Evaluation of the RAPID score as a predictor of postoperative morbidity and mortality in patients undergoing pulmonary decortication for stage III pleural empyema.

OBJECTIVE: This study aims to correlate the RAPID score with the 3-month survival and surgical results of patients undergoing lung decortication with stage III pleural empyema. METHODS: This was a retrospective study with the population of patients with pleural empyema who underwent pulmonary decortication between January 2019 and June 2022. Data were collected from the institution's database, and patients were classified as low, medium, and high risk according to the RAPID score. The primary outcome was 3-month mortality. Secondary outcomes were the length of hospital stay, readmission rate, and the need for pleural re-intervention. RESULTS: Of the 34 patients with pleural empyema, according to the RAPID score, patients were stratified into low risk (23.5 %), medium risk (47.1 %), and high risk (29.4 %). The high-risk group had a 3-month mortality of 40 %, while the moderate-risk group had a 6.25 % and the low-risk group had no deaths within 90 days, confirming a good correlation with the RAPID score (p < 0.05). Sensitivity and specificity for the primary outcome in the high-risk score were 80.0 % and 79.3 %, respectively. The secondary outcomes did not reach statistical significance. CONCLUSIONS: In this retrospective series, the RAPID score had a good correlation with 3-month mortality in patients undergoing lung decortication. The morbidity indicators did not reach statistical significance. The present data justifies further studies to explore the capacity of the RAPID score to be used as a selection tool for treatment modality in patients with stage III pleural empyema.

Improving morbidity and mortality in hip fragility fractures.

PURPOSE OF REVIEW: Hip fragility fractures (HFF) carry high morbidity and mortality for patients and will increase in frequency and in proportion to the average patient age. Provision of effective, timely care for these patients can decrease their morbidity and mortality and reduce the large burden they place on the healthcare system. RECENT FINDINGS: There are associative relationships between prefracture frailty, postoperative delirium and increased morbidity and mortality. The use of a multidisciplinary approach to HFF care has shown improved outcomes in care with focus on modifiable factors including admission to specialty care floor, use of peripheral nerve blocks preoperatively and Anesthesia and Physical Therapy involvement in the care team. Peripheral nerve blocks including pericapsular nerve group (PENG) blocks have shown benefit in lowering morbidity and mortality. SUMMARY: HFF are associated with >40% chance of continued pain and inability to return to prefracture functional status at 1 year as well as >30% mortality at 2 years. In this opinion piece, we will discuss how a multidisciplinary approach that includes Anesthesia as well as utilization of peripheral nerve blocks can help to lessen postoperative issues and improve recovery.

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

BACKGROUND: Pancreaticoduodenectomy (PD) remains the only curative option for patients with pancreatic adenocarcinoma (PDAC). Infectious complications (IC) can negatively impact patient outcomes and delay adjuvant therapy in most patients. This study aims to determine IC effect on overall survival (OS) following PD for PDAC. STUDY DESIGN: Patients who underwent PD for PDAC between 2010 and 2020 were identified from a single institutional database. Patients were categorized into two groups based on whether they experienced IC or not. The relationship between postoperative IC and OS was investigated using Kaplan-Meier and Cox-regression multivariate analysis. RESULTS: Among 655 patients who underwent PD for PDAC, 197 (30%) experienced a postoperative IC. Superficial wound infection was the most common type of infectious complication (n = 125, 63.4%). Patients with IC had significantly more minor complications (Clavien-Dindo [CD] < 3; [59.4% vs. 40.2%, p < 0.001]), major complications (CD ≥ 3; [37.6% vs. 18.8%, p < 0.001]), prolonged LOS (47.2% vs 20.3%, p < 0.001), biochemical leak (6.1% vs. 2.8%, p = 0.046), postoperative bleeding (4.1% vs. 1.3%, p = 0.026) and reoperation (9.6% vs. 2.2%, p < 0.001). Time to adjuvant chemotherapy was delayed in patients with IC versus those without (10 vs. 8 weeks, p < 0.001). Median OS for patients who experienced no complication, noninfectious complication, and infectious complication was 33.3 months, 29.06 months, and 27.58 months respectively (p = 0.023). On multivariate analysis, postoperative IC were an independent predictor of worse OS (HR 1.32, p = 0.049). CONCLUSIONS: IC following PD for PDAC independently predict worse oncologic outcomes. Thus, efforts to prevent and manage IC should be a priority in the care of patients undergoing PD for PDAC.

