Predicting Risk of Post-Operative Morbidity and Mortality following Gynaecological Oncology Surgery (PROMEGO): A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study.

The medical complexity of surgical patients is increasing, and surgical risk calculators are crucial in providing high-value, patient-centered surgical care. However, pre-existing models are not validated to accurately predict risk for major gynecological oncology surgeries, and many are not generalizable to low- and middle-income country settings (LMICs). The international GO SOAR database dataset was used to develop a novel predictive surgical risk calculator for post-operative morbidity and mortality following gynecological surgery. Fifteen candidate features readily available pre-operatively across both high-income countries (HICs) and LMICs were selected. Predictive modeling analyses using machine learning methods and linear regression were performed. The area-under-the-receiver-operating characteristic curve (AUROC) was calculated to assess overall discriminatory performance. Neural networks (AUROC 0.94) significantly outperformed other models (p < 0.001) for evaluating the accuracy of prediction across three groups, i.e., minor morbidity (Clavien-Dindo I-II), major morbidity (Clavien-Dindo III-V), and no morbidity. Logistic-regression modeling outperformed the clinically established SORT model in predicting mortality (AUROC 0.66 versus 0.61, p < 0.001). The GO SOAR surgical risk prediction model is the first that is validated for use in patients undergoing gynecological surgery. Accurate surgical risk predictions are vital within the context of major cytoreduction surgery, where surgery and its associated complications can diminish quality-of-life and affect long-term cancer survival. A model that requires readily available pre-operative data, irrespective of resource setting, is crucial to reducing global surgical disparities.

Current Trends in Mortality Attributable to Racial or Ethnic Disparities in Post-Surgical Population in The United States: A Population-Based Study.

Background: No study has contextualized the excess mortality attributable to racial and ethnic disparities in surgical outcomes. Further, not much effort has been made to quantify the effort needed to eliminate these disparities. Objective: We examined the current trends in mortality attributable to racial or ethnic disparities in the US postsurgical population. We then identified the target for mortality reduction that would be necessary to eliminate these disparities by 2030. Methods: We performed a population-based study of 1,512,974 high-risk surgical procedures among adults (18-64 years) performed across US hospitals between 2000 and 2020. Results: Between 2000 and 2020, the risk-adjusted mortality rates declined for all groups. Nonetheless, Black patients were more likely to die following surgery (adjusted relative risk 1.42; 95% CI, 1.39-1.46) driven by higher Black mortality in the northeast (1.60; 95% CI, 1.52-1.68), as well as the West (1.53; 95% CI, 1.43-1.62). Similarly, mortality risk remained consistently higher for Hispanics compared with White patients (1.21; 95% CI, 1.19-1.24), driven by higher mortality in the West (1.26; 95% CI, 1.21-1.31). Overall, 8364 fewer deaths are required for Black patients to experience mortality on the same scale as White patients. Similar figures for Hispanic patients are 4388. To eliminate the disparity between Black and White patients by 2030, we need a 2.7% annualized reduction in the projected mortality among Black patients. For Hispanics, the annualized reduction needed is 0.8%. Conclusions: Our data provides a framework for incorporating population and health systems measures for eliminating disparity in surgical mortality within the next decade.

Resultados del tratamiento quirúrgico del cáncer de recto y ano en el Hospital Español / Results of the surgical treatment of rectal and anal cancer in the Hospital Español / Resultados do tratamento cirúrgico do câncer de reto e ânus no Hospital Español

La cirugía del cáncer de recto y ano se ha desarrollado considerablemente en las últimas décadas. En función de dichos avances, se ha observado una disminución en la morbimortalidad operatoria, así como también una mejoría en el pronóstico de estos pacientes. El objetivo del presente estudio es exponer y analizar los resultados del tratamiento quirúrgico del cáncer de recto y ano en un servicio universitario. Se realizó un estudio observacional, descriptivo y retrospectivo de todos los pacientes intervenidos por cáncer de recto y ano en el Hospital Español entre 2016 y 2020. Las variables registradas fueron: variables demográficas, clínico-oncológicas, relacionadas a la morbimortalidad operatoria y a la recidiva locorregional, y la sobrevida a 5 años. El procedimiento más realizado fue la resección anterior de recto (RAR) en 11 intervenciones (58%), mientras que las 8 restantes correspondieron a amputaciones abdominoperineales (AAP) (42%). Se diagnosticaron un total de 6 complicaciones intraoperatorias en 5 pacientes, siendo la perforación del tumor la más frecuente, y un total de 18 complicaciones postoperatorias en 11 pacientes, siendo la más frecuente la infección de la herida quirúrgica abdominal. La morbilidad operatoria mayor fue de 31,6% y la mortalidad operatoria a 90 días fue de 0%. La sobrevida global a 5 años fue de 63,2%. Los resultados quirúrgicos en la presente casuística fueron comparables con los de la bibliografía consultada. Destacamos la nula mortalidad a 90 días, con resultados oncológicos similares a los reportados en la literatura.

