BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgica...BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.展开更多
Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is...Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is frequently associated with a spectrum of postoperative complications that significantly impact patient prognosis and quality of life.This comprehensive review systematically analyzes the classification,underlying pathophysiological mechanisms,and associated risk factors of these complications,with a particular focus on less commonly explored entities such as postoperative granuloma(PPG),corneal dellen,and scleral necrosis,alongside the more prevalent issue of recurrence.We delineate these complications based on their temporal presentation(early,intermediate,and late),and provide an in-depth analysis of general and specific contributing factors,including surgical trauma,individual patient characteristics,surgical technique,and perioperative management.Furthermore,this review synthesizes advancements in preventive strategies and therapeutic interventions,encompassing refined surgical techniques[e.g.,femtosecond laser-assisted pterygium surgery(FLAPS),pterygium extended removal followed by extended conjunctival transplant(P.E.R.F.E.C.T.)technique,Tissue Tuck technique],judicious application of adjuvant therapies[e.g.,mitomycin C(MMC),5-fluorouracil(5-FU),corticosteroids,anti-vascular endothelial growth factor(VEGF)agents],and optimized postoperative care protocols.By consolidating current evidence and identifying future research priorities,this review aims to provide ophthalmologists with a valuable theoretical foundation to guide individualized surgical planning,dynamic postoperative management,and ultimately minimize complications and improve patient satisfaction.展开更多
Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplica...Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.展开更多
BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outc...BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outcomes.AIM To comprehensively analyze the effect of totally thoracoscopic esophagectomy(TTE)on postoperative complications and serum inflammatory factors in patients diagnosed with EEC.METHODS A total of 113 patients with EEC,who were admitted to our hospital between September 2022 and December 2024,were recruited for this study.Specifically,55 patients were assigned to the control group and underwent conventional surgical procedures,whereas 58 patients formed the research group and underwent TTE.Subsequently,a series of comparisons and analyses were conducted between the two groups.These comparisons included surgery-related parameters,such as incision length,operation duration,and the number and extent of lymph node dissection;postoperative complications,namely,empyema,pulmonary infection,incision infection,anastomotic fistula,and delayed gastric emptying;postoperative pain,which was quantitatively evaluated by the Numerical Rating Scale;postoperative hospitalization duration;serum inflammatory factors,including interleukin(IL)-6,IL-8,and tumor necrosis factor-α;and stress response-associated indicators,such as C-reactive protein,cortisol,and adrenaline.RESULTS Statistical data demonstrated that compared with the control group,the research group exhibited substantially shorter incision length and postoperative hospitalization duration.The two groups had comparable number and extent of lymph node dissection.Notably,both the overall incidence of postoperative complications and the Numerical Rating Scale score on postoperative day 3 were remarkably lower in the research group.Although the levels of IL-6,IL-8,tumor necrosis factor-α,C-reactive protein,cortisol,and adrenaline in the research group increased statistically postoperatively,they were still considerably lower than those in the control group.CONCLUSION In patients with EEC,TTE not only reduces the risk of postoperative complications but also effectively alleviates the body’s inflammatory and stress responses associated with surgery.展开更多
BACKGROUND Gastric ulcer perforation is a critical condition that can lead to significant morbidity and mortality if not promptly addressed.It is often the result of chronic peptic ulcer disease,which is characterized...BACKGROUND Gastric ulcer perforation is a critical condition that can lead to significant morbidity and mortality if not promptly addressed.It is often the result of chronic peptic ulcer disease,which is characterized by a breach in the gastric wall due to ulceration.Surgical intervention is essential for managing this life-threatening complication.However,the optimal surgical technique remains debatable among clinicians.Various methods have been employed,including simple closure,omental patch repair,and partial gastrectomy,each with distinct advantages and disadvantages.Understanding the comparative efficacy and postoperative outcomes of these techniques is crucial for improving patient care and surgical decision-making.This study addresses the need for a comprehensive analysis in this area.AIM To