Ecografía en el postoperatorio de cirugía cardíaca / Ultrasound use after cardiac surgery

La complejidad de los procedimientos quirúrgicos, así como la comorbilidad de los pacientes sometidos a cirugía cardiaca, van en aumento. La detección y el tratamiento precoz de las complicaciones posquirúrgicas son parte del éxito en la reducción de la morbimortalidad. La introducción de la técnica ecográfica ha sido fundamental en la valoración cardiopulmonar, hemodinámica y etiológica del paciente crítico, aportando información inmediata, fiable y a veces concluyente, permitiendo aclarar muchas situaciones clínicas sin respuesta terapéutica aceptable, por lo que se trata de una herramienta diagnóstica esencial. En este capítulo nos centraremos, fundamentalmente, en la valoración funcional y hemodinámica, y en la detección de las complicaciones cardiológicas más frecuentes en el postoperatorio de cirugía cardiaca. (AU)

Surgical complexity as well as comorbidities in patients undergoing cardiac surgery is increasing. Early detection and management of post-surgical complications are key points to reduce morbidity and mortality. Ultrasound technique plays a main rol in cardiopulmonary, hemodynamic and etiological assessment of the critically ill, providing immediate, reliable and, sometimes, conclusive information, clarifying many clinical situations with an inappropriate therapeutic response. For all these reasons ultrasound is an essential diagnostic tool. In this chapter we will focus, mainly, on functional and hemodynamic assessment and on the detection of most common cardiological complications in the postoperative period after cardiac surgery. (AU)

Quality of Surgical Care Within the Criminal Justice Health Care System.

Importance: Individuals who are incarcerated represent a vulnerable group due to concerns about their ability to provide voluntary and informed consent, and there are considerable legal protections regarding their participation in medical research. Little is known about the quality of surgical care received by this population. Objective: To evaluate perioperative surgical care provided to patients who are incarcerated within the Texas Department of Criminal Justice (TDCJ) and compare their outcomes with that of the general nonincarcerated population. Design, Setting, and Participants: This cohort study analyzed data from patients who were incarcerated within the TDCJ and underwent general or vascular surgery at the University of Texas Medical Branch (UTMB) from 2012 to 2021. Case-specific outcomes for a subset of these patients and for patients in the general academic medical center population were obtained from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) and compared. Additional quality metrics (mortality index, length of stay index, and excess hospital days) from the Vizient Clinical Data Base were analyzed for patients in the incarcerated and nonincarcerated groups who underwent surgery at UTMB in 2020 and 2021 to provide additional recent data. Patient-specific demographics, including age, sex, and comorbidities were not available for analysis within this data set. Main Outcome and Measures: Perioperative outcomes (30-day morbidity, mortality, and readmission rates) were compared between the incarcerated and nonincarcerated groups using the Fisher exact test. Results: The sample included data from 6675 patients who were incarcerated and underwent general or vascular surgery at UTMB from 2012 to 2021. The ACS-NSQIP included data (2012-2021) for 2304 patients who were incarcerated and 602 patients who were not and showed that outcomes were comparable between the TDCJ population and that of the general population treated at the academic medical center with regard to 30-day readmission (6.60% vs 5.65%) and mortality (0.91% vs 1.16%). However, 30-day morbidity was significantly higher in the TDCJ population (8.25% vs 5.48%, P = .01). The 2020 and 2021 data from the Vizient Clinical Data Base included 629 patients who were incarcerated and 2614 who were not and showed that the incarcerated and nonincarcerated populations did not differ with regard to 30-day readmission (12.52% vs 11.30%) or morbidity (1.91% vs 2.60%). Although the unadjusted mortality rate was significantly lower in the TDCJ population (1.27% vs 2.68%, P = .04), mortality indexes, which account for case mix index, were similar between the 2 populations (1.17 vs 1.12). Conclusions and Relevance: Findings of this cohort study suggest that patients who are incarcerated have equivalent rates of mortality and readmission compared with a general academic medical center population. Future studies that focus on elucidating the potential factors associated with perioperative morbidity and exploring long-term surgical outcomes in the incarcerated population are warranted.

