scholarly journals V9 Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Rohan Gujjuri ◽  
Keyword(s):  
Cohort Studies ◽  
Primary Outcome ◽  
Pulmonary Complication ◽  
Postoperative Mortality ◽  
Pooled Analysis ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Curative Intent ◽  
Elective Resection ◽  
Risk Of Death

Abstract Introduction Whilst the severe consequences of COVID-19 around the time of surgery are well described, no comparison has been made to pulmonary complications in the absence of infection. This study aimed to compare postoperative death in patients with and without SARS-CoV-2 infection. Methods A patient-level comparative analysis of two international prospective cohort studies; one conducted before (January to October 2019) and one during the SARS-CoV-2 pandemic (from local emergence of COVID-19 to April 2020). Patients undergoing elective resection of an intra-abdominal cancer with curative intent were included in a multilevel logistic regression. The primary outcome was 30-day postoperative mortality. Results Of 7402 patients included, 3031 underwent surgery before and 4371 during the pandemic. Overall, 6.5% (n = 484) patients suffered a pulmonary complication, 5.1% had a SARS-CoV-2 infection diagnosed, and 1.4% patients (n = 107) died. Compared to patients without pulmonary complications, those with SARS-CoV-2 pulmonary complications had a higher adjusted odds of death (OR: 54.14, 95%CI: 23.46 to 124.91, p < 0.001) than those with non-SARS-CoV-2 pulmonary complications (OR: 7.20, 95%CI: 3.85 to 13.45, p < 0.001). Conclusion Postoperative pulmonary complications were associated with increased 30-day mortality. SARS-CoV-2 associated pulmonary complications were associated with a far higher mortality than a non-SAR-CoV-2 pulmonary complication.

scholarly journals 813 Risk of Death Following Pulmonary Complications After Surgery with And Without SARS-Cov-2 Infection: A Pooled Analysis of Individual Patient Data from Pre-Pandemic and Pandemic International Cohort Studies

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
◽  
Keyword(s):  
Bladder Cancer ◽  
Cohort Studies ◽  
Individual Patient Data ◽  
Bladder Tumour ◽  
Healthcare Services ◽  
Pooled Analysis ◽  
Pulmonary Complications ◽  
Patient Data ◽  
Risk Of Death ◽  
Flexible Cystoscopy

Abstract Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies Introduction Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results 8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

scholarly journals O22 Risk of death following pulmonary complications of surgery with and without SARS-CoV-2 infection: a comparative analysis of pre-pandemic and pandemic cohort studies

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
Keyword(s):  
Comparative Analysis ◽  
Cohort Studies ◽  
Elective Surgery ◽  
Population Attributable Fraction ◽  
Pulmonary Complications ◽  
Care Providers ◽  
Elective Resection ◽  
Risk Of Death ◽  
Surgical Services ◽  
Primary Driver

Abstract Introduction No comparison has been made between the risk of death following pulmonary complications in patients with and without SARS-CoV-2 infection. This study aimed to determine the incidence and impact of pulmonary complications before and during the SARS-CoV-2 pandemic. Method A patient-level comparative analysis of two international prospective cohort studies; conducted pre-pandemic (22 January to 19 October 2019) and during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines were included in analysis. The primary outcome measure was the mortality within 30 days of surgery. Result This study included 7402 patients from 50 countries; 3031 (40.9%) were operated pre-pandemic and 4371 (59.1%) during the pandemic. 5.1% (n = 224/4371) of patients during the pandemic developed a postoperative SARS-CoV-2 infection. Despite selection of lower risk cases during the pandemic, the rates of pulmonary complications pre were similar (6.3% vs 6.9%, P = 0.280). However, the risk of death after surgery was higher during the pandemic (2.0% vs 0.7%, P < 0.001). The population attributable fraction of deaths due to pulmonary complications was 37.7% (95% CI: 15.2–64.7%) pre-pandemic and 66.0% (95% CI: 48.6–79.3%) during the pandemic. The increased mortality was largely attributable to SARS-CoV-2 infection; 68.9% (n = 31/45) of deaths patients with pulmonary complications occurred following SARS-CoV-2 infection. Conclusion Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection. Take-home Message Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection.

scholarly journals Regional Anesthesia for Abdominal Surgery in a Patient with Severe Chronic Respiratory Failure: A Case Report

2021 ◽  
Vol 27 (2) ◽  
pp. 118-120
Author(s):  
Misoon Lee ◽  
Younghoon Woo ◽  
Jaewoong Jung ◽  
Yang-Hoon Chung ◽  
Bon Sung Koo ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Abdominal Surgery ◽  
Anesthetic Management ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Pulmonary Complications ◽  
Chronic Respiratory Failure ◽  
Postoperative Pulmonary Complications ◽  
Physical Status ◽  
Anesthesia Technique

General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

2021 ◽  
pp. 026921552110432
Author(s):  
Xinyi Xu ◽  
Denise Shuk Ting Cheung ◽  
Robert Smith ◽  
Agnes Yuen Kwan Lai ◽  
Chia-Chin Lin
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Pulmonary Complication ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