compare the efficacy and postoperative complications of different surgical methods for the treatment of gastric ulcer perforation.METHODS A retrospective analysis was conducted on 120 patients who underwent surgery for gastric ulcer perforation between September 2020 and June 2023.The patients were divided into three groups based on the surgical method:Simple closure,omental patch repair,and partial gastrectomy.The primary outcomes were the operative success rate and incidence of postoperative complications.Secondary outcomes included the length of hospital stay,recovery time,and long-term quality of life.RESULTS The operative success rates for simple closure,omental patch repair,and partial gastrectomy were 92.5%,95%,and 97.5%,respectively.Postoperative complications occurred in 20%,15%,and 17.5%of patients in each group,respectively.The partial gastrectomy group showed a significantly longer operative time(P<0.001)but the lowest rate of ulcer recurrence(2.5%,P<0.05).The omental patch repair group demonstrated the shortest hospital stay(mean 7.2 days,P<0.05)and fastest recovery time.CONCLUSION While all three surgical methods showed high success rates,omental patch repair demonstrated the best overall outcomes,with a balance of high efficacy,low complication rates,and shorter recovery time.However,the choice of the surgical method should be tailored to individual patient factors and the surgeon’s expertise.展开更多
Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods...Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods:We analyzed the clinicopathological data of 3,926 gastrointestinal cancer patients from the Prevalence of Abdominal Complications After GastroEnterological surgery(PACAGE)database,covering 20 medical centers from December 2018 to December 2020.The predictive performance was evaluated using receiver operating characteristic(ROC)curves and Brier Score.Results:The patients were divided into gastric(2,271 cases)and colorectal cancer(1,655 cases)groups and further divided into training and external validation sets.The overall postoperative complication rates for gastric and colorectal cancer groups were 18.1%and 14.8%,respectively.The most common complication was the intraabdominal infection in both gastric and colorectal cancer groups.In the training set,the Random Forest(RF)model predicted the highest mean area under the curve(AUC)values for overall complications and different types of complications,in both the gastric cancer group and the colorectal cancer group,with similar results obtained in the external validation set.ROC curve analysis showed good predictive performance of the RF model for overall and infectious complications.An application-based clinical tool was developed for easy application in clinical practice.Conclusions:This model demonstrated good predictive performance for overall and infectious complications based on the multi-center database,supporting clinical decision-making and personalized treatment strategies.展开更多
Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary su...Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.展开更多
BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Iden...BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.展开更多
Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included pati...Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.展开更多
BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic...BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.展开更多
BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic ...BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.展开更多
AIM: To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.
AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who un...AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study.The study endpoint was the analysis of postoperative complications in inpatients. RESULTS:About 31%of patients had early postoperative complications,and complications of infection occurred most frequently.Intra-abdominal hemorrhage and anastomotic leak were the main causes of reoperation,which accounted for about 2.2%.Mortality was 11.1%in the reoperation group,but was only 0.8%in other patients.The duration of postoperative stay in hospital was significantly longer and the total expenditure was markedly higher in the patients who underwent reoperation(P<0.001).There was no significant association of any available factors in this study with the high rate of reoperation.CONCLUSION:Reoperation significantly increases the mortality rate and raises the burden of the surgical unit.More prospective studies are required to explore the potential risk factors.展开更多
BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative d...BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child- Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4% other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufficiency (19%), ascites (10%), hemoperitoneum (10%), or biliary fistula (6%). The variables associated with the technical aspects of the surgical procedure thatwere responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001); the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0,04); and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighed in the selection of patients eligible for liver resection.展开更多
AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with pre...AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.展开更多
AIM： To study the postoperative complications in patients with preoperative portal vein thrombosis （PVT） undergoing liver transplantation （LT） and to evaluate the complications with Doppler ultrasonography.METHOD...AIM： To study the postoperative complications in patients with preoperative portal vein thrombosis （PVT） undergoing liver transplantation （LT） and to evaluate the complications with Doppler ultrasonography.METHODS： Retrospective studies were performed on 284 patients undergoing LT （286 LT） with respect to pre- and postoperative clinical data and Doppler ultrasonography. According to the presence and grade of preoperative PVT, 286 LTs were divided into three groups： complete PVT （c-PVT）, partial PVT （p-PVT） and non-PVT, with 22, 30 and 234 LTs, respectively. Analyses were carried out to compare the incidence of early postoperative complications.RESULTS： PVT, inferior vena cava （IVC） thrombosis, hepatic artery thrombosis （HAT） and biliary complications were found postoperatively. All complications were detected by routine Doppler ultrasonography and diagnoses made by ultrasound were confirmed by clinical data or/and other imaging studies. Nine out of 286 LTs had postoperative PVT. The incidence of the c-Pv-r group was 22.7%, which was higher than that of the p-Pv-r group （3.3%, P 〈 0.05） and non- PVT group （1.3%, P 〈 0.005）. No difference was found between the p-PVT and non-PVT groups （P 〉 0.25）. Of the 9 cases with postoperative PVT, recanalizations were achieved in 7 cases after anticoagulation under the guidance of ultrasound, 1 case received portal vein thrombectomy and 1 case died of acute injection. Ten LTs had postoperative 1VC thrombosis. The c-PVT group had a higher incidence of IVC thrombosis than the non- PVT group （9.1% vs 2.6%, P 〈 0.05）; no significant difference was found between either the c-PV-T and p-PVT groups （9.1% vs 6.7%, P 〉 0.5） or between the p-PVT and non-PVT groups （P 〉 0.25）. Nine cases with IVC thrombosis were cured by anticoagulation under the guidance of ultrasound, and 1 case gained natural cure without any medical treatment after 2 mo. HAT was found in 2 non-PVT cases, giving a rate of 0.7% among 286 LTs. Biliary complications were seen in 12 LTs. The incidence of biliary complications in the c-PVT, p-PVT and non-PVT groups was 9.1%, 3.3% and 4.3%, respectively （P 〉 0.25 for all）, among which 2 stenosis led retransplantations and others were controlled by relative therapy.CONCLUSION： C-PVT patients tend to have a higher incidence of PVT and IVC thrombosis than non- PVT patients after LT. The incidence of postoperative complications in p-PVT patients does not differ from that of non-PVT patients, A relatively low incidence of HAT was seen in our study, Doppler ultrasonography is a convenient and efficient method for detecting posttransplant complications and plays an important role in guiding treatment.展开更多
BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Cons...BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.展开更多
BACKGROUND Carotid artery cross-clamping during carotid endarterectomy(CEA)may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses.Neutrophil-to-ly...BACKGROUND Carotid artery cross-clamping during carotid endarterectomy(CEA)may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses.Neutrophil-to-lymphocyte ratio(NLR)is an indicator that reflects systemic inflammation.However,the correlation between NLR and complications after CEA remains unclear.AIM To investigate the association between NLR and major complications after surgery in patients undergoing CEA.METHODS This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital.Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected.The primary outcome was the composite of major postoperative complications including neurological,pulmonary,cardiovascular and acute kidney injuries.The secondary outcomes included infections,fever,deep venous thrombosis,length of hospitalization and cost of hospitalization.Statistical analyses were performed using EmpowerStats software and R software.RESULTS A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses;of whom,40(19.42%)developed major postoperative complications.NLR within 24 h after CEA was significantly correlated with major postoperative complications(P=0.026).After confounding factors were adjusted,the odds ratio was 1.15(95%CI:1.03–1.29,P=0.014).The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group(P=0.002).CONCLUSION NLR is associated with major postoperative complications in patients undergoing CEA.展开更多
Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the co...Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.展开更多
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
文摘BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.
