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BACKGROUND: Living-donor organ transplant has a higher long-term survival rate compared to deceased-donor organ transplant, with kidney transplantation being the optimal treatment for most kidney failure patients. However, early hospital readmission within 30 days of discharge can occur due to various factors and can negatively affect long-term outcomes. Effective communication with patients pre-and post-transplant is crucial for a better quality of life and for reducing readmissions. Chronic kidney disease and co-morbid conditions must also be addressed for better long-term outcomes. The incidence and causes of early hospital readmission vary depending on local characteristics and other factors. METHODS: A retrospective cohort study of outcomes in patients who underwent living-donor renal transplantation at King Abdulaziz Medical City (KAMC) between 2015 and 2022. Data were collected by chart review using the BestCare system. The data collected included patients' demographics, comorbidities, surgery-related data, and the outcome of transplantation. The categorical data were presented using percentages and frequencies, while the numerical data were presented as mean and standard deviation. The Chi-square test was used for inferential statistics to find the association between categorical variables. RESULTS: Regarding sociodemographic characteristics, the majority of patients were male, aged 19-50 years, and either overweight or had obesity class 1. The incidence of complications, graft failure, and mortality after renal transplant was low, with only a small percentage of patients experiencing these outcomes within one year of transplant. There is no significant association between gender, age, BMI, and the likelihood of readmission after renal transplantation. Patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. The study provides an association between readmission after renal transplantation and various factors such as surgical complications, previous transplant, age at transplant, graft failure, and mortality. Out of the 107 readmitted patients, 2.8% had surgical complications, and 5.6% had a previous transplant, but the association was not statistically significant. CONCLUSION: Early hospital readmission within 30 days of discharge can be a concern for patients undergoing renal transplants. While the incidence of complications, graft failure, and mortality after renal transplant was low, patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. Although the association between surgical complications and readmission was not statistically significant, it is important to continue monitoring this factor in future studies. Effective communication with patients pre-and post-transplant can play a crucial role in reducing readmissions and improving long-term outcomes.
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INTRODUCTION: Colorectal cancer (CRC) is common worldwide, and surgery is one of the main treatments. Postoperative complications are a concern. The primary objective of this study is to determine whether elevated body mass index (BMI), the presence of comorbidities, tumor characteristics, and the type of surgery are associated with an increased risk of postoperative complications such as wound infections, pulmonary complications, anastomotic leak, venous thromboembolism (VTE), bowel obstruction, and incisional hernia. The secondary objective is to describe the characteristics of colorectal cancer patients with different BMI groups. METHODOLOGY: A retrospective cohort study was conducted using a non-probability sampling technique at a tertiary National Guard Hospital in Riyadh, Saudi Arabia. This study involved 122 patients aged 18 years or more who underwent elective or emergency surgery for colorectal cancer between the years 2015 and 2022. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 27 (IBM SPSS Statistics, Armonk, NY). Descriptive statistics (mean and standard deviation) were used for quantitative variables, while qualitative variables were presented as percentages and frequencies. Non-parametric tests were applied to compare qualitative variables. Quantitative variables were analyzed using the analysis of variance (ANOVA) test. Significance was established at a p-value of 0.05. Ethical considerations were followed throughout the study. Prior to conducting the study, ethical approval was obtained from the Institutional Review Board of King Abdullah International Medical Research Center (KAIMRC) (approval number: IRB/1598/23). RESULTS: High BMI scores were observed in patients with postoperative complications. A statistically significant variation in BMI scores (p-value < 0.05) was found between patients with complications and without complications. This observation suggests that factors beyond excessive body weight might contribute to the onset of postoperative complications. Moreover, elevated BMI scores were more prevalent in males and were associated with reduced hemoglobin (Hgb) levels, underscoring the potential influence of physiological variables on the emergence of postoperative complications (p-value < 0.05). Tumors located in the rectum or rectosigmoid regions, as well as partial colectomy procedures, exhibited a higher risk of postoperative complications (p-value < 0.05). However, no significant connections were identified between the presence of comorbidities and the occurrence of postoperative complications (p-value > 0.05). CONCLUSION: This study highlights the impact of BMI on postoperative outcomes in colorectal cancer patients. Higher BMI was associated with unfavorable postoperative outcomes, such as an increased risk of VTE and fluid collection. However, no significant differences in mortality rates or length of hospital stay (LOS) were observed across various BMI categories. Factors beyond BMI, including tumor characteristics, the type of surgical intervention, and preoperative care, play a significant role in determining postoperative outcomes. Therefore, it is essential to adopt a comprehensive approach that considers multiple factors when managing postoperative complications in colorectal cancer patients, particularly those with higher BMI.
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Background This research study investigates the prevalence of acute kidney injury (AKI) in trauma patients undergoing emergency laparotomies. AKI is a common complication in major surgeries and is associated with various adverse effects. The study aims to explore the relationship between AKI and other comorbidities in this specific context. Methodology This is a retrospective cohort study. All patients who had laparotomy after abdominal trauma at King Abdulaziz Medical City (KAMC) and met the inclusion criteria were included in the study. Nonprobability consecutive sampling was used. Data were collected by chart review using the Best-Care system at KAMC. Descriptive statistics were used to summarize and describe the characteristics of the study participants. Frequencies and percentages were calculated for categorical variables, such as comorbidities. For continuous variables, mean and standard deviations were calculated and tabulated. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA). Results This research study included 152 patients who underwent laparotomy, and the majority of patients (146, 96%) did not experience AKI. Several comorbidities were observed, with hypertension and diabetes being the most prevalent at 37 (24.3%) and 35 (23%), respectively. Intraoperative hypotension was experienced by 23 (15.1%) patients, while 129 (84.9%) did not have this issue. Norepinephrine was the most common vasopressor used (25.7%), followed by ephedrine and a combination of norepinephrine and epinephrine. Gender and age groups did not show significant associations with AKI, comorbidities like diabetes, heart failure, and chronic kidney disease (CKD) demonstrated significant relationships with AKI. There was no significant difference in eGFR and serum creatinine baseline levels between patients meeting AKI criteria and those who did not. Conclusions The low overall incidence of AKI in this patient population is encouraging. However, healthcare professionals must be aware of the significant impact of comorbidities such as diabetes, heart failure, and CKD on AKI development. Vigilant monitoring of postoperative kidney function, particularly serum creatinine levels within the first 48 hours, is essential for early detection and timely intervention. By understanding and addressing these risk factors, healthcare providers can take proactive steps to prevent and manage AKI in patients undergoing laparotomy, ultimately leading to improved patient outcomes and reduced healthcare costs.