Case Sampling for Evaluating Hospital Postoperative Morbidity in US Surgical Quality Improvement Programs.

Importance: US surgical quality improvement (QI) programs use data from a systematic sample of surgical cases, rather than universal review of all cases, to assess and compare risk-adjusted hospital postoperative complication rates. Given decreasing postoperative complication rates over time and the types of cases eligible for abstraction, it is unclear whether case sampling is robust for identifying hospitals with higher than expected complications. Objective: To compare the assessment of hospital 30-day complication rates derived from sampling strategy used by some US surgical QI programs relative to universal review of all cases. Design, Setting, and Participants: This US hospital-level analysis took place from January 1, 2016, through September 30, 2020. Data analysis was performed from July 1, 2022, through December 21, 2022. Quarterly, risk-adjusted, 30-day complication observed to expected (O-E) ratios were calculated for each hospital using the sample (n = 502 730) and universal review (n = 1 725 364). Outlier hospitals (ie, those with higher than expected mortality) were identified using an O-E ratio significantly greater than 1.0. Patients 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases) were included. Main Outcome Measure: Thirty-day complications. Results: Most patients in both the representative sample and the universal sample were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively (P < .001). Over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7%, 7.2%, and 7.4% for outliers identified using the sample only, universal review only, and concurrent identification in both data sources, respectively. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review. For those identified with universal review, 44.6% were concurrently identified using the sample. Conclusion: In this observational study, case sampling identified less than half of hospitals with excess risk-adjusted postoperative complication rates. Future work is needed to ascertain how to best use currently collected data and whether alternative data collection strategies may be needed to better inform local QI efforts.

Association Between Mobilization and Composite Postoperative Complications Following Major Elective Surgery.

Importance: Mobilization after surgery is a key component of Enhanced Recovery after Surgery (ERAS) pathways. Objective: To evaluate the association between mobilization and a collapsed composite of postoperative complications in patients recovering from major elective surgery as well as hospital length of stay, cumulative pain scores, and 30-day readmission rates. Design, Setting, and Participants: This retrospective observational study conducted at a single quaternary US referral center included patients who had elective surgery between February 2017 and October 2020. Mobilization was assessed over the first 48 postoperative hours with wearable accelerometers, and outcomes were assessed throughout hospitalization. Patients who had elective surgery lasting at least 2 hours followed by at least 48 hours of hospitalization were included. A minimum of 12 hours of continuous accelerometer monitoring was required without missing confounding variables or key data. Among 16 203 potential participants, 8653 who met inclusion criteria were included in the final analysis. Data were analyzed from February 2017 to October 2020. Exposures: Amount of mobilization per hour for 48 postoperative hours. Outcomes: The primary outcome was a composite of myocardial injury, ileus, stroke, venous thromboembolism, pulmonary complications, and all-cause in-hospital mortality. Secondary outcomes included hospital length of stay, cumulative pain scores, and 30-day readmission. Results: Of 8653 included patients (mean [SD] age, 57.6 [16.0] years; 4535 [52.4%] female), 633 (7.3%) experienced the primary outcome. Mobilization time was a median (IQR) of 3.9 (1.7-7.8) minutes per monitored hour overall, 3.2 (0.9-7.4) in patients who experienced the primary outcome, and 4.1 (1.8-7.9) in those who did not. There was a significant association between postoperative mobilization and the composite outcome (hazard ratio [HR], 0.75; 95% CI, 0.67-0.84; P < .001) for each 4-minute increase in mobilization. Mobilization was associated with an estimated median reduction in the duration of hospitalization by 0.12 days (95% CI, 0.09-0.15; P < .001) for each 4-minute increase in mobilization. The were no associations between mobilization and pain score or 30-day readmission. Conclusions and Relevance: In this study, mobilization measured by wearable accelerometers was associated with fewer postoperative complications and shorter hospital length of stay.

