Background
Postoperative pulmonary embolism (PE) is a serious thrombotic complication in the patients with otolaryngologic cancers. We investigated the risk factors associated with postoperative PE after radical resection of head and neck cancers.
Methods
A total of 3512 patients underwent head and neck cancers radical resection from 2013 to 2019. A one-to-three control group without postoperative PE was selected matched by age, gender, and type of cancer. Univariate analyses were performed for the perioperative patient data including hemodynamic management factors. Conditional logistic regression was used to analyze the factors and their odds ratios.
Results
Postoperative PE was prevalent in 0.85% (95%CI = 0.56–1.14). Univariate analyses showed that a high ASA grade, high BMI, and smoking history may be related to postoperative PE. There was significantly difference in operation time between the two groups, especially for> 4 h [22(78.6%) vs 43(51.2%), P = .011]. The urine output was lower [1.37(0.73–2.21) ml·kg− 1·h− 1 vs 2.14(1.32–3.46) ml·kg− 1·h− 1, P = .006] and the incidence of oliguria was significantly increased (14.3% vs 1.2%, P = .004) in the PE group. Multivariable conditional logistic regression showed postoperative PE were associated with the cumulative duration for intraoperative hypotension (OR = 2.330, 95%CI = 1.428–3.801, P = .001), oliguria (OR = 14.844, 95%CI = 1.089–202.249, P = .043), and operation time > 4 h (OR = 4.801, 95%CI = 1.054–21.866, P = .043).
Conclusions
The intraoperative hypotension, oliguria, and operation time > 4 h are risk factors associated with postoperative PE after radical resection of head and neck cancers. Improving intraoperative hemodynamics management to ensure adequate blood pressure and urine output may reduce the occurrence of such complications.
Background and Objective
Postoperative gastrointestinal dysfunction (POGD) is a leading cause of delayed hospital stay after abdominal surgery. Goal-directed fluid therapy (GDFT) may improve gastrointestinal (GI) function, but the evidence for beneficial effects of GDFT for recovery of GI function remains controversial. The aim of this study was to evaluate the effect of GDFT on the postoperative recovery of GI function and length of hospital stay in patients undergoing major abdominal oncologic surgery.
Methods
In this randomized, partly blinded, controlled trial, adult patients scheduled for elective major abdominal oncologic surgery with general anesthesia, were randomly divided into GDFT group where fluid management was guided by stroke volume variation (SVV) and cardiac output index (CI) and the control group where fluid infusion was given based on conventional fluid therapy. Postoperative GI function was evaluated by Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) score system and I-FEED score ≥ 6 was defined as POGD. Time to the first flatus, time to first tolerate oral diet and the length of hospital stay were recorded.
Results
One hundred patients completed the study protocol. Two of 50 patients (4%) developed POGD in the GDFT group, whereas POGD occurred in 16 of 50 patients (32%) in the control group (P < 0.0001). GDFT significantly shorten time to first flatus by 11 hours [GDFT: 28.2 hours (9.2-48.0hours) versus Control: 39.4 hours (24.9–67.5 hours), P = 0.009] and time to first tolerate oral diet by 2 days [GDFT: 4.0 days (2.7-6.0 days) versus Control: 6.0 days (5.0-9.3days), P < 0.0001]. Moreover, the length of hospital stay was significantly shorter in GDFT group compared with the control group [GDFT: 9.0 days (5.8days) versus Control: 12.0 days (4.6days), P = 0.001].
Conclusions
GDFT guided by SVV and CI could accelerate the postoperative recovery of GI function and shorten length of hospital stay following major abdominal oncologic surgery.
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