1
|
Vianna FSL, Neves LL, Testa R, Nassar AP, Peres JHF, da Silva RÁJ, de Paula Sales F, Raglione D, Del Bianco Madureira B, Dalfior L, Malbouisson LMS, Ribeiro U, da Silva JM. Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study. Ann Surg Oncol 2024; 31:3639-3648. [PMID: 38530529 DOI: 10.1245/s10434-024-15152-9] [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: 01/04/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic. METHODS This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes). RESULTS After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91). CONCLUSIONS Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.
Collapse
Affiliation(s)
- Felipe Souza Lima Vianna
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Renato Testa
- Fundação Antonio Prudente- A C Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Dante Raglione
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Dalfior
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - João Manoel da Silva
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital do Câncer de Barretos- Fundação Pio XII, Barretos, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| |
Collapse
|
2
|
Ajeje ET, Gandolfi JV, Cavallari V, Silva-Jr JM, de Freitas Chaves RC, Berger-Estilita J, Lobo SM. Measurements of I-FABP and citrulline in the postoperative period of non-cardiac surgeries with gastrointestinal complications: A prospective cohort observational study. J Crit Care 2024; 81:154530. [PMID: 38335862 DOI: 10.1016/j.jcrc.2024.154530] [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: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Acute Gastrointestinal Injury (AGI) is associated with adverse clinical outcomes, including increased mortality. We aimed to investigate the potential of citrulline and intestinal fatty acid binding protein (I-FABP) as biomarkers for early AGI diagnosis and predicting outcomes in surgical patients. METHODS Prospective cohort study involving patients who underwent non-cardiac surgeries and were admitted to Intensive Care Units. AGI diagnosis was based on specific criteria, and severity was categorised following established guidelines. Statistical analyses were performed to assess the diagnostic accuracy of the biomarkers and their association with outcomes, P significant when <0.05. RESULTS AGI was identified in 40.3% of patients with varying severity. Mortality rates were significantly higher in the AGI group in the ICU (19.4% vs. 0%, p = 0.001) and hospital (22.6% vs. 2.17%, p = 0.003). Urinary I-FABP levels on days 3 and 7 showed reasonable and good accuracy for AGI diagnosis (AUC 0.732 and 0.813, respectively). Urinary I-FABP levels on days 2 and 3 accurately predict sepsis. Urinary citrulline levels on day one predicted mortality (AUC 0.87) furthermore urinary I-FABP levels on day 2 showed reasonable accuracy (sensitivity 83.3%, specificity 92.4%). CONCLUSION Urinary I-FABP and citrulline levels are promising diagnostic and prognostic markers in ICU patients following non-cardiac surgeries.
Collapse
Affiliation(s)
- Eduarda Tebet Ajeje
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - Joelma Villafanha Gandolfi
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - Vinicius Cavallari
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - João Manoel Silva-Jr
- Hospital Israelita Albert Einstein- São Paulo (SP), Brazil; Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Renato Carneiro de Freitas Chaves
- Hospital Israelita Albert Einstein- São Paulo (SP), Brazil; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Joana Berger-Estilita
- Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group, Schänzlistrasse 39, 3013 Bern, Switzerland; Institute for Medical Education, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Suzana Margareth Lobo
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil.
| |
Collapse
|
3
|
Treml RE, Katayama HT, Caldonazo T, Pereira TS, Malbouisson LMS, Carmona MJC, Tanaka P, Silva JM. Perioperative organ dysfunction: a burden to be countered. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844480. [PMID: 38301970 PMCID: PMC10847857 DOI: 10.1016/j.bjane.2024.844480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Ricardo Esper Treml
- Friedrich-Schiller-University, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany; Stanford Health Care, Department of Anesthesiology, Perioperative and Pain Medicine, California, USA
| | | | - Tulio Caldonazo
- Friedrich-Schiller-University, Department of Cardiothoracic Surgery, Jena, Germany
| | - Talison Silas Pereira
- Hospital do Servidor Público Estadual, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | | | - Maria José C Carmona
- Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Pedro Tanaka
- Stanford Health Care, Department of Anesthesiology, Perioperative and Pain Medicine, California, USA
| | - João Manoel Silva
- Hospital do Servidor Público Estadual, Departamento de Anestesiologia, São Paulo, SP, Brazil; Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Wu J, Li J, Chen H, Shang X, Yu R. Optimization of central venous pressure during the perioperative period is associated with improved prognosis of high-risk operation patients. JOURNAL OF INTENSIVE MEDICINE 2023; 3:165-170. [PMID: 37188112 PMCID: PMC10175704 DOI: 10.1016/j.jointm.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/18/2022] [Accepted: 06/24/2022] [Indexed: 05/17/2023]
Abstract
