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Schootman M, Li C, Ying J, Orcutt ST, Laryea J. Maximizing Readmission Reduction in Colon Cancer Patients. J Surg Res 2024; 295:587-596. [PMID: 38096772 PMCID: PMC10922981 DOI: 10.1016/j.jss.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Multiple studies have identified risk factors for readmission in colon cancer patients. We need to determine which risk factors, when modified, produce the greatest decrease in readmission for patients so that limited resources can be used most effectively by implementing targeted evidence-based performance improvements. We determined the potential impact of various modifiable risk factors on reducing 30-d readmission in colon cancer patients. METHODS We used a cohort design with the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program data to track colon cancer patients for 30 d following surgery. Colon cancer patients who received colectomies and were discharged alive were included. Readmission (to the same or another hospital) for any reason within 30 d of the resection was the outcome measure. Modifiable risk factors were the use of minimally invasive surgery (MIS) versus open colectomy, mechanical bowel preparation, preoperative antibiotic use, functional status, smoking, complications (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke, infections, anastomotic leakage, prolonged postoperative ileus, extensive blood loss, and sepsis), serum albumin, and hematocrit. RESULTS 111,691 patients with colon cancer were included in the analysis. About half of the patients were male, most were aged 75 or older, and were discharged home. Overall, 11,138 patients (10.0%) were readmitted within 30 d of surgery. In adjusted analysis, the reduction in readmission would be largest by preventing both prolonged ileus and by switching open colectomies to MIS (28.0% relative reduction) followed by preventing anastomotic leaks (6.2% relative reduction). Improving other modifiable risk factors would have a more limited impact. CONCLUSIONS The focus of readmission reduction should be on preventing prolonged ileus, increasing the use of MIS, and preventing anastomotic leaks.
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Affiliation(s)
- Mario Schootman
- Division of Community Health and Research, Department of Internal Medicine, College of Medicine, The University of Arkansas for Medical Sciences, Springdale, Arkansas; Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jun Ying
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sonia T Orcutt
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Surgical Oncology, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan Laryea
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Colorectal Surgery, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Song I, Nam H, Lee B, Park BK, Kim JK, Ryoo SB, Park KJ, Han EC. Real-world survival after colorectal surgery for malignancy in Korean patients with chronic kidney disease: an analysis of Korean healthcare big data, 2002-2019. Ann Surg Treat Res 2023; 105:281-289. [PMID: 38023436 PMCID: PMC10648614 DOI: 10.4174/astr.2023.105.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/03/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Globally, chronic kidney disease (CKD) is common and has been associated with an increased risk of colorectal cancer (CRC). There is a dearth of literature on the real-world morbidity and mortality associated with CKD comorbid with CRC. This study was performed to evaluate real-world survival outcomes of colorectal malignancy in Korean CKD patients. Methods The National Health Insurance Service of Korea provided data on patients who underwent surgical resection among patients diagnosed with CRC from 2002 to 2019. Results A total of 219,550 patients were included: 6,181 patients with underlying CKD and 213,369 patients without it. Each morbidity was significantly higher in the CKD-CRC group, and the postoperative mortality rates for the 30-day (3.11% vs. 1.78%, P < 0.001), 60-day (5.95% vs. 3.83%, P < 0.001), and 90-day mortality rate (8.12% vs. 5.32%, P < 0.001) were significantly higher in the CKD group. The median survival time (MST, year) was significantly lower in the CKD-CRC group (5.63; interquartile range [IQR], 5.26-5.91) than in the non-CKD-CRC group (8.71; IQR, 8.37-8.93). MST was significantly lower among CKD patients who received chemotherapy after adjustment by multivariate analysis (adjusted hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.37-1.49; P < 0.001]). Subgroup analysis showed that in the CKD-CRC group, MST was lower in patients who received dialysis than in those who did not, even after multivariate analysis (adjusted HR, 2.38; 95% CI, 2.20-2.58; P < 0.001). Conclusion Prevention of CKD-to-end-stage renal disease progression should be adopted as a strategy to increase postoperative survival, along with active surveillance and cancer treatment.
