The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study.

INTRODUCTION: Surgical- and nonsurgical complications significantly worsen postoperative outcomes, and identification of patients at risk is crucial to improve care. This study investigated whether comorbidities, graded by the Charlson Comorbidity Index (CCI), impact complication rates and impair long-term outcome in a cohort of left-sided colorectal resections. METHODS: Retrospective analysis of patients undergoing oncological left-sided colorectal resections due to colorectal cancer between 01/2015 and 12/2020 in two referral centers in Austria using electronic medical records and national statistical bureau survival data. Patients with recurrent disease, peritoneal carcinomatosis, and emergency surgeries were excluded. Comorbidities were assessed using the CCI, and complication severity was defined by the Clavien-Dindo classification (CDC). Logistic regression analysis was performed to identify factors influencing the risk for postoperative complications, and overall survival was assessed using data from the national statistics bureau. RESULTS: A total of 471 patients were analyzed. Multinominal logistic regression analysis identified a CCI greater than or equal to 6 ( P =0.049; OR 1.59, 95% CI: 1.10-2.54) and male sex ( P =0.022; OR 1.47, 95% CI: 1.21-2.98) as independent risk factors for major complications. While patients with a high CCI had the worst postoperative survival rates, perioperative complications only impacted on overall survival in patients with low CCIs, but not in patients with high CCIs. CONCLUSION: Although a high CCI is a risk factor for major postoperative complications, the presence of comorbidities should not result in withholding surgery.

Postoperative efficacy and safety of vessel sealing: an experimental study on carotid arteries of the pig.

BACKGROUND: The aim of this preclinical study was to analyze the burst pressure of large in vivo sealed vessels, not just immediately, but also in the first 7 postoperative days. METHODS: In 26 anesthetized pigs, the right carotid artery was sealed and cut using a novel device that integrates bipolar and ultrasonic energy. The animals were then awakened. They underwent a second surgical procedure after different follow-up periods ranging from 1 to 7 days: the left common carotid artery was sealed and cut in the same way as the contralateral artery. Perioperative and postoperative clinical events, evolution of burst pressure over time, and comparison between immediate and delayed burst pressure were analyzed. RESULTS: All sealings were successful. There were no perioperative or postoperative complications. Median immediate (day 0) burst pressure was 949 mmHg (IQR 781-1181). Burst pressure decreased postoperatively but was never below 500 mmHg in any pig. CONCLUSION: Postoperative variations are observed in the burst pressure of in vivo sealed arteries. Immediate burst pressure alone should not be used for validating vascular sealing devices.