Albumin Difference as a New Predictor of Postoperative Complications following Pancreatectomy

2021 ◽  
pp. 1-9
Author(s):  
Jian Shen ◽  
Feng Guo ◽  
Yan Sun ◽  
Dianyun Ren ◽  
Jingyuan Zhao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Delayed Gastric Emptying ◽  
Training Group ◽  
Comprehensive Complication Index ◽  
Specific Complication ◽  
High Incidence ◽  
Intra Abdominal Infection ◽  
The Relationship ◽  
Preoperative Albumin ◽  
Good Calibration

<b><i>Background:</i></b> Postoperative complications after pancreatectomy are a challenging problem due to their high incidence and serious consequences. The majority of studies have focused on a specific complication, but data on predictors of overall postoperative complications (OPCs) are limited. <b><i>Methods:</i></b> The data of patients who underwent pancreatectomy at a single institute between 2017 and 2019 were analyzed retrospectively. Univariate and multivariate logistic regression were used to investigate predictors of the outcomes of interest. The Clavien-Dindo classification and comprehensive complication index (CCI) were used to assess postoperative complications and the severity of postoperative complications. The relationship between predictors and the CCI was evaluated by linear regression. <b><i>Results:</i></b> A total of 490 patients were divided into a training group (<i>n</i> = 339) and a validation group (<i>n</i> = 151). The rate of OPCs was 44.25%. Fluid transfusion and albumin difference (AD) were predictors of OPCs. AD showed a good discrimination (AUC = 0.70) and good calibration in the validation cohort. AD was associated with complications, including pancreatic fistula, intra-abdominal hemorrhage, intra-abdominal infection, delayed gastric emptying, and re-intervention, and was positively correlated with complication severity. Intraoperative blood loss and preoperative albumin were independent predictors of AD. <b><i>Conclusions:</i></b> AD, a variable that reflects dynamic physiological changes is a new and accessible predictor of OPCs following pancreatectomy.

scholarly journals Relationship between the Preoperative Albumin Levels and Postoperative Complications in Carcinoma Stomach Patients

2021 ◽  
pp. 24-28
Author(s):  
Marella Haneesh ◽  
Samuel Dev Merlin
Keyword(s):  
Postoperative Complications ◽  
Haemoglobin Level ◽  
Albumin Level ◽  
Preoperative Period ◽  
Duration Of Stay ◽  
Medical College ◽  
The Mean ◽  
Carcinoma Stomach ◽  
The Relationship ◽  
Preoperative Albumin

Background: Malnutrition in gastrointestinal cancer patients adversely affects the surgical outcomes. low serum albumin and postoperative complications were associated with one another. Objectives: To find out the relationship between preoperative albumin levels and postoperative complications among carcinoma stomach patients. Materials and Methods: The present study was a single institution retrospective study carried out in the department of general surgery, Saveetha medical college and hospital between February 2021 to July 2021. Fifty patients diagnosed with carcinoma stomach and electively posted for surgery during the study period were included into the study. The data was collected using structured proforma. Preoperative albumin and haemoglobin levels were estimated using blood samples. All the data collected were analysed using SPSS version 23. Results: The preoperative albumin levels among those who had reported complication was 3.04±0.19 g/dl while those who had no complication in the postoperative period had preoperative albumin level of 3.82±0.31g/dl. The preoperative mean haemoglobin level among those who developed complications in the post operative period was 9.68±0.95 mg/dl and the mean haemoglobin level among those with no complication was 11.46±1.89 mg/dl. Albumin and haemoglobin values were found to be negatively correlated with duration of stay in hospital. Conclusion: Malnutrition in the preoperative period would increase the probability of occurrence of postoperative complications and increased duration of stay in hospital. Attending to malnutrition of the admitted patients in the preoperative period would help in decreasing the postoperative complications and duration of stay.

Board of Director Characteristics, Institutional Ownership, and Fraud: Evidence from Australia

2004 ◽  
Vol 23 (2) ◽  
pp. 105-117 ◽  
Author(s):  
Vineeta D. Sharma
Keyword(s):  
Research Evidence ◽  
Institutional Ownership ◽  
Board Of Director ◽  
Composition And Structure ◽  
High Incidence ◽  
The Board Of Directors ◽  
Director Characteristics ◽  
The Relationship ◽  
The U.S

Due to the high incidence of fraud in Australia, regulatory reports suggest strengthening the monitoring role of the board of directors (BOD). These reports recommend greater independence and no duality (chairperson of the BOD should not be the CEO) on the BOD. While there is no Australian evidence, research evidence in the U.S. supports these suggested reforms. It is not clear whether the research evidence observed in the U.S. will generalize to the Australian setting because of contextual differences. This study extends the U.S. findings to the Australian context and investigates the relationship between two attributes of the BOD, independence and duality, and fraud. In addition, I examine whether institutional ownership plays a role in the context of fraud. The more highly concentrated institutional ownership in Australia suggests the presence of some relationship. Using a matched sample of fraud and no-fraud firms from 1988–2000, I find that as the percentage of independent directors and the percentage of independent institutional ownership increases, the likelihood of fraud decreases. As expected, the results show a positive relationship between duality and the likelihood of fraud. These results support the call for strengthening the composition and structure of the BOD in Australia.

Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

2021 ◽  
pp. 000313482098881
Author(s):  
Yehonatan Nevo ◽  
Tali Shaltiel ◽  
Naama Constantini ◽  
Danny Rosin ◽  
Mordechai Gutman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Complication Rates ◽  
Activity Tracking ◽  
Primary Endpoints ◽  
Specific Complication ◽  
Secondary Endpoints ◽  
Enhanced Recovery Programs

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

scholarly journals Postoperative Rise of Circulating Mitochondrial DNA Is Associated with Inflammatory Response in Patients following Pancreaticoduodenectomy

2021 ◽  
pp. 1-7
Author(s):  
Niv Pencovich ◽  
Nadav Nevo ◽  
Roi Weiser ◽  
Ekaterina Bonder ◽  
Yoel Bogoch ◽  
...  
Keyword(s):  
Mitochondrial Dna ◽  
Inflammatory Response ◽  
Delayed Gastric Emptying ◽  
Clinical Course ◽  
Severe Trauma ◽  
Postoperative Fever ◽  
Postoperative Course ◽  
Cell Counts ◽  
White Blood Cell Counts ◽  
The Relationship

<b><i>Introduction:</i></b> Accumulation of plasma mitochondrial DNA (mtDNA) following severe trauma has been shown to correlate with the development of systemic inflammatory response syndrome (SIRS) and may predict mortality. Our objective was to investigate the relationship between levels of circulatory mtDNA following pancreaticoduodenectomy (PD) and the postoperative course. <b><i>Methods:</i></b> Levels of plasma mtDNA were assessed by real-time PCR of the mitochondrial genes <i>ND1</i> and <i>COX3</i> in 23 consecutive patients who underwent PD 1 day prior to surgery, within 8 h after surgery, and on postoperative day (POD)1 and POD5. The abundance of mtDNA was assessed relative to preoperative levels and in relation to parameters reflecting the postoperative clinical course. <b><i>Results:</i></b> When pooled for all patients, the circulating mtDNA levels were significantly increased after surgery. However, while a significant (at least &#x3e;2-fold and up to &#x3e;20-fold) rise was noted in 11 patients, no change in mtDNA levels was noted in the other 12 following surgery. Postoperative rise in circulating mtDNA was associated with an increased rate of postoperative fever until day 5, decreased hemoglobin and albumin levels, and increased white blood cell counts. These patients also suffered from increased rates of delayed gastric emptying. No significant differences were demonstrated in other postoperative parameters. <b><i>Conclusion:</i></b> Circulating mtDNA surge is associated with an inflammatory response following PD and may potentially be used as an early marker for postoperative course. Studies of larger patient cohorts are warranted.

scholarly journals Otitis Media and Obesity—An Unusual Relationship in Children

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 458
Author(s):  
Cristina Gavrilovici ◽  
Elena-Lia Spoială ◽  
Anca-Viorica Ivanov ◽  
Adriana Mocanu ◽  
Violeta Ștreangă ◽  
...  
Keyword(s):  
Risk Factors ◽  
Otitis Media ◽  
Tobacco Exposure ◽  
Taste Changes ◽  
Electronic Search ◽  
Obesity And Overweight ◽  
High Incidence ◽  
Ear Infections ◽  
The Relationship ◽  
Published Research

Otitis media (OM) represents a public health matter, being the main cause of preventable hearing loss in pediatric patients. Besides well-established risk factors for developing OM, such as craniofacial abnormalities, prematurity, low birth weight, or tobacco exposure, there is evidence that obesity could be associated with a high incidence of OM. Our aim is to perform a literature review on the state of current published research on the relationship between OM and obesity and to discuss the interconnectivity between these two entities. We conducted an electronic search in PubMed and EMBASE databases. Out of 176 references, 15 articles were included in our study. Our findings suggest that obesity and overweight might be risk factors for developing OM, and vice versa. The main mechanisms for developing OM in obese patients include alteration in cytokine profile, increased gastroesophageal reflux, and/or fat accumulation. Conversely, ear infections exposure might increase the risk of obesity, mostly by taste changes through middle ear cavity inflammation.

scholarly journals Preoperative endothelial dysfunction in cutaneous microcirculation is associated with postoperative organ injury after cardiac surgery using extracorporeal circulation: a prospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stanislas Abrard ◽  
Olivier Fouquet ◽  
Jérémie Riou ◽  
Emmanuel Rineau ◽  
Pierre Abraham ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Endothelial Dysfunction ◽  
Postoperative Complications ◽  
Sofa Score ◽  
Primary Objective ◽  
Laser Speckle ◽  
Organ Injury ◽  
Contrast Imaging ◽  
The Relationship

