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de Jong D, Thangavelu A, Broadhead T, Chen I, Burke D, Hutson R, Johnson R, Kaufmann A, Lodge P, Nugent D, Quyn A, Theophilou G, Laios A. Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications. J Ovarian Res 2023; 16:214. [PMID: 37951927 PMCID: PMC10638711 DOI: 10.1186/s13048-023-01303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS). RESULTS R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed. CONCLUSIONS Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.
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Affiliation(s)
- Diederick de Jong
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Amudha Thangavelu
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Timothy Broadhead
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Inga Chen
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Dermot Burke
- Department of Surgery, Colorectal Surgery Service, St. James's University Hospital LTHT, Leeds, UK
| | - Richard Hutson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Racheal Johnson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Angelika Kaufmann
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Peter Lodge
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - David Nugent
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Aaron Quyn
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Alexandros Laios
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK.
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Ritchie J, Birsner ML, Zighelboim I, Taylor NP. Common obstetrics and gynecologic topics in critical care: A narrative review. Int J Crit Illn Inj Sci 2023; 13:38-43. [PMID: 37180304 PMCID: PMC10167811 DOI: 10.4103/ijciis.ijciis_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/15/2022] [Accepted: 01/23/2023] [Indexed: 05/16/2023] Open
Abstract
The fields of Obstetrics and Gynecology and Critical Care often share medically and surgically complex patients. Peripartum anatomic and physiologic changes can predispose or exacerbate certain conditions and rapid action is often needed. This review discusses some of the most common conditions responsible for the admission of obstetrical and gynecological patients to the critical care unit. We will consider both obstetrical and gynecologic concepts including postpartum hemorrhage, antepartum hemorrhage, abnormal uterine bleeding, preeclampsia and eclampsia, venous thromboembolism, amniotic fluid embolism, sepsis and septic shock, obstetrical trauma, acute abdomen, malignancies, peripartum cardiomyopathy, and substance abuse. This article aims to be a primer for the Critical Care provider.
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Affiliation(s)
- Julia Ritchie
- Department of Obstetrics and Gynecology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Meredith L. Birsner
- Department of Gynecologic Oncology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Israel Zighelboim
- Department of Gynecologic Oncology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Nicholas P. Taylor
- Department of Maternal Fetal Medicine, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
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Stratification of Length of Stay Prediction following Surgical Cytoreduction in Advanced High-Grade Serous Ovarian Cancer Patients Using Artificial Intelligence; the Leeds L-AI-OS Score. Curr Oncol 2022; 29:9088-9104. [PMID: 36547125 PMCID: PMC9776955 DOI: 10.3390/curroncol29120711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: Length of stay (LOS) has been suggested as a marker of the effectiveness of short-term care. Artificial Intelligence (AI) technologies could help monitor hospital stays. We developed an AI-based novel predictive LOS score for advanced-stage high-grade serous ovarian cancer (HGSOC) patients following cytoreductive surgery and refined factors significantly affecting LOS. (2) Methods: Machine learning and deep learning methods using artificial neural networks (ANN) were used together with conventional logistic regression to predict continuous and binary LOS outcomes for HGSOC patients. The models were evaluated in a post-hoc internal validation set and a Graphical User Interface (GUI) was developed to demonstrate the clinical feasibility of sophisticated LOS predictions. (3) Results: For binary LOS predictions at differential time points, the accuracy ranged between 70-98%. Feature selection identified surgical complexity, pre-surgery albumin, blood loss, operative time, bowel resection with stoma formation, and severe postoperative complications (CD3-5) as independent LOS predictors. For the GUI numerical LOS score, the ANN model was a good estimator for the standard deviation of the LOS distribution by ± two days. (4) Conclusions: We demonstrated the development and application of both quantitative and qualitative AI models to predict LOS in advanced-stage EOC patients following their cytoreduction. Accurate identification of potentially modifiable factors delaying hospital discharge can further inform services performing root cause analysis of LOS.