Rectal and anus surgery have been developed considerably in the last decades. Based on these advancements, it has been observed a decrease in the surgical morbidity and mortality, as well as an improved prognosis of these patients. The aim of the present study is to expose and analyze the results of the anus and rectal surgical treatment in a university service. An observational, descriptive and retrospective study was performed of all the intervened patients for rectum and anus cancer in the Hospital Español between 2016 and 2020. We recorded data about demographic, clinical-oncologic, related to the surgical morbidity and mortality, locoregional relapse and overall 5 year survival. The most performed procedure was the rectum anterior resection in 11 interventions (58%), while the 8 left corresponded to abdominoperineal resection (42%). There was a total of 6 intraoperative complications diagnosed in 5 patients, being the tumor perforation the most frequent one, and a total of 18 postoperative complications diagnosed in 11 patients, being the surgical wound infection the most frequent one. The serious surgical morbidity was 31,6%, while the surgical mortality rate at 90 days was 0%. Overall 5 year survival was 63,2%. The surgical results in the present study about the rectum and anal cancer were comparable with the results reported on the consulted bibliography. We highlight the null mortality within 90 days, with oncologic results similar to the ones reported in the literature.

A cirurgia do câncer retal e anal desenvolveu-se consideravelmente nas últimas décadas. Com base nesses avanços, observou-se diminuição da morbimortalidade operatória, bem como melhora no prognóstico desses pacientes. O objetivo deste estudo é apresentar e analisar os resultados do tratamento cirúrgico do câncer de reto e anal em um serviço universitário. Foi realizado um estudo observacional, descritivo e retrospectivo de todos os pacientes operados por câncer de reto e ânus no Hospital Espanhol entre 2016 e 2020. As variáveis ​​registradas foram: variáveis ​​demográficas, clínico-oncológicas, relacionadas à morbidade e mortalidade operatórias e recorrência locorregional. , e sobrevida em 5 anos. O procedimento mais realizado foi a ressecção anterior do reto (RAR) em 11 intervenções (58%) e as 8 restantes corresponderam a amputações abdominoperineais (AAP) (42%). Foram diagnosticadas 6 complicações intraoperatórias em 5 pacientes, sendo a perfuração tumoral a mais frequente, e um total de 18 complicações pós-operatórias em 11 pacientes, sendo a infecção da ferida operatória abdominal a mais frequente. A morbidade operatória maior foi de 31,6% e a mortalidade operatória em 90 dias foi de 0%. A sobrevida global em 5 anos foi de 63,2%. Os resultados cirúrgicos da presente casuística foram comparáveis ​​aos da bibliografia consultada. Destacamos a mortalidade nula em 90 dias, com resultados oncológicos semelhantes aos relatados na literatura.

Seguridad en cirugía mayor. Experiencia de cinco años / Safety in major surgery. Five-year experience

Introducción: los errores en cirugía existen desde que el hombre mismo se atrevió a violar la integridad del cuerpo humano buscando resolver un problema de salud. La Organización de la Salud, en el 2008 lanza el programa "Cirugías Seguras", pues ha calculado que se realizan 234 millones de cirugías mayores al año y se producen alrededor de un millón de muertes relacionadas con procedimientos quirúrgicos mayores. Objetivo: determinar la seguridad en las cirugías mayores. Material y Métodos: se realizó un estudio observacional descriptivo y retrospectivo analizando los resultados de las cirugías mayores en el servicio de cirugía general del Hospital Militar Docente "Dr. Mario Muñoz Monroy" de Matanzas, en el periodo comprendido de enero del 2011 a diciembre del 2015. Resultados: se realizó un total de 7366 cirugías mayores, electivas 5525(75%), urgentes 1841(25%). Fueron clasificadas como A1 7264 (98,6%), se efectuaron 127 reintervenciones (1,7%), se produjeron 107 eventos adversos (1,4%) y una mortalidad operatoria de 86 pacientes (1,16%). Conclusiones: son seguras las intervenciones de cirugías mayores. Los eventos adversos se presentaron por debajo de lo reportado en la literatura médica mundial. La mortalidad operatoria está dentro de parámetros aceptados en estándares internacionales (AU).