文摘Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is frequently associated with a spectrum of postoperative complications that significantly impact patient prognosis and quality of life.This comprehensive review systematically analyzes the classification,underlying pathophysiological mechanisms,and associated risk factors of these complications,with a particular focus on less commonly explored entities such as postoperative granuloma(PPG),corneal dellen,and scleral necrosis,alongside the more prevalent issue of recurrence.We delineate these complications based on their temporal presentation(early,intermediate,and late),and provide an in-depth analysis of general and specific contributing factors,including surgical trauma,individual patient characteristics,surgical technique,and perioperative management.Furthermore,this review synthesizes advancements in preventive strategies and therapeutic interventions,encompassing refined surgical techniques[e.g.,femtosecond laser-assisted pterygium surgery(FLAPS),pterygium extended removal followed by extended conjunctival transplant(P.E.R.F.E.C.T.)technique,Tissue Tuck technique],judicious application of adjuvant therapies[e.g.,mitomycin C(MMC),5-fluorouracil(5-FU),corticosteroids,anti-vascular endothelial growth factor(VEGF)agents],and optimized postoperative care protocols.By consolidating current evidence and identifying future research priorities,this review aims to provide ophthalmologists with a valuable theoretical foundation to guide individualized surgical planning,dynamic postoperative management,and ultimately minimize complications and improve patient satisfaction.
文摘Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Plan Project,No.2023ZL424.
文摘BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outcomes.AIM To comprehensively analyze the effect of totally thoracoscopic esophagectomy(TTE)on postoperative complications and serum inflammatory factors in patients diagnosed with EEC.METHODS A total of 113 patients with EEC,who were admitted to our hospital between September 2022 and December 2024,were recruited for this study.Specifically,55 patients were assigned to the control group and underwent conventional surgical procedures,whereas 58 patients formed the research group and underwent TTE.Subsequently,a series of comparisons and analyses were conducted between the two groups.These comparisons included surgery-related parameters,such as incision length,operation duration,and the number and extent of lymph node dissection;postoperative complications,namely,empyema,pulmonary infection,incision infection,anastomotic fistula,and delayed gastric emptying;postoperative pain,which was quantitatively evaluated by the Numerical Rating Scale;postoperative hospitalization duration;serum inflammatory factors,including interleukin(IL)-6,IL-8,and tumor necrosis factor-α;and stress response-associated indicators,such as C-reactive protein,cortisol,and adrenaline.RESULTS Statistical data demonstrated that compared with the control group,the research group exhibited substantially shorter incision length and postoperative hospitalization duration.The two groups had comparable number and extent of lymph node dissection.Notably,both the overall incidence of postoperative complications and the Numerical Rating Scale score on postoperative day 3 were remarkably lower in the research group.Although the levels of IL-6,IL-8,tumor necrosis factor-α,C-reactive protein,cortisol,and adrenaline in the research group increased statistically postoperatively,they were still considerably lower than those in the control group.CONCLUSION In patients with EEC,TTE not only reduces the risk of postoperative complications but also effectively alleviates the body’s inflammatory and stress responses associated with surgery.
文摘BACKGROUND Gastric ulcer perforation is a critical condition that can lead to significant morbidity and mortality if not promptly addressed.It is often the result of chronic peptic ulcer disease,which is characterized by a breach in the gastric wall due to ulceration.Surgical intervention is essential for managing this life-threatening complication.However,the optimal surgical technique remains debatable among clinicians.Various methods have been employed,including simple closure,omental patch repair,and partial gastrectomy,each with distinct advantages and disadvantages.Understanding the comparative efficacy and postoperative outcomes of these techniques is crucial for improving patient care and surgical decision-making.This study addresses the need for a comprehensive analysis in this area.AIM To compare the efficacy and postoperative complications of different surgical methods for the treatment of gastric ulcer perforation.METHODS A retrospective analysis was conducted on 120 patients who underwent surgery for gastric ulcer perforation between September 2020 and June 2023.The patients were divided into three groups based on the surgical method:Simple closure,omental patch repair,and partial gastrectomy.The primary outcomes were the operative success rate and incidence of postoperative complications.Secondary outcomes included the length of hospital stay,recovery time,and long-term quality of life.RESULTS The operative success rates for simple closure,omental patch repair,and partial gastrectomy were 92.5%,95%,and 97.5%,respectively.Postoperative complications occurred in 20%,15%,and 17.5%of patients in each group,respectively.The partial gastrectomy group showed a significantly longer operative time(P<0.001)but the lowest rate of ulcer recurrence(2.5%,P<0.05).The omental patch repair group demonstrated the shortest hospital stay(mean 7.2 days,P<0.05)and fastest recovery time.CONCLUSION While all three surgical methods showed high success rates,omental patch repair demonstrated the best overall outcomes,with a balance of high efficacy,low complication rates,and shorter recovery time.However,the choice of the surgical method should be tailored to individual patient factors and the surgeon’s expertise.