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Yetneberk T, Firde M, Tiruneh A, Fentie Y, Tariku M, Mihret G, Moore J. Incidence of unplanned intensive care unit admission following surgery and associated factors in Amhara regional state hospitals. Sci Rep 2022; 12:20121. [PMID: 36418456 PMCID: PMC9684567 DOI: 10.1038/s41598-022-24571-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Unplanned postoperative critical care admission poses a potential risk to patients and places unanticipated pressure on clinical services and it has become an important parameter to assess patient safety in perioperative services. This study was aimed to determine the incidence of unplanned intensive care unit admission following surgery and the associated factors. A multi-center cross-sectional study was conducted on postoperative patients admitted to the ICU of three hospitals located in the Amhara region. Data were collected via a structured survey tool and analyzed using SPSS version 23 software with binary logistic regression analysis. The statistical significance to identify patient, anesthetic and surgical related factors in the preoperative, intraoperative, and postoperative period was < 0.05 for multivariable regression with a 95% confidence interval. Predominantly patients were admitted to the ICU in an unplanned manner. ASA status, preoperative hemoglobin (Hgb) level, intraoperative estimated blood loss, and adverse events occurring in the operating room were significantly associated with intensive care unit admission following surgery. Patients who had a low preoperative Hgb value were 35.1 times more likely to be admitted to the intensive care unit in an unplanned manner compared with their counterparts [(Adjust odds ratio (AOR) 35.16; CI 12.82, 96.44)]. Patients with ASA II and III were 19.4 and 16.2 times more likely to be admitted to ICU in an unplanned way compared to patients who had ASA I physical status [(AOR 51.79; CI 8.28, 323.94) (AOR 67.8 CI 14.68, 313.53)]. Unplanned ICU admission after surgery was high in this study, suggesting poor perioperative planning, risk stratification, and optimization of patients.
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Affiliation(s)
- Tikuneh Yetneberk
- grid.510430.3Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
| | - Meseret Firde
- grid.510430.3Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebe Tiruneh
- grid.510430.3Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yewlsew Fentie
- grid.510430.3Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mequanent Tariku
- grid.510430.3Department of Gynecology and Obstetrics, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Mihret
- grid.510430.3School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Jolene Moore
- grid.7107.10000 0004 1936 7291School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Tseng JH, Bristow RE. Complications associated with cytoreductive surgery for advanced ovarian cancer: Surgical timing and surmounting obstacles. Gynecol Oncol 2022; 166:5-7. [PMID: 35725134 DOI: 10.1016/j.ygyno.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jill H Tseng
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA
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An overview of Clinical Quality Registries (CQRs) on gynecological oncology worldwide. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2094-2103. [DOI: 10.1016/j.ejso.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
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Rozeboom PD, Henderson WG, Dyas AR, Bronsert MR, Colborn KL, Lambert-Kerzner A, Hammermeister KE, McIntyre RC, Meguid RA. Development and Validation of a Multivariable Prediction Model for Postoperative Intensive Care Unit Stay in a Broad Surgical Population. JAMA Surg 2022; 157:344-352. [PMID: 35171216 PMCID: PMC8851361 DOI: 10.1001/jamasurg.2021.7580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite limited capacity and expensive cost, there are minimal objective data to guide postoperative allocation of intensive care unit (ICU) beds. The Surgical Risk Preoperative Assessment System (SURPAS) uses 8 preoperative variables to predict many common postoperative complications, but it has not yet been evaluated in predicting postoperative ICU admission. OBJECTIVE To determine if the SURPAS model could accurately predict postoperative ICU admission in a broad surgical population. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model was a retrospective, observational analysis of prospectively collected patient data from the 2012 to 2018 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, which were merged with individual patients' electronic health record data to capture postoperative ICU use. Multivariable logistic regression modeling was used to determine how the 8 preoperative variables of the SURPAS model predicted ICU use compared with a model inputting all 28 preoperatively available NSQIP variables. Data included in the analysis were collected for the ACS NSQIP at 5 hospitals (1 tertiary academic center, 4 academic affiliated hospitals) within the University of Colorado Health System between January 1, 2012, and December 31, 2018. Included patients were those undergoing surgery in 9 surgical specialties during the 2012 to 2018 period. Data were analyzed from May 29 to July 30, 2021. EXPOSURE Surgery in 9 surgical specialties, including general, gynecology, orthopedic, otolaryngology, plastic, thoracic, urology, vascular, and neurosurgery. MAIN OUTCOMES AND MEASURES Use of ICU care up to 30 days after surgery. RESULTS A total of 34 568 patients were included in the analytical data set: 32 032 (92.7%) in the cohort without postoperative ICU use and 2545 (7.4%) in the cohort with postoperative ICU use (no ICU use: mean [SD] age, 54.9 [16.6] years; 18 188 women [56.8%]; ICU use: mean [SD] age, 60.3 [15.3] years; 1333 men [52.4%]). For the internal chronologic validation of the 7-variable SURPAS model, data from 2012 to 2016 were used as the training data set (n = 24 250, 70.2% of the total sample size of 34 568) and data from 2017 to 2018 were used as the test data set (n = 10 318, 29.8% of the total sample size of 34 568). The C statistic improved in the test data set compared with the training data set (0.933; 95% CI, 0.924-0.941 vs 0.922; 95% CI, 0.917-0.928), whereas the Brier score was slightly worse in the test data set compared with the training data set (0.045; 95% CI, 0.042-0.048 vs 0.045; 95% CI, 0.043-0.047). The SURPAS model compared favorably with the model inputting all 28 NSQIP variables, with both having good calibration between observed and expected outcomes in the Hosmer-Lemeshow graphs and similar Brier scores (model inputting all variables, 0.044; 95% CI, 0.043-0.048; SURPAS model, 0.045; 95% CI, 0.042-0.046) and C statistics (model inputting all variables, 0.929; 95% CI, 0.925-0.934; SURPAS model, 0.925; 95% CI, 0.921-0.930). CONCLUSIONS AND RELEVANCE Results of this decision analytical model study revealed that the SURPAS prediction model accurately predicted postoperative ICU use across a diverse surgical population. These results suggest that the SURPAS prediction model can be used to help with preoperative planning and resource allocation of limited ICU beds.
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Affiliation(s)
- Paul D. Rozeboom
- Department of Surgery, University of Colorado School of Medicine, Aurora,Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora
| | - William G. Henderson
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Adam R. Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora,Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora
| | - Michael R. Bronsert
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora
| | - Kathryn L. Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora,Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Karl E. Hammermeister
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Robert C. McIntyre
- Department of Surgery, University of Colorado School of Medicine, Aurora,Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora
| | - Robert A. Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora,Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora
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Machine Learning-Based Risk Prediction of Critical Care Unit Admission for Advanced Stage High Grade Serous Ovarian Cancer Patients Undergoing Cytoreductive Surgery: The Leeds-Natal Score. J Clin Med 2021; 11:jcm11010087. [PMID: 35011828 PMCID: PMC8745521 DOI: 10.3390/jcm11010087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Achieving complete surgical cytoreduction in advanced stage high grade serous ovarian cancer (HGSOC) patients warrants an availability of Critical Care Unit (CCU) beds. Machine Learning (ML) could be helpful in monitoring CCU admissions to improve standards of care. We aimed to improve the accuracy of predicting CCU admission in HGSOC patients by ML algorithms and developed an ML-based predictive score. A cohort of 291 advanced stage HGSOC patients with fully curated data was selected. Several linear and non-linear distances, and quadratic discriminant ML methods, were employed to derive prediction information for CCU admission. When all the variables were included in the model, the prediction accuracies were higher for linear discriminant (0.90) and quadratic discriminant (0.93) methods compared with conventional logistic regression (0.84). Feature selection identified pre-treatment albumin, surgical complexity score, estimated blood loss, operative time, and bowel resection with stoma as the most significant prediction features. The real-time prediction accuracy of the Graphical User Interface CCU calculator reached 95%. Limited, potentially modifiable, mostly intra-operative factors contributing to CCU admission were identified and suggest areas for targeted interventions. The accurate quantification of CCU admission patterns is critical information when counseling patients about peri-operative risks related to their cytoreductive surgery.
