement Database (NSQIP) who experienced postoperative pneumonia after undergoing primary THA and TKA. RESULTS Many characteristics including old age, anemia, diabetes, cardiac comorbidities, dialysis, and smoking were independent risk factors for postoperative pneumonia after THA or TKA. CONCLUSION This analysis offers new evidence on risk factors associated with the development of pneumonia after THA and TKA. These risk factors can help guide clinicians in preventing postoperative pneumonia after THA and TKA.
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Affiliation(s)
- Syeda Akila Ally
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Michael Foy
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
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Outcome of bile leakage following liver resection with hepaticojejunostomy for liver cancer. Updates Surg 2021; 73:411-417. [PMID: 33471344 DOI: 10.1007/s13304-021-00974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
We aimed to investigate contemporary management and outcomes of bile leakage in patients who underwent hepatectomy with hepaticojejunostomy for liver malignancy. The NSQIP database was used to study clinical data of patients who underwent a hepatectomy with hepaticojejunostomy for a primary hepatobiliary cancer and developed bile leakage between 1/2014 and 12/2017. Multivariate regression analysis was performed to investigate outcomes. Five hundred patients underwent a hepatectomy with hepaticojejunostomy for a malignant primary hepatobiliary cancer (41% intrahepatic cholangiocarcinoma, 38.2% hilar cholangiocarcinoma, 9.8% hepatocellular carcinoma, 6% gallbladder cancer, and 5% others). The rate of bile leakage was 33.4%. Most patients (90.4%) did not require re-exploration. In 77 of 157 patients (49.1%), bile leakages were contained with intraoperatively placed drain(s) and no additional surgical intervention was required. A total of 71 patients (42.5%)-including 64 patients with intraoperative drains-required interventional radiology (IR)-guided drainage, with a 88.7% success rate. A total of 16 patients (9.6%) required re-exploration to control the leakage, with 8 of them having undergone failed IR-drainage. When running multivariate analysis, post-hepatectomy liver failure (AOR: 158.26, P < 0.01), preoperative sepsis (AOR: 36.24, P = 0.03), and smoking (AOR: 14.07, P = 0.03) were significantly associated with mortality of patients. Biliary leakage is relatively common following hepatectomy with hepaticojejunostomy for liver malignancy (33.4%), but most patients (90.4%) do not require re-exploration. Intraoperatively placed drains successfully controlled 46.7% of bile leakages. IR-guided drain placement had a 88.7% success rate for adequate leak control.
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Matsuo Y, Nomi T, Hokuto D, Yoshikawa T, Kamitani N, Sho M. Pulmonary complications after laparoscopic liver resection. Surg Endosc 2020; 35:1659-1666. [DOI: 10.1007/s00464-020-07549-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/04/2020] [Indexed: 01/13/2023]
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Ashrafizadeh A, Mehta S, Nahm CB, Doane M, Samra JS, Mittal A. Preoperative cardiac and respiratory investigations do not predict cardio-respiratory complications after pancreatectomy. ANZ J Surg 2019; 90:97-102. [PMID: 31625268 DOI: 10.1111/ans.15515] [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: 07/11/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The process of undergoing a pancreatic resection places a patient under notable physiologic strain throughout the perioperative journey, with well recognized risks of postoperative cardiopulmonary complications. Preoperative preparations and screening often incorporate a barrage of testing, including electrocardiograms, transthoracic echocardiography, chest X-rays and spirometric evaluations. However, the current literature does not demonstrate whether these common tests provide any predictive correlation with postoperative cardiopulmonary complications. This retrospective study is structured to identify complications in post-pancreatic resection patients and assess for a predictive correlation with preoperative test results. METHODS A retrospective analysis of all patients having undergone a pancreatic resection at a single tertiary centre, between 2014 and 2016. The inpatient medical records were reviewed for 30-day postoperative complications, including acute myocardial infarction, cardiac dysrhythmia, pulmonary embolism, pneumonia or pleural effusions. The results of routine preoperative diagnostic tests and complication rates were analysed. RESULTS A total of 244 patients, median age of 66 years (range 18-88 years) were included in the study. Of these, 11 patients experienced a cardiac complication and 16 patients experienced a respiratory complication. Among those who experienced cardiac events, only two patients had abnormalities in their preoperative electrocardiograms. Patients who sustained a cardiac or respiratory event did not have any evidence of abnormality in their preoperative transthoracic echocardiography or respiratory investigations, respectively. CONCLUSION Despite the recommendation that high-risk procedures such as pancreatic resections warrant thorough, routine, preoperative cardiac and respiratory investigation, a more functional preoperative assessment should be considered to stratify and predict postoperative outcomes.