Effect of technologic advancements in radiotherapy on postoperative pulmonary complications after neoadjuvant chemoradiation in esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 110-110
Author(s):  
Bevan H. Myles ◽  
Caimiao Wei ◽  
Ritsuko Komaki ◽  
Ara A. Vaporciyan ◽  
Reza J. Mehran ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Pulmonary Complication ◽  
Neoadjuvant Chemoradiation ◽  
Pulmonary Complications ◽  
Complication Rates ◽  
Postoperative Pulmonary Complications ◽  
Radiation Technology ◽  
3D Crt

110 Background: Although 3D conformal radiation therapy (3D-CRT) is currently the de facto standard for the treatment of esophageal cancers, technologies such as Intensity Modulated Radiation Therapy (IMRT) or Proton Beam Therapy (PBT) are increasingly being used, but the evidence for the clinical benefits of these technologies are lacking. We hypothesized that radiation technology influences perioperative complications in esophageal cancer patients treated with neoadjuvant chemoradiation. Methods: We evaluated 423 patients (3D-CRT (n=208, 1998-2008), IMRT (n=165, 2004-2011), and PBT (n=50, 2006-2011)) treated with surgical resection after chemoradiation from 1998-2011 at M. D. Anderson Cancer Center. Postoperative complications (Pulmonary, GI, cardiac, wound healing) were recorded up to 30 days postoperatively. Kruskal-Wallis tests and Chi-square or Fisher’s exact tests assessed associations between continuous and categorical variables and the radiation technology, respectively. Logistic regression model tested the association between treatment technologies and complications adjusting for other significant patient characteristics. Results: While radiation modality was not significantly associated with postoperative GI (leak, ileus, fistula), cardiac (MI, AF, CHF), and wound complications, there was a significant reduction in postoperative pulmonary complications (ARDS, pleural effusion, respiratory insufficiency, pneumonia) for IMRT compared to 3D-CRT (OR 0.46, 95%CI 0.25, 0.83) and PBT compared to 3D-CRT (OR 0.26, 95%CI 0.09, 0.70), but not when IMRT was compared to PBT (OR 1.74, 95%CI 0.66, 4.61) after adjusting for preRT DLCO level. The median length of hospital stay was also significantly different between treatment modalities (12, 10, and 8 days for 3D-CRT, IMRT, and PBT, respectively, p<0.0001). There was no significant association between treatment year with pulmonary complication rates. Conclusions: Radiation technologies such as IMRT and PBT reduced postoperative pulmonary complication rates compared to 3D-CRT in esophageal cancer patients. This result needs to be confirmed in larger prospective studies.

scholarly journals Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
François Martin Carrier ◽  
Éva Amzallag ◽  
Vincent Lecluyse ◽  
Geneviève Côté ◽  
Étienne J. Couture ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Postoperative Mortality ◽  
Pulmonary Complications ◽  
Postoperative Outcomes ◽  
Canadian Province ◽  
Multicenter Cohort Study ◽  
Time Of Surgery ◽  
Multicenter Cohort ◽  
Baseline Characteristics

Abstract Background Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who underwent a surgery and the pandemic impact on surgical activities. Methods We conducted a multicenter cohort study between March 13 and June 192,020. We included all COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included concomitant suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and postoperative mortality. Our primary outcome was 30-day mortality. We also collected data on overall surgical activities during this first wave and during the same period in 2019. Results We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was high (15.9%). This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22,616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44,486 cases). Conclusion In this Canadian cohort study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was high (15.9%). Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. Trial registration ClinicalTrials.gov Identifier: NCT04458337.

scholarly journals Evaluation of Postoperative Pulmonary Complications after Emergency Abdominal Surgery- A Prospective Study

2020 ◽  
Author(s):  
Kailash Charokar ◽  
Akash Shrikhande
Keyword(s):  
Respiratory Failure ◽  
Pleural Effusion ◽  
Abdominal Surgery ◽  
Acute Respiratory Failure ◽  
Pulmonary Edema ◽  
Primary Outcome ◽  
Pulmonary Complications ◽  
Research Centre ◽  
Postoperative Pulmonary Complications ◽  
Emergency Abdominal Surgery

Introduction: The clinical outcomes following the emergency abdominal surgery besides the surgical complications and the complications due to co-morbidities are influenced by Postoperative Pulmonary Complications (PPC). Continuous health care improvements are directed towards delivering quality care for postoperative patients is the need of the hour in prevailing patient-centric health services in the society. Aim: To evaluate the outcomes after emergency abdominal surgery in relation to pulmonary complications. Materials and Methods: A prospective observational study was conducted in the Department of Pulmonary Medicine and General Surgery at Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India for a period of one year. Thirty five patients who were operated for emergency abdominal surgery were included in the study. A predesigned and validated proforma was used for the collection of data. In the postoperative period, continuous clinical monitoring and evaluation was done periodically. The primary outcome was PPC like atelectasis, pneumonia, pleural effusion, pulmonary edema, acute respiratory failure. The European Perioperative Clinical Outcome (EPCO) definitions were used for the primary outcome. Descriptive statistics were used for data analysis. The association of pre and postoperative data with the occurrence of PPC was analysed using the Z-test for two sample proportions. The p-value <0.05 was taken as statistically significant. Results: In the study group of 35 patients, 18 patients (51.4%) developed PPC as defined by the selected criteria. Nine (25.7%) patients had pneumonia, 4 (11.4%) patients had acute respiratory failure, 2 (5.7%) patients had pleural effusion, 2 (5.7%) patients had pulmonary edema and 1 (2.9%) patient had atelectasis. The habit of smoking (p=0.003), presence of pre-existing underlying lung disease (p=0.004), and low socioeconomic status (p=0.012) were associated with increased risk for PPC in patients undergoing emergency abdominal surgery with statistically significant results. Conclusion: Pulmonary complications after emergency abdominal surgery are common and leads to the morbidity of patients and may result in fatal outcomes.