Introduction: mistakes in surgery are committed since the moment the man had the courage of violating the integrity of the human body looking for solving a health problem. The World Health Organization started the program Cirugías seguras (Safe Surgeries in English) in 2008, because they calculated that 234 millions of major surgeries are done and around a million of deaths are related with major surgical procedures every year. Aim: to determine the safety of the major surgeries. Materials and Methods: an observational, descriptive and retrospective study was carried out analyzing the results of the major surgeries in the Teaching Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas in the period from January 2011 to December 2015. Results: a total of 7 366 major surgeries were done: 5 525 elective surgeries (75 %) and 1 841 emergency surgeries (25 %). 7 264 were classified as A1 (98,6); 127 surgical re-interventions were done (1,7 %); 107 adverse events took place (1,4 %) and the surgical mortality was 86 patients (1,16 %). Conclusions: major surgical interventions are safe. The adverse events were less than data reported in the international medical literature. Surgical mortality fulfills the parameters accepted in international standards (AU).

Seguridad en cirugía mayor. Experiencia de cinco años / Safety in major surgery. Five-year experience

Introducción: los errores en cirugía existen desde que el hombre mismo se atrevió a violar la integridad del cuerpo humano buscando resolver un problema de salud. La Organización de la Salud, en el 2008 lanza el programa "Cirugías Seguras", pues ha calculado que se realizan 234 millones de cirugías mayores al año y se producen alrededor de un millón de muertes relacionadas con procedimientos quirúrgicos mayores. Objetivo: determinar la seguridad en las cirugías mayores. Material y Métodos: se realizó un estudio observacional descriptivo y retrospectivo analizando los resultados de las cirugías mayores en el servicio de cirugía general del Hospital Militar Docente "Dr. Mario Muñoz Monroy" de Matanzas, en el periodo comprendido de enero del 2011 a diciembre del 2015. Resultados: se realizó un total de 7366 cirugías mayores, electivas 5525(75%), urgentes 1841(25%). Fueron clasificadas como A1 7264 (98,6%), se efectuaron 127 reintervenciones (1,7%), se produjeron 107 eventos adversos (1,4%) y una mortalidad operatoria de 86 pacientes (1,16%). Conclusiones: son seguras las intervenciones de cirugías mayores. Los eventos adversos se presentaron por debajo de lo reportado en la literatura médica mundial. La mortalidad operatoria está dentro de parámetros aceptados en estándares internacionales (AU).

Introduction: mistakes in surgery are committed since the moment the man had the courage of violating the integrity of the human body looking for solving a health problem. The World Health Organization started the program Cirugías seguras (Safe Surgeries in English) in 2008, because they calculated that 234 millions of major surgeries are done and around a million of deaths are related with major surgical procedures every year. Aim: to determine the safety of the major surgeries. Materials and Methods: an observational, descriptive and retrospective study was carried out analyzing the results of the major surgeries in the Teaching Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas in the period from January 2011 to December 2015. Results: a total of 7 366 major surgeries were done: 5 525 elective surgeries (75 %) and 1 841 emergency surgeries (25 %). 7 264 were classified as A1 (98,6); 127 surgical re-interventions were done (1,7 %); 107 adverse events took place (1,4 %) and the surgical mortality was 86 patients (1,16 %). Conclusions: major surgical interventions are safe. The adverse events were less than data reported in the international medical literature. Surgical mortality fulfills the parameters accepted in international standards (AU).

