Electrolyte and Acid-Base Disturbances in Emergency High-Risk Abdominal Surgery, a Retrospective Study

Risk factors analysis of hypokalemia after radical resection of esophageal cancer and establishment of a nomogram risk prediction model

Objective

This study aimed to explore the risk factors of hypokalemia after radical resection of esophageal cancer (EC) and establish a nomogram risk prediction model to evaluate hypokalemia risk after esophagectomy. Thus, this study provides a reference for the clinical development of intervention measures.

Methods

Clinical data of EC patients who underwent radical surgery from January 2020 to November 2022 in the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. The relevant variables were screened using multivariate logistic regression analysis with IBM SPSS 25.0 and R 4.2.0 software, and a nomogram for predicting hypokalemia risk was established. The established nomogram was evaluated by receiver operating characteristic (ROC), calibration, and decision curves. The model was also internally validated by 1000 bootstrap resampling methods.

Results

After radical EC resection, the incidence rate of hypokalemia in 213 patients was 19.2% (41/213). The hemoglobin levels, total serum protein, serum albumin, calcium ion concentration, direct bilirubin, prothrombin time (PT), and activated partial thromboplastin time (APTT) were related (p < 0.05). The multivariate logistic analysis showed that the white blood cell count, serum albumin level, direct bilirubin, and operation time were risk factors for hypokalemia after radical EC resection (p < 0.05). The area under the ROC curve (AUC) was 0.764, demonstrating the good discriminative ability of the established nomogram for hypokalemia prediction. The calibration curve showed a good fit between the predicted and actual observed probabilities. The model maintained a high C-index in the internal validation (C-index = 0.758), supporting that the nomogram can be widely used for hypokalemia prediction.

Conclusion

The prediction model for hypokalemia risk with individualized scores based on the patient's white blood cell count, serum albumin level, direct bilirubin, and operation time can screen out high-risk patients who might develop hypokalemia. It is of certain reference value for clinicians to screen and follow up with patients with emphasis and to formulate preoperative and postoperative intervention strategies.

Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute appendicitis

PURPOSE

This study aims to explore the value of multiple indicators in the evaluation of risk factors for intestinal adhesion (IA) after appendectomy in children with acute appendicitis (AA).

METHODS

A retrospective study was conducted on 608 patients who underwent appendectomy in the Department of Pediatric Surgery, Children's Medical Center of Jilin Province from January 2017 to April 2023, with a one-year follow-up period to record the occurrence of IA after appendectomy. Univariate and multivariate analysis were used to screen the risk factors of postoperative IA, and a prediction model was established to predict postoperative IA.

RESULTS

There were 527 patients in the non-IA group and 81 patients in the IA group. Binary Logistic regression was used to determine the strength of correlation with postoperative intestinal adhesion. The risk factors identified were as follows: DS ≥ 43 h (OR = 3.903, 5points), CRP ≥ 65 mg/L (OR = 3.424, 4.5points), PCT ≥ 0.9 µg/L (OR = 8.683, 8points), Surgical duration ≥ 100 min (OR = 6.457, 7points), Appendiceal perforation (OR = 6.073, 6.5points), Postoperative exhaust time ≥ 55 h (OR = 14.483, 10points). After test, the nomogram drawn based on binary logistic regression can obtain good prediction efficiency. In the training set, the area under the curve was 0.960, the sensitivity was 0.898, and the specificity was 0.905. In the test set, the area under the curve was 0.957, the sensitivity was 0.864, and the specificity was 0.906.

CONCLUSION

Postoperative exhaust time ≥ 55 h has a high risk of IA after appendicitis surgery in children. Early recovery of intestinal peristalsis function is essential. This scoring model is a novel and promising method for predicting postoperative IA.

Bioimpedance spectroscopy fluid analysis in acute high-risk abdominal surgery, a prospective clinician-blinded observational feasibility study

Objective assessment of fluid status in critical surgical care may help optimize perioperative fluid administration and prevent postoperative fluid retention. We evaluated the feasibility of hydration status and fluid distribution assessment by Bioimpedance spectroscopy Analysis (BIA) in patients undergoing acute high-risk abdominal (AHA) surgery. This observational study included 73 patients undergoing AHA surgery. During the observational period (0-120 h), we registered BIA calculated absolute fluid overload (AFO) and relative fluid overload (RFO), defined as AFO/extracellular water ratio, as well as cumulative fluid balance and weight. Based on RFO values, hydration status was classified into three categories: dehydrated (RFO <  - 10%), normohydrated (- 10% ≤ RFO ≤  + 15%), overhydrated RFO > 15%. We performed a total of 365 BIA measurements. Preoperative overhydration was found in 16% of patients, increasing to 66% by postoperative day five. The changes in BIA measured AFO correlated with the cumulative fluid balance (r2 = 0.44, p < .001), and change in weight (r2 = 0.55, p < .0001). Perioperative overhydration measured with BIA was associated with worse outcome compared to patients with normo- or dehydration. We have demonstrated the feasibility of obtaining perioperative bedside BIA measurements in patients undergoing AHA surgery. BIA measurements correlated with fluid balance, weight changes, and postoperative clinical complications. BIA-assessed fluid status might add helpful information to guide fluid management in patients undergoing AHA surgery.