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Research Progress of PCNA in Reproductive System Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2391917. [PMID: 34721621 PMCID: PMC8553460 DOI: 10.1155/2021/2391917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/11/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
Reproductive system diseases have become a public health problem that endangers human physical and mental health. The causes of reproductive diseases are complex and diverse. From a biological point of view, abnormal cell proliferation may affect important physiological functions of reproductive organs and cause various gynecological or andrological diseases. Proliferating cell nuclear antigen (PCNA) is the most commonly used indicator for detecting cell proliferation activity. The up- or downregulation of its expression is of great significance in reproductive system diseases. This review summarizes the significance of the latest research on PCNA expression in reproductive system diseases.
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Thomakos N, Prodromidou A, Haidopoulos D, Machairas N, Rodolakis A. Postoperative Admission in Critical Care Units Following Gynecologic Oncology Surgery: Outcomes Based on a Systematic Review and Authors' Recommendations. In Vivo 2021; 34:2201-2208. [PMID: 32871742 DOI: 10.21873/invivo.12030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The present study aimed to evaluate the predictors of admission to the Critical Care Units (CCUs) and factors predisposing to prolonged stay in CCUs after gynecological oncology surgery. PATIENTS AND METHODS Studies which addressed cases of women who underwent surgery for gynecological malignancies and required postoperative CCU admission were included. RESULTS Seven studies with 3820 patients were included. Among them, 1680 required admission to CCU. Advanced age, higher Charlson Comorbidity Index (CCI) score, longer operative times, protracted blood loss and intestinal resection were associated with higher probability of CCU admission. Patients' age, operative times, blood loos and intestinal resection were significant predictors of prolonged stay to CCUs. CONCLUSION Admission to CCU and length of stay following surgery for gynecologic malignancies is driven by specific patient characteristics as well as intraoperative values. Further studies are needed to validate high risk patients who will benefit from postoperative care to CCUs to ensure favorable postoperative outcomes and cost-effectiveness.
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Affiliation(s)
- Nikolaos Thomakos
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Prodromidou
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Haidopoulos
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Surgical Apgar score is strongly associated with postoperative ICU admission. Sci Rep 2021; 11:115. [PMID: 33420227 PMCID: PMC7794529 DOI: 10.1038/s41598-020-80393-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 12/29/2022] Open
Abstract
Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.
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12
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Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia 2020; 75 Suppl 1:e62-e74. [DOI: 10.1111/anae.14793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 12/17/2022]
Affiliation(s)
- D. N. Onwochei
- Department of Anaesthesia Guy's & St. Thomas’ NHS Foundation Trust London UK
| | - J. Fabes
- Department of AnaesthesiaRoyal Free NHS Foundation Trust LondonUK
| | - D. Walker
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
| | - G. Kumar
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
| | - S. R. Moonesinghe
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
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Smith CG, Davenport DL, Gorski J, McDowell A, Burgess BT, Fredericks TI, Baldwin LA, Miller RW, DeSimone CP, Dietrich CS, Gallion HH, Pavlik EJ, van Nagell JR, Ueland FR. Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery. Healthcare (Basel) 2019; 7:E85. [PMID: 31277282 PMCID: PMC6787623 DOI: 10.3390/healthcare7030085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012-2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012-2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0-38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38-2.13) or IV (aOR 1.88, 95% CI 1.44-2.46), presence of ascites (aOR 1.88, 95% CI 1.44-2.46), older age (aOR 1.23, 95% CI 1.13-1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29-2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28-94.77), disseminated cancer (aOR 1.28, 95% CI 1.03-1.60), increased length of operation (121-180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13-3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59-2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.
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Affiliation(s)
- Christopher G Smith
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA.
| | - Daniel L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Justin Gorski
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Anthony McDowell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Brian T Burgess
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Tricia I Fredericks
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Lauren A Baldwin
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Rachel W Miller
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Christopher P DeSimone
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Charles S Dietrich
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Holly H Gallion
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Edward J Pavlik
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - John R van Nagell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
| | - Frederick R Ueland
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
- Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
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