Síndrome de hipoplasia de corazón izquierdo: experiencia de 10 años de un programa de etapificación quirúrgica / Hypoplastic left heart syndrome: 10 year experience with staged surgical management

Resumen El síndrome de hipoplasia de corazón izquierdo (SHCI) es una cardiopatía congénita con letalidad superior al 95%. La etapificación quirúrgica es la principal vía de tratamiento, y se inicia con la operación de Norwood; la sobrevida a largo plazo de los pacientes tratados es desconocida en nuestro medio. Objetivos 1) Revisar nuestra experiencia en el manejo de todos los pacientes con SHCI evaluados entre enero 2000 y junio 2010. 2) Identificar factores de riesgo de mortalidad quirúrgica. Pacientes y método Estudio retrospectivo de una única institución con una cohorte de pacientes con SHCI. Se revisan antecedentes clínicos, quirúrgicos, y registros de seguimiento. Resultados Se evaluaron 76 pacientes con SHCI; 9/76 tenían comunicación interauricular (CIA) restrictiva, y 8/76, aorta ascendente de < 2 mm; 65/76 fueron tratados: 77% tuvieron operación de Norwood con conducto entre ventrículo derecho y ramas pulmonares como fuente de flujo pulmonar, 17% Norwood con shunt de Blalock-Taussig, y 6% otra cirugía. La mortalidad en la primera etapa quirúrgica fue del 23%, y en operación de Norwood, del 21,3%. En el período 2000-2005 la mortalidad en la primera etapa quirúrgica fue del 36%, y entre 2005-2010, del 15% (p = 0,05). La sobrevida global fue del 64% a un año y del 57% a 5 años. Por análisis multivariado fueron factores de riesgo para mortalidad la presencia de aorta ascendente diminuta y CIA restrictiva. Conclusiones Nuestros resultados inmediatos y a largo plazo en la etapificación quirúrgica de SHCI son similares a la experiencia de grandes centros. Hay una mejoría en mortalidad operatoria en la segunda mitad de la serie. Se identifican factores de riesgo de mortalidad.

Abstract Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. Objectives 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. Patients and method Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. Results Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤ 2 mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P = .05). Actuarial survival was 64% at one year, and 57% at 5 years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. Conclusions Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

Desproporción prótesis-paciente en la cirugía de sustitución valvular aórtica y mortalidad quirúrgica / Disproportion prosthesis-patient surgery for aortic valve replacement and surgical mortality

La incidencia de desproporción prótesis-paciente (DPP), expresada como área del orificio efectivo indexada (AOEI), varía entre 19%-70% y su efecto sobre la morbimortalidad es controvertido. Esto es de interés debido a la frecuencia del procedimiento. Objetivo: determinar la incidencia acumulada de DPP y mortalidad quirúrgica en pacientes elegidos para cirugía de sustitución valvular aórtica (CSVA). Material y método: entre enero de 2004 y junio de 2007 se realizaron 131 CSVA en portadores de estenosis aórtica. Caso incidente de DPP: si AOEI < 0,85 cm2/m2; moderada, entre 0,85- 0,65 y severa < 0,65. En 13 (9,9%) no fue posible determinar el área del orificio efectivo (AOE). La mortalidad quirúrgica se considera según la Society of Thoracic Surgeons (EE.UU.). Las incidencias acumuladas (IC95%) se calcularon estratificadas por severidad de la DPP. La asociación DPP - mortalidad quirúrgica se exploró por probabilidad exacta. Resultado: la incidencia acumulada de DPP fue 41/118 (34,7%, IC95%: 26%-44%), moderada en 26/118 pacientes (22,0%, IC95%: 15%-31%) y severa en 15/118 (12,7%, IC95%: 7%-20%). En todos, la mortalidad quirúrgica fue 10/131 (7,6%, IC95%: 4%-14%), y en los que se estimó DPP fue 9/118 (7,6%, IC95%: 4%-14%). En los pacientes sin DPP fue 6/77 (7,8%, IC95%: 3%-17%) similar a los con DPP que fue 3/41 (7,3%, IC95%: 2%-20%), p=1. En la DPP moderada la mortalidad quirúrgica fue 1/26 (3,8% IC95%: 1%-19%) y en DPP severa 2/15 (13%, IC95%: 2%-40%). Conclusión: más del 30% de los pacientes con CSVA tuvieron DPP, siendo severa en 13%. No se encontró asociación entre DPP y mortalidad quirúrgica.