基金supported by the Natural Science Foundation of Fujian Province(No.2022J01755)。
文摘Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods:We analyzed the clinicopathological data of 3,926 gastrointestinal cancer patients from the Prevalence of Abdominal Complications After GastroEnterological surgery(PACAGE)database,covering 20 medical centers from December 2018 to December 2020.The predictive performance was evaluated using receiver operating characteristic(ROC)curves and Brier Score.Results:The patients were divided into gastric(2,271 cases)and colorectal cancer(1,655 cases)groups and further divided into training and external validation sets.The overall postoperative complication rates for gastric and colorectal cancer groups were 18.1%and 14.8%,respectively.The most common complication was the intraabdominal infection in both gastric and colorectal cancer groups.In the training set,the Random Forest(RF)model predicted the highest mean area under the curve(AUC)values for overall complications and different types of complications,in both the gastric cancer group and the colorectal cancer group,with similar results obtained in the external validation set.ROC curve analysis showed good predictive performance of the RF model for overall and infectious complications.An application-based clinical tool was developed for easy application in clinical practice.Conclusions:This model demonstrated good predictive performance for overall and infectious complications based on the multi-center database,supporting clinical decision-making and personalized treatment strategies.
基金supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031)the National Natural Sci-ence Foundation of China(92269204)Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。
文摘Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.
基金Supported by the Chongqing Natural Science Foundation,No.cstc2020jcyj-msxmX0288the Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.
文摘Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.
基金Supported by Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment,Chinese Academy of Medical Sciences,No.2021RU016.
文摘BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.
文摘BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.
基金Supported by National Basic Research Program of China(973 Program),No.2010CB529301the Key Program for Anticancer Research of Tianjin Municipal Science and Technology Commission,No.12ZCDZSY16400
文摘AIM: To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.
文摘AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study.The study endpoint was the analysis of postoperative complications in inpatients. RESULTS:About 31%of patients had early postoperative complications,and complications of infection occurred most frequently.Intra-abdominal hemorrhage and anastomotic leak were the main causes of reoperation,which accounted for about 2.2%.Mortality was 11.1%in the reoperation group,but was only 0.8%in other patients.The duration of postoperative stay in hospital was significantly longer and the total expenditure was markedly higher in the patients who underwent reoperation(P<0.001).There was no significant association of any available factors in this study with the high rate of reoperation.CONCLUSION:Reoperation significantly increases the mortality rate and raises the burden of the surgical unit.More prospective studies are required to explore the potential risk factors.
文摘BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child- Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4% other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufficiency (19%), ascites (10%), hemoperitoneum (10%), or biliary fistula (6%). The variables associated with the technical aspects of the surgical procedure thatwere responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001); the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0,04); and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighed in the selection of patients eligible for liver resection.
文摘AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.
