Integrating StEP-COMPAC Definition and Enhanced Recovery after Surgery Status in a Machine-learning-based Model for Postoperative Pulmonary Complications in Laparoscopic Hepatectomy.

BACKGROUND: Postoperative pulmonary complications (PPCs) contribute to high mortality rates and impose significant financial burdens. In this study, a machine learning-based prediction model was developed to identify patients at high risk of developing PPCs following laparoscopic hepatectomy. METHODS: Data were collected from 1022 adult patients who underwent laparoscopic hepatectomy at two centres between January 2015 and February 2022. The dataset was divided into a development set and a temporal external validation set based on the year of surgery. A total of 42 factors were extracted for pre-modelling, including the implementation status of Enhanced Recovery after Surgery (ERAS). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) method. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). The model with the best performance was externally validated using temporal data. RESULTS: The incidence of PPCs was 8.7%. Lambda.1se was selected as the optimal lambda for LASSO feature selection. For implementation of ERAS, serum gamma-glutamyl transferase levels, malignant tumour presence, total bilirubin levels, and age-adjusted Charleston Comorbidities Index were the selected factors. Seven models were developed. Among them, logistic regression demonstrated the best performance, with an AUC of 0.745 in the internal validation set and 0.680 in the temporal external validation set. CONCLUSIONS: Based on the most recent definition, a machine learning model was employed to predict the risk of PPCs following laparoscopic hepatectomy. Logistic regression was identified as the best-performing model. ERAS implementation was associated with a reduction in the number of PPCs.

WITHDRAWN: The Analgesic Effect of Regional Blocks for Modified Radical Mastectomy: A Network Meta-analysis.

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Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study.

Introduction: Geriatric postoperative stroke is a rare but serious complication after surgery. The association between hypertriglyceridemia and postoperative stroke remains controversial, especially in older patients undergoing non-cardiac, non-neurological surgery. The study aims to address this clinical dilemma. Materials and methods: We conducted a nested case-control study among 9601 aged patients undergoing non-cardiac non-neurological surgery from October 2015 to 2021. A total of 22 positive cases were matched for the surgical type and time, to 88 control patients by a ratio of 1:4. The effect of hypertriglyceridemia on the occurrence of postoperative stroke within 30 days after surgery was estimated using conditional logistic regression analysis by adjusting to various potential confounders. Results: A total of 22 cases developed ischemia stroke after surgery, and compared with the non-stroke group, they had more postoperative ICU admission, longer postoperative hospitalization and higher total cost (all p < 0.05), and more patients were presenting with preoperative hypertriglyceridemia [8 (36.4%) vs. 15 (17.0%), p = 0.045]. There was a significant association between hypertriglyceridemia and postoperative stroke, with adjusted odds ratios of 6.618 (95% CI 1.286, 34.064) (p = 0.024). The above results remained robust in the sensitivity analyses. Conclusion: Among older patients undergoing non-cardiac and non-neurological surgery, hypertriglyceridemia was associated with significant increased risk of postoperative stroke.

Tree-based, two-stage risk factor analysis for postoperative sepsis based on Sepsis-3 criteria in elderly patients: A retrospective cohort study.

Background: Sepsis remains the leading cause of postoperative death in elderly patients and is defined as organ dysfunction with proven or suspected infection according to Sepsis-3 criteria. To better avoid potential non-linear associations between the risk factors, we firstly used a tree-based analytic methods to explore the putative risk factors of geriatric sepsis based on the criteria in the study. Methods: Data of 7,302 surgical patients aged ≥ 65 years at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2020 were collected. An analytic method that combined tree-based analysis with the method of Mantel-Haenszel and logistic regression was adopted to assess the association between 17 putative risk factors and postoperative sepsis defined by the Sepsis-3 guideline by controlling 16 potential confounding factors. Results: Among the 16 potential covariates, six major confounders were statistically identified by the tree-based model, including cerebrovascular diseases, preoperative infusion of red blood cells, pneumonia, age ≥ 75, malignant tumor and diabetes. Our analysis indicated that emergency surgery increases the risk of postoperative sepsis in elderly patients by more than six times. The type of surgery is also a crucial risk factor for sepsis, particularly transplantation and neurosurgery. Other risk factors were duration of surgery > 120 min, administration of steroids, hypoalbuminemia, elevated creatinine, blood urea nitrogen, hematocrit, platelets, glucose, white blood cell count, abnormal neutrophil-to-lymphocyte ratio and elevated hsCRP-to-albumin ratio. Conclusions: Our study uses an effective method to explore some risk factors for postoperative sepsis in elderly by adjusting many potential confounders and it can provide information for intervention design.

Association between glucose-to-lymphocyte ratio and in-hospital mortality in intensive care patients with sepsis: A retrospective observational study based on Medical Information Mart for Intensive Care IV.