The incidence of prosthesis-patient mismatch (PPM) expressed as the indexed effective orifice area (IEOA) varies between 19%-70% and its effect on morbidity and mortality is controversial. This is of interest because the frequency of the procedure.Objective: determine cumulative incidence of PPM and surgical mortality in patients selected for aortic valve replacement surgery (AVRS). Material and method: between January 2004 and June 2007, 131 surgeries for aortic stenosis were done. PPM incident case if AOEI <0,85 cm2/m2; moderate between 0,85-0,65 and severe <0,65. In 13 (9,9%) was not possible to determine EOA. Surgical mortality is considered as the Society of Thoracic Surgeons, USA. The cumulative incidence (95% CI) were calculated stratified by severity of the PPM. The association PPM - surgical mortality was explored by exact test. Results: The cumulative incidence of PPM was 41/118 (34,7%, 95% CI: 26%-44%), moderate in 26/118 patients (22,0%, 95% CI: 15%-31%) and severe in 15/118 (12,7 %, 95% CI: 7%-20%). In all the surgical mortality was 10/131 (7,6%, 95% CI: 4%-14%), and the PPM was estimated to be 9 / 118 (7,6%, 95% CI: 4%-14%). In patients without PPM was 6 / 77 (7,8%, 95% CI: 3%-17%) similar to the PPM which was 3 / 41 (7,3%, 95% CI: 2%-20%), p=1. In the PPM moderate surgical mortality was 1/26 (3,8%, 95% CI: 1%-19%) and severe PPM 2/15 (13%, 95% CI: 2%-40%). Conclusion: more than 30% of patients with AVRS had PPM, being severe in 13%. No association was found between PPM and surgical mortality.

Surgical Experiences of Unruptured Intracranial Aneurysms / 대한뇌혈관외과학회지

Object : This study was conducted to evaluate the surgical results of the active treatment of unruptured intracranial aneurysms (UIAs) and to suggest treatment indications. METHODS: Operations were performed on 49 patients with 52 UIAs between 1999 and 2005. Medical records and radiologic studies of the patients with UIAs were retrospectively reviewed. The clinical outcomes were evaluated in each patient by the modified Glasgow Outcome Scale (m-GOS) one month after operation. RESULTS: UIAs had a high frequency of a middle cerebral artery (MCA) and an internal carotid artery (ICA) aneurysm. Forty-four UIAs (84.6%) ranged between 5 mm to 15 mm in diameter. Fortysix UIAs were treated by clipping, 2 by wrapping, and coil embolization was used in 3 UIAs. In one patient, which had only one UIA, one procedure and one operation was performed. There was no surgical mortality. In most patients, surgical complications or neurological deteriorations were not found. In three patients, minor neurological deficits of ptosis (2 patients) and spinal subdural hematoma (1 patient) were newly developed after operation. However the patients completely recovered within 3 months after operation. Finally, the surgical mortality and morbidity rate was 0%. CONCLUSION: If the UIAs are larger than 5 mm in diameter and located in a susceptible area for rupture, surgical treatment should be considered for the UIAs. If operation is performed by an expert neurosurgeon, surgical clipping is one of the best treatment modalities with or without endovascular treatment.

Results of Direct Intracranial Surgery and Classification for 135 Anterior Communicating Artery Aneurysms

During the 10-year period up to December 1984, 176 patients with anterior communicating aneurysn(ACOMA) among total 467 patients of intracranial aneurysms were admitted to this Catholic Medical Center. Of these, 135 cases of ACOMA were operated by direct intracranial procedures. To analyse the factors influencing the mortality involving in surgery of 135 patients with ACOMA, a classification of ACOMA was attempted. The origins and projections of aneurysms, anatomical variations were analysed with the aid of angiography, intraoperative findings and intraoperative photographs which permitted the establishment of a classification of ACOMA with their direction. Our classification of operated 135 cases of ACOMA are seven types : 32 anterior(23.7%), 30 anterior-rostral(22.2%), 42 antefior-caudal(31.1%), 3 posterior(2.2%), 18 posterior-rostral(13.4%), 4 posteriorcaudal(3.0%), caudal 6(4.4%), respectively. Most of ACOMA projecting anteriorly, anterio-rostrally were situated above or between the optic nerve, and the less frequent posterior-caudal and inferior aneurysms were in close proximity to hypothalamic branches of the anterior communicating artery and A2 segment. There was on overall operative mortality of 6%. The surgical morbidity and mortality were significantly higher in the posteriorly projecting group, garticulary in the posterior-caudal direction. In direct surgery of ACOMA, subpial resection of the gyrus rectus was effective for not only anteriorly, but also posteriorly directing aneurysms.