Neurosurgery Morbidity and Mortality: A Prospective Surgical and Medical Analysis.

OBJECTIVE: The analysis of morbidity and mortality is fundamental for improving the quality of patient care. The objective of this study was to evaluate the combined medical and surgical morbidity and mortality of neurosurgical patients. METHODS: We performed a daily prospective compilation of morbidities and mortalities during a consecutive 4-month period in all the patients who were 18 years of age or older and had been admitted to the neurosurgery service at the Puerto Rico Medical Center. For each patient, any surgical or medical complication, adverse event, or death within 30 days was included. The patients' comorbidities were analyzed for their influence on mortality. RESULTS: Fifty-seven percent of the patients presented at least 1 complication. The most frequent complications were hypertensive episodes, mechanical ventilation for more than 48 hours, sodium disturbances, and bronchopneumonia. Twenty-one patients died, for an overall 30-day mortality of 8.2%. Mechanical ventilation for more than 48 hours, sodium disturbances, bronchopneumonia, unplanned intubation, acute kidney injury, blood transfusion, shock, urinary tract infection, cardiac arrest, arrhythmia, bacteremia, ventriculitis, sepsis, elevated intracranial pressure, vasospasm, stroke, and hydrocephalus were significant factors for mortality. None of the analyzed patients' comorbidities were significant for mortality or longer length of stay. The type of surgical procedure did not influence the length of stay. CONCLUSION: The mortality and morbidity analysis provided valuable neurosurgical information that may influence future treatment management and corrective recommendations. Indication and judgment errors were significantly associated with mortality. In our study, the patients' comorbidities were not significant for mortality or increased length of stay.

Minimum heart rate and mortality after cardiac surgery: retrospective analysis of the Multi-parameter Intelligent Monitoring in Intensive Care (MIMIC-III) database.

Low heart rate is a risk factor of mortality in many cardiovascular diseases. However, the relationship of minimum heart rate (MHR) with outcomes after cardiac surgery is still unclear, and the association between optimum MHR and risk of mortality in patients receiving cardiac surgery remains unknown. In this retrospective study using the Multi-parameter Intelligent Monitoring in Intensive Care (MIMIC-III) database, 8243 adult patients who underwent cardiac surgery were included. The association between MHR and the 30-day, 90-day, 180-day, and 1-year mortality of patients undergoing cardiac surgery was analyzed using multivariate Cox proportional hazard analysis. As a continuous variable, MHR was evaluated using restricted cubic regression splines, and appropriate cut-off points were determined. Kaplan-Meier curve was used to further explore the relationship between MHR and prognosis. Subgroup analyses were performed based on age, sex, hypertension, diabetes, and ethnicity. The rates of the 30-day, 90-day, 180-day, and 1-year mortalities of patients in the low MHR group were higher than those in the high MHR group (4.1% vs. 2.9%, P < 0.05; 6.8% vs. 5.3%, P < 0.05; 8.9% vs. 7.0%, P < 0.05, and 10.9% vs. 8.8%, P < 0.05, respectively). Low MHR significantly correlated with the 30-day, 90-day, 180-day, and 1-year mortality after adjusting for confounders. A U-shaped relationship was observed between the 30-day, 90-day, 180-day, and 1-year mortality and MHR, and the mortality was lowest when the MHR was 69 bpm. Kaplan-Meier curve analysis also indicated that low MHR had poor prognosis in patients undergoing cardiac surgery. According to subgroup analyses, the effect of low MHR on post-cardiac surgery survival was restricted to patients who were < 75 years old, male, without hypertension and diabetes, and of White ethnicity. MHR (69 bpm) was associated with better 30-day, 90-day, 180-day, and 1-year survival in patients after cardiac surgery. Therefore, effective HR control strategies are required in this high-risk population.