Background: This study aimed to evaluate the association between the glucose-to-lymphocyte ratio (GLR) and in-hospital mortality in intensive care unit (ICUs) patients with sepsis. Methods: This is a retrospective cohort study. Patients with sepsis from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database had their baseline data and in-hospital prognosis retrieved. Multivariable Cox regression analyses were applied to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI). Survival curves were plotted, and subgroup analyses were stratified by relevant covariates. To address the non-linearity relationship, curve fitting and a threshold effect analysis were performed. Results: Of the 23,901 patients, 10,118 patients with sepsis were included. The overall in-hospital mortality rate was 17.1% (1,726/10,118). Adjusted for confounding factors in the multivariable Cox regression analysis models, when GLR was used as a categorical variable, patients in the highest GLR quartile had increased in-hospital mortality compared to patients in the lowest GLR quartile (HR = 1.26, 95% CI: 1.15-1.38). When GLR was used as a continuous variable, each unit increase in GLR was associated with a 2% increase in the prevalence of in-hospital mortality (adjusted HR = 1.02, 95% CI: 1.01-1.03, p = 0.001). Stratified analyses indicated that the correlation between the GLR and in-hospital mortality was stable. The non-linear relationship between GLR and in-hospital mortality was explored in a dose-dependent manner. In-hospital mortality increased by 67% (aHR = 1.67, 95% CI: 1.45-1.92) for every unit GLR increase. When GLR was beyond 1.68, in-hospital mortality did not significantly change (aHR: 1.04, 95% CI: 0.92-1.18). Conclusion: There is a non-linear relationship between GLR and in-hospital mortality in intensive care patients with sepsis. A higher GLR in ICU patients is associated with in-hospital mortality in the United States. However, further research is needed to confirm the findings.

Which is the best analgesia treatment for total knee arthroplasty: Adductor canal block, periarticular infiltration, or liposomal bupivacaine? A network meta-analysis.

STUDY OBJECTIVE: To review all randomized controlled trials (RCTs) comparing the analgesic efficacy of adductor canal block (ACB), periarticular infiltration (PAI), and any other mode of these treatments in analgesia, such as PAI with liposomal bupivacaine (LB), continuous adductor canal block (cACB) or ACB + PAI, after total knee arthroplasty (TKA). DESIGN: Systematic review and network meta-analysis of RCTs. PATIENTS: We searched PubMed, Embase, and the Cochrane database to detect all relevant RCTs on investigating the analgesic effects of ACB, PAI and LB for TKA published until April 2020. INTERVENTIONS: Use of different analgesic methods of ACB, PAI, cACB, ACB + PAI and LB. MEASUREMENTS: The primary endpoint was visual analog scale (VAS) score at rest and movement. The secondary endpoints were opioids consumption, length of hospitalization and knee range of motion (ROM). We used Cochrane risk of bias to assess the quality of evidence for outcomes. RESULTS: Forty-two studies involving 3785 patients with 5 different methods containing ACB, PAI, ACB + PAI, continuous ACB (cACB), LB, were evaluated. According to surface under the cumulative ranking curve value, 24 h resting VAS score was the lowest the ACB + PAI (88.4%), followed by cACB (73.4%); Resting VAS score at 48 h and movement VAS score at 24 h and 48 h was the lowest in the cACB (99.9%, 92% and 100%). Total opioids consumption was the least in LB (81.4%) before cACB (60.8%). ROM was the largest in the ACB + PAI (84.1%) before cACB (78.8%). CONCLUSION: Although all analgesic methods available were not evaluated, and further studies are needed to establish our results, the 24 h resting VAS score was lowest in ACB + PAI and 48 h resting and movement VAS score was lowest in cACB. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD 42020168102).

[Comparative of coopdech bronchial blocker and double-lumen tube on one lung ventilation in children].

OBJECTIVE: To compare the application of Coopdech bronchial blocker and double lumen bronchial tube during one lung ventilation in children. METHODS: Forty children undergoing one lung ventilation for thoracic surgery at Shantou Central Hospital from January 2012 to June 2013, approved by hospital ethics committee, were randomized into Coopdech bronchial blocker group (group A) and double-lumen tube group (group B). Anesthetic management and lung isolation were performed according to a standardized protocol. Two groups of children with the intubation time, intubation success rate, collapse score, the frequency of postoperative hoarseness were recorded. Before and after one lung ventilation in patients of the two groups of PaCO2, PaO2 and airway pressure (PAW) changes were recorded. RESULTS: The intubation time in A was longer than those of group B ((224 ± 72)vs(165 ± 46) s, P < 0.05), the success rate of intubation(100% vs 85%, P < 0.05), collapse score in A group was higher than in group B (95% vs 75%, P < 0.05) , Sore throat hoarseness occurred after operation in A group was lower than in B group (10% vs 35%, P < 0.05) , PaO2 was higher in group A after one lung ventilation for 30 min ((206 ± 58)vs(148 ± 63) mmHg, P < 0.05), PaCO2 and PAW were lower than group B ((36 ± 4) vs (45 ± 7) mmHg;(21.6 ± 3.2)vs(29.3 ± 5.5) cm H2O, P < 0.05). CONCLUSION: The Coodech bronchial blocker provided effective surgical exposure with less throat injuries, higher intubation success rate, lower airway pressure in children during video-assisted thoracoscopic surgery.