Background While central venous pressure (CVP) measurement is used to guide fluid management for high-risk surgical patients during the perioperative period, its relationship to patient prognosis is unknown. Methods This single-center, retrospective observational study enrolled patients undergoing high-risk surgery from February 1, 2014 to November 31, 2020, who were admitted to the surgical intensive care unit (ICU) directly after surgery. Patients were divided into the following three groups according to the first CVP measurement (CVP1) after admission to the ICU: low, CVP1 <8 mmHg; moderate, 8 mmHg≤ CVP1 ≤ 12 mmHg; and high, CVP1 >12 mmHg. Perioperative fluid balance, 28-day mortality, length of stay in the ICU, and hospitalization and surgical complications were compared across groups. Results Of the 775 high-risk surgical patients enrolled in the study, 228 were included in the analysis. Median (interquartile range) positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group (low CVP1: 770 [410, 1205] mL; moderate CVP1: 1070 [685, 1500] mL; high CVP1: 1570 [1008, 2000] mL; all P <0.001). The volume of positive fluid balance during the perioperative period was correlated with CVP1 (r=0.336, P <0.001). The partial arterial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups (low CVP1: 400.0 [299.5, 443.3] mmHg; moderate CVP1: 362.5 [330.0, 434.9] mmHg; high CVP1: 335.3 [254.0, 363.5] mmHg; all P <0.001). The incidence of postoperative acute kidney injury (AKI) was lowest in the moderate CVP1 group (low CVP1: 9.2%; moderate CVP1: 2.7%; high CVP1: 16.0%; P=0.007). The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group (low CVP1: 1.5%; moderate CVP1: 0.9%; high CVP1: 10.0%; P=0.014). Logistic regression analysis showed that intraoperative hypotension and CVP1 >12 mmHg were risk factors for AKI within 72 h after surgery (adjusted odds ratio[aOR]=3.875, 95% confidence interval[CI]: 1.378-10.900, P=0.010 and aOR=1.147, 95%CI: 1.006-1.309, P=0.041). Conclusions CVP that is either too high or too low increases the incidence of postoperative AKI. Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid. However, CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.
Collapse
Affiliation(s)
| | | | | | - Xiuling Shang
- Corresponding authors: Xiuling Shang and Rongguo Yu.
| | - Rongguo Yu
- Corresponding authors: Xiuling Shang and Rongguo Yu.
| |
Collapse
|
5
|
Postoperative hypothermia following non-cardiac high-risk surgery: A prospective study of temporal patterns and risk factors. PLoS One 2021; 16:e0259789. [PMID: 34780517 PMCID: PMC8592479 DOI: 10.1371/journal.pone.0259789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background and objectives Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients’ characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan–Meier curve was generated and adjusted using a Cox regression model. Results In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3–34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1–22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0–35.8°C]) was 64% (95% CI = 58.3–70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15–2.0), especially coagulation and infection. Conclusions Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications.
Collapse
|
6
|
Katayama HT, Gomes BC, Lobo SMA, Chaves RCDF, Corrêa TD, Assunção MSC, Serpa Neto A, Malbouisson LMS, Silva-Jr JM. The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients. Ren Fail 2021; 43:1338-1348. [PMID: 34579622 PMCID: PMC8477947 DOI: 10.1080/0886022x.2021.1977318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication. METHODS A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients. RESULTS A total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; p = 0.001), and a higher length of ICU and hospital stay (p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69-29.07), elective surgery (OR = 0.45; 95% CI 0.21-0.97), SAPS 3 (OR = 1.04; 95% CI 1.02-1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34-4.55), post-operative infection (OR = 8.82; 95% CI 2.43-32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58-19.79). CONCLUSION AKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - João Manoel Silva-Jr
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | |
Collapse
|
7
|
Silva JM, Katayama HT, Lopes FMV, Toledo DO, Amendola CP, Oliveira FDS, Andraus LMR, Carmona MJC, Lobo SM, Malbouisson LMS. Referral to immediate postoperative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire. Braz J Anesthesiol 2021; 71:265-270. [PMID: 33930339 PMCID: PMC9373420 DOI: 10.1016/j.bjane.2021.03.025] [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: 06/03/2019] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction and objective Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. Methods A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results 360 physicians participated in the study, with median time of 10 (5–18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. Conclusion Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.
Collapse
Affiliation(s)
- João Manoel Silva
- Hospital Servidor Público Estadual de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Departamento de Pacientes Graves, São Paulo, SP, Brazil; Hospital de Câncer de Barretos, Departamento de Anestesiologia e Terapia Intesiva, Barretos, SP, Brazil.
| | - Henrique Tadashi Katayama
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
| | | | - Diogo Oliveira Toledo
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Departamento de Pacientes Graves, São Paulo, SP, Brazil
| | - Cristina Prata Amendola
- Hospital de Câncer de Barretos, Departamento de Anestesiologia e Terapia Intesiva, Barretos, SP, Brazil
| | | | | | - Maria José C Carmona
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
| | - Suzana Margareth Lobo
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Dülger D, Albuz Ö. Risk indices that predict in-hospital mortality of elderly patients. Turk J Med Sci 2020; 50:969-977. [PMID: 32490649 PMCID: PMC7379462 DOI: 10.3906/sag-2005-67] [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: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background/aim Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status. Material and methods We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayıs State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population. Results Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53–2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90–3.26), P < 0.001). Conclusion Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.
Collapse
Affiliation(s)
- Dilek Dülger
- Department of Microbiology, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Özgür Albuz
- Deparment of General Surgery, Keçiören Training and Research Hospital,Ankara,Turkey
| |
Collapse
|