Association of Preoperative Neutrophil-to-Lymphocyte Ratio with Postoperative Acute Kidney Injury and Mortality Following Major Noncardiac Surgeries.

BACKGROUND: Acute kidney injury (AKI) is a major complication that occurs following an operation. Therefore, there is an increasing need to discover new predictors of AKI. We hypothesized that the preoperative neutrophil-to-lymphocyte ratio (NLR) was associated with postoperative AKI and in-hospital mortality following noncardiac surgery. METHODS: This is a retrospective observational study of patients who underwent noncardiac surgery at Sichuan University West China Hospital from 2018 to 2020. Multivariable logistic regression was performed as the major analytic method. In addition, sensitivity and subgroup analyses were performed to validate the results. RESULTS: A total of 44,065 patients were included in this study. The prevalence of postoperative AKI was 5.62%, and the in-hospital mortality was 1.58%. Multivariable analysis demonstrated that NLR ≥ 5 was independently associated with the development of postoperative AKI (OR 1.42, 1.24-1.73; P < 0.001) and in-hospital mortality (OR 2.03, 1.63-2.52; P < 0.001). Similar results were achieved when propensity-score matching was performed for patients with NLR ≥ 5 and < 5 on the baseline. In stratified analysis, the associations remained persistent in most subgroups. For the sensitivity analysis, we took NLR as a continuous variable and demonstrated the potential linear relationship between NLR and postoperative AKI and mortality. CONCLUSIONS: Our results indicated that preoperative NLR is associated with the prevalence of postoperative AKI and in-hospital mortality that occur after major noncardiac surgery. These findings suggest that NLR has the potential to be a significant correlation biomarker associated with perioperative risk assessment of patients undergoing noncardiac surgeries.

Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry.

Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.

Hospital volume, postoperative mortality, and costs after gastrectomy for gastric cancer in colombia: is there any association? / Volume hospitalar, mortalidade pós-operatória e custos após gastrectomia por câncer gástrico na colômbia: existe associação?

ABSTRACT BACKGROUND: There are no information in the literature associating the volume of gastrectomies with survival and costs for the health system in the treatment of patients with gastric cancer in Colombia. AIMS: The aim of this study was to analyze how gastrectomy for gastric cancer is associated with hospital volume, 30-day and 180-day postoperative mortality, and healthcare costs in Bogotá, Colombia. METHODS: A retrospective cohort study based on hospital data of all adult patients with gastric cancer who underwent gastrectomy between 2014 and 2016 using a paired propensity score. The surgical volume was identified as the average annual number of gastrectomies performed by the hospital. RESULTS: A total of 743 patients were included in the study. Hospital mortality at 30 and 180 days postoperatively was 36 (4.85%) and 127 (17.09%) patients, respectively. The average health care cost was USD 3,200. A total of 26 or more surgeries were determined to be the high surgical volume cutoff. Patients operated on in hospitals with a high surgical volume had lower 6-month mortality (HR 0.44; 95%CI 0.27-0.71; p=0.001), and no differences were found in health costs (mean difference 398.38; 95%CI-418.93-1,215.69; p=0.339). CONCLUSIONS: This study concluded that in Bogotá (Colombia), surgery in a high-volume hospital is associated with better 6-month survival and no additional costs to the health system.