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Affiliation(s)
- Inho Song
- Division of Colorectal Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | | | - Bora Lee
- RexSoft Corporation, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Byung Kwan Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-ki Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eon Chul Han
- Division of Colorectal Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
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Frezin J, Navez J, Johnson P, Bouchard P, Drolet S. Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center. Acta Chir Belg 2022; 122:92-98. [PMID: 33496207 DOI: 10.1080/00015458.2020.1871290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) and renal replacement therapy (RRT) are important risk factors for post-operative morbidity and mortality but remains poorly reported in colorectal surgery. This study aims to evaluate postoperative outcomes of ESRD patients under RRT undergoing colorectal resection. METHODS All ESRD patients under RRT who underwent colorectal resection between 2006 and 2019 were retrospectively reviewed. Perioperative outcomes were analysed, such as risk factors of postoperative complications. RESULTS Forty-two patients were analysed, including 27 emergency and 15 elective surgeries. The most frequent indication was acute colonic ischemia for emergency and malignancy for elective procedures. Laparoscopic approach was used in 12 patients (29%), without difference between elective and emergency groups. Postoperative severe complications rate (including deaths) was 50% (21/42), including 56% (15/27) and 40% (6/15) in emergency and elective groups, respectively (p = .334). Anastomotic leak was observed in 3 of the 23 patients (13%) undergoing digestive anastomosis, (1 in emergency and 2 in elective groups, p = .246). The postoperative mortality rate was 29%, not significantly different between groups. The median hospital stay was 14.5 days (8-42). At univariate analysis, history of cardiac event (p = .028) and open approach (p = .040) were associated with severe complications, and ASA score >3 (p = .043), history of cardiac event (p = .001) and diabetes (p = .030) associated with mortality. CONCLUSIONS Colorectal surgery in ESRD patient exposes to high risk of morbidity and mortality, even in the elective setting, especially in patients with comorbidities like cardiac event and diabetes. Careful patient selection and closed management is required in such fragile patients.
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Affiliation(s)
- Julie Frezin
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
- Department of General Surgery, Clinique Notre Dame de Grâce de Gosselies, Charleroi, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paryse Johnson
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Philippe Bouchard
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
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Effect of preoperative asymptomatic renal dysfunction on the clinical course after colectomy for colon cancer. Surg Today 2021; 52:106-113. [PMID: 34455492 DOI: 10.1007/s00595-021-02363-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the effect of mild renal dysfunction on the clinical course after colectomy in patients with colon cancer. METHODS The subjects of this retrospective study were 263 patients who underwent surgical resection for colon cancer at our hospital between 2011 and 2015. Renal function was assessed based on preoperative estimated glomerular filtration rate (eGFR) values. Patients were divided into groups based on their eGFR value of 55 ml/min/1.73 m2. The Mann-Whitney U test, chi-square or Fisher exact test, and log-rank test were used in the data analysis. RESULTS There were 59 patients (22.4%) in the low eGFR group and 204 patients in the normal eGFR group. There were differences between the groups in age, comorbidities, and the levels of hemoglobin, albumin, and serum creatinine. The overall postoperative complication rate, frequency of severe complications, and length of stay were significantly higher in the low eGFR group than in the normal eGFR group. Multivariate analysis revealed that low eGFR was the only independent risk factor for severe complications (Clavien-Dindo classification III/IV). There were no differences in survival between the groups. CONCLUSION Preoperative asymptomatic renal dysfunction may be correlated with the development of postoperative complications and a possible significant risk factor for severe complications after colon cancer surgery.
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Comparisons of postoperative outcomes after breast cancer surgery in patients with and without renal replacement therapy: a matched-pair cohort study using a Japanese nationwide inpatient database. Breast Cancer 2021; 28:1112-1119. [PMID: 33837897 DOI: 10.1007/s12282-021-01248-7] [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: 01/05/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although patients receiving renal replacement therapy (RRT) have more comorbidities and higher mortality and morbidity risks than the general population, surgery during breast cancer treatment is crucial because of limitations in anticancer agents for patients with renal insufficiency. We aimed to compare the short-term postoperative outcomes between patients with and without RRT. METHODS Patients who underwent surgery for stages 0-III breast cancer between July 2010 and March 2017 were retrospectively identified in a Japanese nationwide inpatient database and divided into those with RRT (RRT group, n = 1547) and those without RRT (control group, n = 364,047). We generated a 1:4 matched-pair cohort matched for age, institution, and fiscal year at admission. We conducted multivariable regression analyses to compare postoperative complications, 30-day readmission, and anesthesia duration between the two groups. RESULTS The RRT group was more likely to have comorbidities (95.0% vs. 24.1%) and undergo total mastectomy (64.2% vs. 47.0%) than the control group. The RRT group was not significantly associated with complications (odds ratio 1.18; 95% confidence interval [CI] 0.89-1.56) and 30-day readmission (odds ratio 0.88; 95% CI 0.65-1.18), but was associated with shorter anesthesia duration (difference, - 6.8 min; 95% CI - 10.7 to - 3.0 min) compared with the control group. CONCLUSIONS The matched-pair cohort analyses revealed no significant differences in postoperative complications after breast cancer surgery between patients with and without RRT. Breast cancer surgery in patients with RRT may be as safe as that in patients without RRT, if comorbidities other than chronic renal failure are adequately addressed.