scholarly journals Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER)

2020 ◽  
Vol 132 (6) ◽  
pp. 1371-1381 ◽  
Author(s):  
Sachin Kheterpal ◽  
Michelle T. Vaughn ◽  
Timur Z. Dubovoy ◽  
Nirav J. Shah ◽  
Lori D. Bash ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Neuromuscular Blockade ◽  
Lower Incidence ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Pulmonary Complications ◽  
Adult Patients ◽  
Postoperative Pulmonary Complications ◽  
Reduced Risk

Abstract Background Five percent of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. The authors hypothesized that the choice of neuromuscular blockade reversal (neostigmine vs. sugammadex) may be associated with a lower incidence of major pulmonary complications. Methods Twelve U.S. Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient noncardiac surgical procedures with general anesthesia and endotracheal intubation receiving a nondepolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade agent (rocuronium vs. vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure. Results Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs. 4.8% neostigmine). A total of 796 (1.7%) patients had pneumonia (1.3% vs. 2.2%), and 582 (1.3%) respiratory failure (0.8% vs. 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio, 0.70; 95% CI, 0.63 to 0.77), 47% reduced risk of pneumonia (adjusted odds ratio, 0.53; 95% CI, 0.44 to 0.62), and 55% reduced risk of respiratory failure (adjusted odds ratio, 0.45; 95% CI, 0.37 to 0.56), compared to neostigmine. Conclusions Among a generalizable cohort of adult patients undergoing inpatient surgery at U.S. hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Intrathecal Morphine and Pulmonary Complications after Arthroplasty in Patients with Obstructive Sleep Apnea

2020 ◽  
Vol 132 (4) ◽  
pp. 702-712 ◽  
Author(s):  
Johnny W. Bai ◽  
Mandeep Singh ◽  
Anthony Short ◽  
Didem Bozak ◽  
Frances Chung ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Depression ◽  
Low Dose ◽  
Pulmonary Complication ◽  
Intrathecal Morphine ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications ◽  
Obstructive Sleep

Abstract Background Intrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with delayed respiratory depression. Patients with obstructive sleep apnea may be at higher risk of postoperative pulmonary complications. However, data is limited regarding the safety of intrathecal morphine in this population undergoing arthroplasty. Methods This retrospective cohort study aimed to determine the safety of intrathecal morphine in 1,326 patients with documented or suspected obstructive sleep apnea undergoing hip or knee arthroplasty. Chart review was performed to determine clinical characteristics, perioperative events, and postoperative outcomes. All patients received neuraxial anesthesia with low-dose (100 μg) intrathecal morphine (exposure) or without opioids (control). The primary outcome was any postoperative pulmonary complication including: (1) respiratory depression requiring naloxone; (2) pneumonia; (3) acute respiratory event requiring consultation with the critical care response team; (4) respiratory failure requiring intubation/mechanical ventilation; (5) unplanned admission to the intensive care unit for respiratory support; and (6) death from a respiratory cause. The authors hypothesized that intrathecal morphine would be associated with increased postoperative complications. Results In 1,326 patients, 1,042 (78.6%) received intrathecal morphine. The mean age of patients was 65 ± 9 yr and body mass index was 34.7 ± 7.0 kg/m2. Of 1,326 patients, 622 (46.9%) had suspected obstructive sleep apnea (Snoring, Tired, Observed, Pressure, Body Mass Index, Age, Neck size, Gender [STOP-Bang] score greater than 3), while 704 of 1,326 (53.1%) had documented polysomnographic diagnosis. Postoperatively, 20 of 1,322 (1.5%) patients experienced pulmonary complications, including 14 of 1,039 (1.3%) in the exposed and 6 of 283 (2.1%) in the control group (P = 0.345). Overall, there were 6 of 1 322 (0.5%) cases of respiratory depression, 18 of 1,322 (1.4%) respiratory events requiring critical care team consultation, and 4 of 1,322 (0.3%) unplanned intensive care unit admissions; these rates were similar between both groups. After adjustment for confounding, intrathecal morphine was not significantly associated with postoperative pulmonary complication (adjusted odds ratio, 0.60 [95% CI, 0.24 to 1.67]; P = 0.308). Conclusions Low-dose intrathecal morphine, in conjunction with multimodal analgesia, was not reliably associated with postoperative pulmonary complications in patients with obstructive sleep apnea undergoing joint arthroplasty. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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