RESUMO RACIONAL: Não há informações na literatura relacionando o volume de gastrectomias bem como a sobrevida e os custos para o sistema de saúde, no tratamento de pacientes com câncer gástrico na Colômbia. OBJETIVOS: analisar como a gastrectomia para câncer gástrico está associada ao volume hospitalar, mortalidade pós-operatória de 30 e 180 dias e custos de saúde em Bogotá, Colômbia. MÉTODOS: Estudo de coorte retrospectivo baseado em dados hospitalares de todos os pacientes adultos com câncer gástrico submetidos à gastrectomia entre 2014 e 2016, utilizando um escore de propensão pareado. O volume cirúrgico foi identificado como o número médio anual de gastrectomias realizadas pelo hospital. RESULTADOS: Foram incluídos no estudo 743 pacientes. A mortalidade hospitalar aos 30 e 180 dias de pós-operatório, foram respectivamente, 36 (4,85%) e 127 (17,09%) pacientes. O custo médio de saúde foi de US$ 3.200. Vinte e seis ou mais cirurgias foram determinadas como ponto de corte de alto volume cirúrgico. Pacientes operados em hospitais de alto volume cirúrgico tiveram menor mortalidade em seis meses (HR 0,44; IC95% 0,27-0,71; p=0,001) e não foram encontradas diferenças nos custos com saúde (diferença média 398,38; IC95% −418,93-1215,69; p=0,339). CONCLUSÕES: Este estudo concluiu que em Bogotá (Colômbia), a cirurgia em um hospital com alto volume cirúrgico está associada a uma melhor sobrevida de seis meses e não há custos adicionais para o sistema de saúde.

Association between postoperative acute kidney injury and mortality after plastic and reconstructive surgery.

Acute kidney injury (AKI) is a common postoperative disorder that is associated with considerable morbidity and mortality. Although the role of AKI as an independent risk factor for mortality has been well characterized in major surgeries, its effect on postoperative outcomes in plastic and reconstructive surgery has not been evaluated. This study explored the association between postoperative AKI and mortality in patients undergoing plastic and reconstructive surgery. Consecutive adult patients who underwent plastic and reconstructive surgery without end-stage renal disease (n = 7059) at our institution from January 2011 to July 2019 were identified. The patients were divided into two groups according to occurrence of postoperative AKI: 7000 patients (99.2%) in the no AKI group and 59 patients (0.8%) in the AKI group. The primary outcome was mortality during the first year, and overall mortality and 30-days mortality were also compared. After inverse probability weighting, mortality during the first year after plastic and reconstructive surgery was significantly increased in the AKI group (1.9% vs. 18.6%; hazard ratio, 6.69; 95% confidence interval, 2.65-16.85; p < 0.001). In this study, overall and 30-day mortalities were shown to be higher in the AKI group, and further studies are needed on postoperative AKI in plastic and reconstructive surgery.

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

Association Between Ageing and Short-Term Survival Outcomes in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma.

BACKGROUND: As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ageing is associated with inferior short-term survival outcomes after RPS surgery. PATIENTS AND METHODS: Patients undergoing surgery for primary RPS between 2008 and 2019 at two tertiary sarcoma centres were analysed. The primary outcome was 1-year mortality, and the primary explanatory variable was patient age, classified as: < 55, 55-64, 65-74 or 75+ years. RESULTS: The 692 patients undergoing surgery (mean age 60.8 ± 13.8 years) had a 1-year mortality rate of 9.4%, which differed significantly by age (p < 0.001), with rates of 7.2%, 6.9%, 8.7% and 22.8% for the < 55, 55-64, 65-74 and 75+ years groups, respectively. The distribution of causes of death also differed significantly by age (p = 0.023), with 22% and 28% of deaths in the 65-74 and 75+ years groups caused by post-operative complications, versus none in the < 55 and 55-64 years groups. On multivariable analysis, age of 75+ years (versus < 55 years) was a significant independent predictor of 1-year mortality [odds ratio (OR) 7.05, 95% confidence interval (CI) 2.63-18.9, p < 0.001]; no significant increase in risk was observed in the 55-64 (OR 0.72, 95% CI 0.28-1.87) or 65-74 (OR 0.89, 95% CI 0.37-2.15) years groups. CONCLUSIONS: Post-operative complications are an important cause of deaths in elderly patients. These findings are relevant to decision-making and counselling when surgery is considered for patients with RPS.