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Miyake K, Iwagami M, Ohtake T, Moriya H, Kume N, Murata T, Nishida T, Mochida Y, Isogai N, Ishioka K, Shimoyama R, Hidaka S, Kashiwagi H, Kawachi J, Ogino H, Kobayashi S. Association of pre-operative chronic kidney disease and acute kidney injury with in-hospital outcomes of emergency colorectal surgery: a cohort study. World J Emerg Surg 2020; 15:22. [PMID: 32216810 PMCID: PMC7098074 DOI: 10.1186/s13017-020-00303-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-operative kidney function is known to be associated with surgical outcomes. However, in emergency surgery, the pre-operative kidney function may reflect chronic kidney disease (CKD) or acute kidney injury (AKI). We examined the association of pre-operative CKD and/or AKI with in-hospital outcomes of emergency colorectal surgery. METHODS We conducted a retrospective cohort study including adult patients undergoing emergency colorectal surgery in 38 Japanese hospitals between 2010 and 2017. We classified patients into five groups according to the pre-operative status of CKD (defined as baseline estimated glomerular filtration rate < 60 mL/min/1.73 m2 or recorded diagnosis of CKD), AKI (defined as admission serum creatinine value/baseline serum creatinine value ≥ 1.5), and end-stage renal disease (ESRD): (i) CKD(-)AKI(-), (ii) CKD(-)AKI(+), (iii) CKD(+)AKI(-), (iv) CKD(+)AKI(+), and (v) ESRD groups. The primary outcome was in-hospital mortality, while secondary outcomes included use of vasoactive drugs, mechanical ventilation, blood transfusion, post-operative renal replacement therapy, and length of hospital stay. We compared these outcomes among the five groups, followed by a multivariable logistic regression analysis for in-hospital mortality. RESULTS We identified 3002 patients with emergency colorectal surgery (mean age 70.3 ± 15.4 years, male 54.5%). The in-hospital mortality was 8.6% (169/1963), 23.8% (129/541), 15.3% (52/340), 28.8% (17/59), and 32.3% (32/99) for CKD(-)AKI(-), CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD, respectively. Other outcomes such as blood transfusion and post-operative renal replacement therapy showed similar trends. Compared to the CKD(-)AKI(-) group, the adjusted odds ratio (95% confidence interval) for in-hospital mortality was 2.54 (1.90-3.40), 1.29 (0.90-1.85), 2.86 (1.54-5.32), and 2.76 (1.55-4.93) for CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD groups, respectively. Stratified by baseline eGFR (> 90, 60-89, 30-59, and < 30 mL/min/1.73 m2) and AKI status, the crude in-hospital mortality and adjusted odds ratio increased in patients with baseline eGFR < 30 mL/min/1.73 m2 among patients without AKI, while these were constantly high regardless of baseline eGFR among patients with AKI. Additional analysis restricting to 2162 patients receiving the surgery on the day of hospital admission showed similar results. CONCLUSIONS The differentiation of pre-operative CKD and AKI, especially the identification of AKI, is useful for risk stratification in patients undergoing emergency colorectal surgery.
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Affiliation(s)
- Katsunori Miyake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan.