Abstract Background Cardiac surgery is known to induce acute endothelial dysfunction, which may be central to the pathophysiology of postoperative complications. Preoperative endothelial dysfunction could also be implicated in the pathophysiology of postoperative complications after cardiac surgery. However, the relationship between preoperative endothelial function and postoperative outcomes remains unknown. The primary objective was to describe the relationship between a preoperative microcirculatory dysfunction identified by iontophoresis of acetylcholine (ACh), and postoperative organ injury in patients scheduled for cardiac surgery using cardiopulmonary bypass (CPB). Methods Sixty patients undergoing elective cardiac surgery using CPB were included in the analysis of a prospective, observational, single-center cohort study conducted from January to April 2019. Preoperative microcirculation was assessed with reactivity tests on the forearm (iontophoresis of ACh and nitroprusside). Skin blood flow was measured by laser speckle contrast imaging. Postoperative organ injury, the primary outcome, was defined as a Sequential Organ Failure Assessment score (SOFA) 48 h after surgery greater than 3. Results Organ injury at 48 h occurred in 29 cases (48.3%). Patients with postoperative organ injury (SOFA score > 3 at 48 h) had a longer time to reach the peak of preoperative iontophoresis of acetylcholine (133 s [104–156] vs 98 s [76–139] than patients without, P = 0.016), whereas endothelium-independent vasodilation to nitroprusside was similar in both groups. Beyond the proposed threshold of 105 s for time to reach the peak of preoperative endothelium-dependent vasodilation, three times more patients presented organ dysfunction at 48 h (76% vs 24% below or equal 105 s). In multivariable model, the time to reach the peak during iontophoresis of acetylcholine was an independent predictor of postoperative organ injury (odds ratio = 4.81, 95% confidence interval [1.16–19.94]; P = 0.030). Conclusions Patients who postoperatively developed organ injury (SOFA score > 3 at 48 h) had preoperatively a longer time to reach the peak of endothelium-dependent vasodilation. Trial registration Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797

scholarly journals Relationship between Oral Bacterial Count and Postoperative Complications among Patients with Cardiovascular Disease Treated by Surgery: A Retrospective Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 850
Author(s):  
Rie Osako ◽  
Yuhei Matsuda ◽  
Chieko Itohara ◽  
Yuka Sukegawa-Takahashi ◽  
Shintaro Sukegawa ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Postoperative Complications ◽  
Operation Time ◽  
Bacterial Count ◽  
Cardiovascular Complications ◽  
Pericardial Fluid ◽  
Bacterial Counts ◽  
Lung Torsion ◽  
Propensity Score Adjustment ◽  
The Relationship

In this retrospective observational study, we evaluated the relationship between perioperative oral bacterial counts and postoperative complications in cardiovascular disease (CVD) patients. From April 2012 to December 2018, all patients scheduled for surgery received perioperative oral management (POM) by oral specialists at a single center. Tongue dorsum bacterial counts were measured on the pre-hospitalization day, preoperatively, and postoperatively. Background data were collected retrospectively. Among the 470 consecutive patients, the postoperative complication incidence rate was 10.4% (pericardial fluid storage, n = 21; postoperative pneumonia, n = 13; surgical site infection, n = 9; mediastinitis, n = 2; and seroma, postoperative infective endocarditis, lung torsion, and pericardial effusion, n = 1 each). Oral bacterial counts were significantly higher in the pre-hospitalization than in the pre- and postoperative samples (p < 0.05). Sex, cerebrovascular disease, and operation time differed significantly between complications and no-complications groups (p < 0.05). Multivariate analysis with propensity score adjustment showed a significant association between postoperative oral bacterial count and postoperative complications (odds ratio 1.26; 95% confidence interval, 1.00–1.60; p = 0.05). Since the development of cardiovascular complications is a multifactorial process, the present study cannot show that POM reduces complications but indicates POM may prevent complications in CVD patients.

scholarly journals ANCA-Associated Glomerulonephritis and Anti-Phospholipid Syndrome in a Patient with SARS-CoV-2 Infection: Just a Coincidence?

2021 ◽  
pp. 214-220
Author(s):  
Federica Maritati ◽  
Maria Ilaria Moretti ◽  
Valentina Nastasi ◽  
Roberta Mazzucchelli ◽  
Manrico Morroni ◽  
...  
Keyword(s):  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Hemodynamic Instability ◽  
Tubular Necrosis ◽  
Complex Processes ◽  
Anca Associated Vasculitis ◽  
High Incidence ◽  
New Diagnosis ◽  
The Relationship

Many reports have described a high incidence of acute kidney injury (AKI) among patients with COVID-19. Acute tubular necrosis has been reported to be the most common damage in these patients, probably due to hemodynamic instability. However, other complex processes may be involved, related to the cytokine storm and the activation of innate and adaptive immunity. Here, we describe a patient who developed an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with rapidly progressive glomerulonephritis and lung involvement and an antiphospholipid syndrome soon after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After viral pneumonia was excluded by bronchoalveolar lavage, the patient has been treated with rituximab for amelioration of kidney function and resolution of thrombosis without any adverse event. We conclude that COVID-19 may trigger autoimmune diseases including ANCA-associated vasculitis. Thus, this diagnosis should be taken in consideration in COVID-19 patients, especially when they develop AKI with active urinary sediment. In addition, considering the relationship between these 2 diseases, SARS-CoV-2 infection should be excluded in all patients with a new diagnosis ANCA-associated vasculitis before starting immunosuppressive therapy.

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