In-hospital clinical outcomes after upper gastrointestinal surgery: Data from an international observational study

Szakmány, Tamás; Ditai, James; Kirov, Mikhail Y.; Protsenko, D.N.; Osinaike, Babatunde; Venara, Aurélien; Demartines, Nicolas; Pearse, Rupert M; Prowle, John R.

doi:10.1016/j.ejso.2017.08.002

Cited by 7 publications

(10 citation statements)

References 35 publications

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“…Despite the incidence of PICs being relatively low in our study, the prolonged hospital stay and increased 30-day mortality associated with PICs indicate the need for more effective treatments for elderly patients who develop PICs and greater nationwide attention to this issue in China. Additionally, like other recent studies, 27 we found that surgical-site infections and pneumonia remain common infectious complications. Perioperative hand hygiene, vascular care, and environmental cleaning may lead to a substantial reduction in surgical-site infections among patients undergoing surgery.…”

Section: Discussionsupporting

confidence: 90%

Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7‐day cohort study from the International Surgical Outcomes Study

Wang

et al. 2021

Psychogeriatrics

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Aim Despite initiatives to increase elderly patients’ access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. Methods We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7‐day prospective cohort study of outcomes after elective surgery in in‐patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. Results Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30‐day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical‐site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. Conclusions The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30‐day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients’ access to surgical interventions should also enhance safe perioperative care to reduce PICs in China.

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Section: Discussionsupporting

confidence: 90%

Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7‐day cohort study from the International Surgical Outcomes Study

Wang

et al. 2021

Psychogeriatrics

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“…Surgery is part of the multimodality treatment of most solid tumours. Though very effective, surgical treatment may lead to postoperative complications . Especially in frail patients, these complications can lead to permanent functional loss and negatively influence survival and long‐term quality of life .…”

Section: Introductionmentioning

confidence: 99%

“…Though very effective, surgical treatment may lead to postoperative complications. 1,2 Especially in frail patients, these complications can lead to permanent functional loss and negatively influence survival and long-term quality of life. 3,4 The benefits of surgery should therefore be carefully weighed against these negative sequelae.…”

Section: Introductionmentioning

confidence: 99%

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Weerink

Hoorn

Leeuwen

et al. 2020

J cachexia sarcopenia muscle

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Background Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery. Methods PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date. Results A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date. Conclusions The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

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“…Grandes avanços com queda na mortalidade pós-operatória foram observados nos últimos anos no mundo, todavia as taxas de complicações continuam elevadas 25 . LRA associa-se a importante morbimortalidade após grandes cirurgias.…”

Section: Resultsunclassified

Lesão renal aguda após cirurgias não cardíacas: incidência e impacto das disfunções orgânicas extra-renais nos desfechos

Goiato¹,

Gandolfi

Cavallari³

et al. 2019

ACS

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Introdução: A permanência de pacientes em Unidades de Terapia Intensiva (UTI) é frequentemente complicada por Lesão Renal Aguda (LRA), principalmente em casos de sepse, baixo débito cardíaco e pós-operatório de grandes cirurgias. Objetivo: Avaliar a incidência, características, desenvolvimento de outras disfunções orgânicas, e desfechos de pacientes com LRA adquirida na UTI após cirurgias não cardíacas. Métodos: Estudo de coorte, prospectivo. Todos os pacientes internados consecutivamente nas UTIs após cirurgias não cardíacas nos meses de abril e maio de 2017 foram analisados quanto ao desenvolvimento ou não de LRA, de outras disfunções orgânicas e ao balanço hídrico. Resultados: A incidência de LRA foi de 16,2%. Os pacientes que desenvolveram LRA no pós-operatório eram mais graves, e diferiram quanto à necessidade de ventilação mecânica (60% vs. 11%, p < 0,001), uso de drogas vasoativas (82% vs. 44%, p = 0,021); presença de infecção (80% vs. 21%, p < 0,001), sepse ou choque séptico (50% vs. 9%, p < 0,001) e a outras complicações pós-operatórias (91% vs. 58%, p = 0,023). Outras disfunções de órgãos e sistemas foram mais fre-quentes nos pacientes com IRA (2 [2-3] vs. 1 [0-1], p < 0,001), particularmente disfunção gas-trointestinal (73% vs. 19%, p < 0,001) e cardiovascular (73% vs. 33%, p = 0,015). O número de pacientes com duas ou mais disfunções orgânicas aumentou de 21% para 82% em pacientes com LRA (RR 3,89, IC: 2,18 – 6,90, p < 0,001). O tempo de internação (13 ± 9 vs. 5 ± 6 dias, p < 0,001) e a mortalidade hospitalar (54,5% vs. 7%, p = 0,013) foram maiores nos pacientes com LRA. Conclusão: Entre pacientes com cirurgias não cardíacas e necessidade de UTI, a incidência de LRA é elevada e associada a complicações de outros sistemas, incluindo os sistemas neurológico, gastrointestinal, respiratório e cardiovascular; somandose a isso, balanço hídrico acumulado positivo, sepse e choque, maior tempo de internação e maiores taxas de mortalidade também foram encontrados nesses pacientes. Palavras-Chave: Lesão Renal Aguda; Unidades de Terapia Intensiva; Epidemiologia; Fatores de Risco; Período Perioperatório.

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In-hospital clinical outcomes after upper gastrointestinal surgery: Data from an international observational study

Abstract: Complications and death are common after upper gastrointestinal surgery. Patients undergoing major surgery for cancer are at greatest risk.

Cited by 7 publications

References 35 publications

Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7‐day cohort study from the International Surgical Outcomes Study

Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7‐day cohort study from the International Surgical Outcomes Study

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Lesão renal aguda após cirurgias não cardíacas: incidência e impacto das disfunções orgânicas extra-renais nos desfechos

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