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Nao Kume
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomoki Nishida
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Increased 30-Day Mortality Risk in Patients With Diabetes Mellitus After Colon Cancer Surgery: A Mediation Analysis. Dis Colon Rectum 2020; 63:290-299. [PMID: 31977584 PMCID: PMC8573828 DOI: 10.1097/dcr.0000000000001586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with (versus without) diabetes mellitus who develop colon cancer are at increased risk of dying within 30 days after surgery. OBJECTIVE The purpose of this study was to identify potential mediators of the effect of diabetes mellitus on all-cause 30-day mortality risk after surgery for colon cancer. DESIGN A retrospective cohort study was conducted using the 2013-2015 National Surgical Quality Improvement Program data. SETTING The study was conducted at various hospitals across the United States (from 435 to 603 hospitals). PATIENTS Patients who underwent resection for colon cancer with or without obstruction based on the National Surgical Quality Improvement Program colectomy module were included. Patients who had ASA physical status classification V or metastatic disease and those who presented emergently were excluded. Patients were classified as "no diabetes," "diabetes not requiring insulin," or "diabetes requiring insulin." Potential reasons for increased risk of dying within 30 days were treatment related, comorbidity, health behaviors, surgical complications, and biomarkers of underlying disease. MAIN OUTCOME MEASURES We measured all-cause 30-day mortality. RESULTS Of 26,060 patients, 18.8% (n = 4905) had diabetes mellitus that was treated with insulin (n = 1595) or other antidiabetic agents (n = 3340). Patients with diabetes mellitus had a 1.57 (95% CI, 1.23-1.99) higher unadjusted odds of dying within 30 days versus patients without diabetes mellitus. In the multivariable model, 76.7% of the association between diabetes mellitus and 30-day mortality was explained; patients with diabetes mellitus were equally likely to die within 30 days versus those without diabetes mellitus (OR = 1.05 (95% CI, 0.81-1.35)). Anemia and sepsis explained 33.7% and 15.2% of the effect of diabetes mellitus on 30-day mortality (each p < 0.0001). Treatment-related variables, cardiovascular disease, surgical complications, and biomarkers played limited roles as mediators. LIMITATIONS The study was limited to larger hospitals, and limited information about duration and type of diabetes mellitus was available. CONCLUSIONS Better management and prevention of anemia and sepsis among patients with diabetes mellitus may reduce their increased risk of death after colon cancer resection. See Video Abstract at http://links.lww.com/DCR/B140. AUMENTO DEL RIESGO DE MORTALIDAD A 30 DÍAS EN PACIENTES DIABETICOS LUEGO DE CIRUGÍA DE CÁNCER DE COLON: ANÁLISIS DE MEDIACIÓN: Los pacientes con (y sin) diabetes que desarrollan cáncer de colon tienen un mayor riesgo de morir dentro de los 30 días posteriores a la cirugía.Identificar los posibles mediadores del efecto de la diabetes sobre el riesgo de mortalidad dentro los 30 días, por cualquier causa después de cirugía por cáncer de colon.Estudio de cohortes retrospectivo entre 2013-2015 utilizando los datos del Programa Nacional de Mejoría en Calidad Quirúrgica.Entre 435 a 603 hospitales en los Estados Unidos.Se incluyeron aquellos pacientes sometidos a resección por cáncer de colon con o sin obstrucción según el módulo de colectomía Programa Nacional de Mejoría en Calidad Quirúrgica. Se excluyeron los pacientes estadío V de la clasificación de la Sociedad Estadounidense de Anestesiólogos (ASA), aquellos con enfermedad metastásica y aquellos operados de urgencia. Los pacientes se clasificaron como "sin diabetes,' "con diabetes que no requiere insulina" o "con diabetes que requiere insulina.' Las posibles razones para un mayor riesgo de morir dentro de los 30 días estuvieron relacionadas con el tratamiento, la comorbilidad, los comportamientos de salud, las complicaciones quirúrgicas y los biomarcadores de enfermedad.Mortalidad de cualquier orígen dentro los 30 días depués de la cirugía.De 26'060 pacientes, 18.8% (n = 4,905) tenían diabetes tratada con insulina (n = 1,595) u otros agentes antidiabéticos (n = 3,340). Los pacientes con diabetes tenían 1.57 (IC 95%: 1.23-1.99) mayores probabilidades no ajustadas de morir dentro de los 30 días en comparación con los pacientes sin diabetes. En el modelo multivariable, se explicó que el 76,7% de la asociación entre diabetes y mortalidad a los 30 días; los pacientes con diabetes tenían la misma probabilidad de morir dentro de los 30 días que aquellos sin diabetes (OR: 1.05; IC 95%: 0.81-1.35). La anemia y la sepsis explicaron el 33,7% y el 15,2% del efecto de la diabetes en la mortandad a 30 días (p <0,0001). Las variables relacionadas con el tratamiento, las enfermedades cardiovasculares, las complicaciones quirúrgicas y los biomarcadores jugaron un papel limitado como mediadores.Estudio limitado a hospitales más grandes e información limitada sobre la duración y el tipo de diabetes.Una mejor prevención y manejo de la anemia y la sepsis en los pacientes con diabetes puede reducir el mayor riesgo de muerte después de la resección del cáncer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B140.