文摘AIM： To study the postoperative complications in patients with preoperative portal vein thrombosis （PVT） undergoing liver transplantation （LT） and to evaluate the complications with Doppler ultrasonography.METHODS： Retrospective studies were performed on 284 patients undergoing LT （286 LT） with respect to pre- and postoperative clinical data and Doppler ultrasonography. According to the presence and grade of preoperative PVT, 286 LTs were divided into three groups： complete PVT （c-PVT）, partial PVT （p-PVT） and non-PVT, with 22, 30 and 234 LTs, respectively. Analyses were carried out to compare the incidence of early postoperative complications.RESULTS： PVT, inferior vena cava （IVC） thrombosis, hepatic artery thrombosis （HAT） and biliary complications were found postoperatively. All complications were detected by routine Doppler ultrasonography and diagnoses made by ultrasound were confirmed by clinical data or/and other imaging studies. Nine out of 286 LTs had postoperative PVT. The incidence of the c-Pv-r group was 22.7%, which was higher than that of the p-Pv-r group （3.3%, P 〈 0.05） and non- PVT group （1.3%, P 〈 0.005）. No difference was found between the p-PVT and non-PVT groups （P 〉 0.25）. Of the 9 cases with postoperative PVT, recanalizations were achieved in 7 cases after anticoagulation under the guidance of ultrasound, 1 case received portal vein thrombectomy and 1 case died of acute injection. Ten LTs had postoperative 1VC thrombosis. The c-PVT group had a higher incidence of IVC thrombosis than the non- PVT group （9.1% vs 2.6%, P 〈 0.05）; no significant difference was found between either the c-PV-T and p-PVT groups （9.1% vs 6.7%, P 〉 0.5） or between the p-PVT and non-PVT groups （P 〉 0.25）. Nine cases with IVC thrombosis were cured by anticoagulation under the guidance of ultrasound, and 1 case gained natural cure without any medical treatment after 2 mo. HAT was found in 2 non-PVT cases, giving a rate of 0.7% among 286 LTs. Biliary complications were seen in 12 LTs. The incidence of biliary complications in the c-PVT, p-PVT and non-PVT groups was 9.1%, 3.3% and 4.3%, respectively （P 〉 0.25 for all）, among which 2 stenosis led retransplantations and others were controlled by relative therapy.CONCLUSION： C-PVT patients tend to have a higher incidence of PVT and IVC thrombosis than non- PVT patients after LT. The incidence of postoperative complications in p-PVT patients does not differ from that of non-PVT patients, A relatively low incidence of HAT was seen in our study, Doppler ultrasonography is a convenient and efficient method for detecting posttransplant complications and plays an important role in guiding treatment.
基金Supported by Horizontal Project of Shanghai Tenth People’s Hospital,No.DS05!06!22016 and No.DS05!06!22017.
文摘BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.
基金Clinical Medicine Development of Special Funding,No.ZYLX201708 and No.DFL20180502Beijing Municipal Administration of Hospitals Incubating Program,No.PX2017037+1 种基金Beijing Hospitals Authority Youth Programme,No.QML20190508Beijing Municipal Science&Technology Commission,No.Z191100006619067.
文摘BACKGROUND Carotid artery cross-clamping during carotid endarterectomy(CEA)may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses.Neutrophil-to-lymphocyte ratio(NLR)is an indicator that reflects systemic inflammation.However,the correlation between NLR and complications after CEA remains unclear.AIM To investigate the association between NLR and major complications after surgery in patients undergoing CEA.METHODS This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital.Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected.The primary outcome was the composite of major postoperative complications including neurological,pulmonary,cardiovascular and acute kidney injuries.The secondary outcomes included infections,fever,deep venous thrombosis,length of hospitalization and cost of hospitalization.Statistical analyses were performed using EmpowerStats software and R software.RESULTS A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses;of whom,40(19.42%)developed major postoperative complications.NLR within 24 h after CEA was significantly correlated with major postoperative complications(P=0.026).After confounding factors were adjusted,the odds ratio was 1.15(95%CI:1.03–1.29,P=0.014).The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group(P=0.002).CONCLUSION NLR is associated with major postoperative complications in patients undergoing CEA.
文摘Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.