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Affiliation(s)
- Amir Ashrafizadeh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Shreya Mehta
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, Sydney, New South Wales, Australia
| | - Christopher B Nahm
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, Sydney, New South Wales, Australia.,Sydney Vital, Sydney, New South Wales, Australia
| | - Matthew Doane
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Pancreatic Centre, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Pancreatic Centre, Sydney, New South Wales, Australia
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13
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Chacon E, Vilchez V, Eman P, Marti F, Morris-Stiff G, Dugan A, Turcios L, Gedaly R. Effect of critical care complications on perioperative mortality and hospital length of stay after hepatectomy: A multicenter analysis of 21,443 patients. Am J Surg 2018; 218:151-156. [PMID: 30528789 DOI: 10.1016/j.amjsurg.2018.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine predictors of critical care complications (CCC) in patients undergoing hepatectomy. METHODS All hepatectomy patients in NSQIP from 2012 to 2016 were analyzed. CCC included prolonged ventilation (>48 h), sepsis/septic shock, renal failure/insufficiency, cardiac arrest/AMI and pulmonary embolism. RESULTS A total of 21,443 patients underwent hepatectomy during the study period. Overall rate of CCC was 11%, with the most common being sepsis/septic shock (6.1%) and respiratory failure (4.9%). On multivariate analysis the preoperative risk factors associated with CCC included ASA Class IV-V (OR:2.04, p < 0.0001), diabetes (OR = 1.28, p = 0.0001), pre-operative ventilator use (OR: 17.75, p = 0.0003); COPD (OR: 1.65, p < 0.0001); pre-operative weight loss >10% (OR: 1.35, p = 0.0026); pre-operative sepsis (OR: 2.14, p < 0.0001). Propensity score matched analysis demonstrated a significant increased risk of mortality in patients with CCC (OR: 26.75, p < 0.0001) and a prolonged LOS of 10.5 days above the mean (β Estimate: 10.51, p < 0.0001). CONCLUSIONS ASA class, diabetes, COPD, pre-operative weight loss >10% and pre-operative sepsis are the strongest predictors of CCC after hepatectomy. The presence of CCC significantly increased the risk of peri-operative mortality 26-fold.
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Affiliation(s)
- Eduardo Chacon
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Valery Vilchez
- Section of Hepato-Pancreato-Biliary Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Pedro Eman
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Francesc Marti
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Gareth Morris-Stiff
- Section of Hepato-Pancreato-Biliary Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Adam Dugan
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Lilia Turcios
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
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14
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Hydrogen sulfide limits neutrophil transmigration, inflammation, and oxidative burst in lipopolysaccharide-induced acute lung injury. Sci Rep 2018; 8:14676. [PMID: 30279441 PMCID: PMC6168479 DOI: 10.1038/s41598-018-33101-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/20/2018] [Indexed: 01/11/2023] Open
Abstract
Transmigration and activation of neutrophils in the lung reflect key steps in the progression of acute lung injury (ALI). It is known that hydrogen sulfide (H2S) can limit neutrophil activation, but the respective mechanisms remain elusive. Here, we aimed to examine the underlying pathways in pulmonary inflammation. In vivo, C57BL/6N mice received the H2S slow releasing compound GYY4137 prior to lipopolysaccharide (LPS) inhalation. LPS challenge led to pulmonary injury, inflammation, and neutrophil transmigration that were inhibited in response to H2S pretreatment. Moreover, H2S reduced mRNA expression of macrophage inflammatory protein-2 (MIP-2) and its receptor in lung tissue, as well as the accumulation of MIP-2 and interleukin-1β in the alveolar space. In vitro, GYY4137 did not exert toxic effects on Hoxb8 neutrophils, but prevented their transmigration through an endothelial barrier in the presence and absence of MIP-2. In addition, the release of MIP-2 and reactive oxygen species from LPS-stimulated Hoxb8 neutrophils were directly inhibited by H2S. Taken together, we provide first evidence that H2S limits lung neutrophil sequestration upon LPS challenge. As proposed underlying mechanisms, H2S prevents neutrophil transmigration through the inflamed endothelium and directly inhibits pro-inflammatory as well as oxidative signalling in neutrophils. Subsequently, H2S pretreatment ameliorates LPS-induced ALI.
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15
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Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, Nadhim A, Shaffiy S, Mont MA. The Epidemiology and Risk Factors for Postoperative Pneumonia. J Clin Med Res 2017; 9:466-475. [PMID: 28496546 PMCID: PMC5412519 DOI: 10.14740/jocmr3002w] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/19/2022] Open
Abstract
Postoperative pneumonia is a common complication of surgery, and is associated with marked morbidity and mortality. Despite advances in surgical and anesthetic technique, it persists as a frequent postoperative complication. Many studies have aimed to assess its burden, as well as associated risk factors. However, this complication varies among the different surgical specialties, and there is a paucity of reports that comprehensively evaluate this complication. Therefore, the purpose of this study was to review the epidemiology and risk factors of postoperative pneumonia in the setting of: 1) general surgery; 2) cardiothoracic surgery; 3) orthopedic and spine surgery; and 4) head and neck surgery.
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Chukwuweike U Gwam
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Nequesha Mohamed
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rafay Khan
- Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Ali Nadhim
- Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Shervin Shaffiy
- St. Georges University School of Medicine, True Blue, Grenada, West Indies
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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16
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Abstract
Post-operative pulmonary complications (PPCs) occur in 5–10% of patients undergoing non-thoracic surgery and in 22% of high risk patients. PPCs are broadly defined as conditions affecting the respiratory tract that can adversely influence clinical course of the patient after surgery. Prior risk stratification, risk reduction strategies, performing short duration and/or minimally invasive surgery and use of anaesthetic technique of combined regional with general anaesthesia can reduce the incidence of PPCs. Atelectasis is the main cause of PPCs. Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation. Pre-operative treatment of IS is more effective. The main reason for post-operative pneumonia is aspiration along the channels formed by longitudinal folds in the high volume, low pressure polyvinyl chloride cuffs of the endotracheal tubes. Use of tapered cuff, polyurethane cuffs and selective rather than the routine use of nasogastric tube can decrease chances of aspiration. Acute lung injury is the most serious PPC which may prove fatal.
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