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Velazquez N, Press B, Renson A, Wysock JS, Taneja S, Huang WC, Bjurlin MA. Development of a Novel Prognostic Risk Score for Predicting Complications of Penectomy in the Surgical Management of Penile Cancer. Clin Genitourin Cancer 2018; 17:e123-e129. [PMID: 30377070 DOI: 10.1016/j.clgc.2018.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Penectomy for PC is useful in staging, disease prognosis, and treatment. Limited studies have evaluated its surgical complications. We sought to assess these complications and determine predictive models to create a novel risk score for penectomy complications. PATIENTS AND METHODS A retrospective review of patients undergoing PC surgical management from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program was performed. Data were queried for partial and total penectomy among those with PC. To develop predictive models of complications, we fit LASSO logistic, random forest, and stepwise logistic models to training data using cross-validation, demographic, comorbidity, laboratory, and wound characteristics as candidate predictors. Each model was evaluated on the test data using receiver operating characteristic curves. A novel risk score was created by rounding coefficients from the LASSO logistic model. RESULTS A total of 304 cases met the inclusion criteria. Overall incidence of penectomy complications was 19.7%, where urinary tract infection (3.0%), superficial surgical site infection (3.0%), and bleeding requiring transfusion (3.9%) were most common. LASSO logistic, random forest, and stepwise logistic models for predicting complications had area under the curve (AUC) [95% confidence interval] values of 0.66 [0.52-0.81], 0.73 [0.63-0.83], and 0.59 [0.45-0.74], respectively. Eleven variables were included in the risk score. The LASSO model-derived risk score had moderately good performance (area under the curve [95% confidence interval] 0.74 [0.66-0.82]). Using a cutoff point of 6, the score attains sensitivity 0.58, specificity 0.74, and kappa 0.26. CONCLUSION PC management through penectomy is associated with appreciable complications rates. Predictive models of penectomy complications performed moderately well. Our novel prognostic risk score may allow for improved preoperative counseling and risk stratification of men undergoing surgical management of PC.
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Affiliation(s)
| | - Benjamin Press
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Audrey Renson
- Department of Clinical Research, NYU Langone Hospital-Brooklyn, Brooklyn, NY; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY
| | | | - Samir Taneja
- Department of Urology, NYU Langone Health, New York, NY
| | | | - Marc A Bjurlin
- Department of Urology, NYU Langone Hospital-Brooklyn, Brooklyn, NY.
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Gastric Cancer Patients Receiving Maintenance Hemodialysis After Surgery With and Without Postoperative Chemotherapy: A Case Series of 6. Int Surg 2018. [DOI: 10.9738/intsurg-d-16-00127.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background:
The management of gastric cancer patients who received gastrectomy and/or postoperative chemotherapy is of high importance. However, the safety and efficacy of chemotherapy in hemodialysis patients have not been established. In this study, we report 6 cases of hemodialysis patients who underwent gastrectomy for gastric cancer.
Case Presentation:
The presented cases included 5 men and 1 woman, with a mean age of 66.3 years (range, 59–74 years). All patients underwent standard laparotomy, with 3 of 6 patients (50%) experiencing postoperative complications. Three patients who did not experience any postoperative complications could receive subsequent chemotherapy. S-1 chemotherapy regimen and uracil and tegafur chemotherapy regimen were administered to 1 and 2 patients, respectively. These 3 patients did not experience any chemotherapy-related side effects. Among the 4 patients who received a diagnosis of pathologic stages II to III, 2 patients treated with postoperative chemotherapy achieved better prognoses than those who did not receive chemotherapy (mean, 25.5 versus 5.0 months).
Discussion and Conclusion:
Hemodialysis patients with gastric cancer who received gastrectomy exhibited a high morbidity rate. Postoperative chemotherapy can be performed immediately after surgery in patients who do not experience postoperative complications. S-1 regimen and uracil and tegafur regimen could be administered safely in hemodialysis patients. Postoperative chemotherapy may lead to a good prognosis in gastric cancer patients receiving hemodialysis.
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