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Shi Y, Wang Q, Huang L, Li N, Ren X, Bi S. Effects of evidence-based nursing on surgical site wound infections in patients undergoing surgery for liver cancer: A meta-analysis. Int Wound J 2024; 21:e14545. [PMID: 38272814 PMCID: PMC10791573 DOI: 10.1111/iwj.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 01/27/2024] Open
Abstract
This study aimed to systematically evaluate the impact of evidence-based nursing (EBN) on perioperative wound infections and postoperative complications in patients undergoing surgery for liver hepatocellular carcinoma (LIHC). Randomised controlled trials (RCTs) on the application of EBN on patients receiving LIHC surgery were searched in PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure from the inception of each database to September 2023. Studies were screened and evaluated by two investigators based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 4.0 was used for data analysis. Overall, 15 RCTs involving 1374 patients with LIHC were included, with 687 in the EBN group and 687 in the conventional care group. The analysis revealed that the incidence of wound infections (odds ratio [OR] = 0.32, 95% confidence interval [CI]: 0.18-0.56, p < 0.001) and postoperative complications (OR = 0.22, 95% CI: 0.15-0.31, p < 0.001) was significantly lower in the EBN group than in the conventional care group. The available evidence suggests that nursing strategies for EBN applied in the perioperative period in patients with LIHC receiving surgery can effectively reduce the incidence of wound infections and postoperative complications and promote postoperative recovery.
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Affiliation(s)
- Yong‐Hong Shi
- Department of Infectious DiseasePeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Qing‐Ju Wang
- Department of General MedicinePeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Li‐Zhen Huang
- Department of Infectious DiseasePeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Na Li
- Department of Infectious DiseasePeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xin‐Ting Ren
- Department of Infectious DiseasePeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shu‐Min Bi
- Department of Gastrointestinal surgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Fan ZQ, Diao YK, Li C, Yao LQ, Zhang CW, Zeng YY, Chen ZX, Zhou YH, Gu WM, Wang H, Chen TH, Zhang YM, Xu X, Liang YJ, Wang XM, Zhang WG, Li J, Wang MD, Wu H, Xu XF, Pawlik TM, Lau WY, Shen F, Yang T, Lv GY. Severe pleural effusion after hepatectomy for hepatocellular carcinoma: multicentre retrospective study. BJS Open 2023; 7:zrad118. [PMID: 38108467 PMCID: PMC10727470 DOI: 10.1093/bjsopen/zrad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Zhong-Qi Fan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
| | - Yong-Kang Diao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Chao Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Lan-Qing Yao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Cheng-Wu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Yong-Yi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, China
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, China
| | - Wei-Min Gu
- The First Department of General Surgery, The Fourth Hospital of Harbin, Harbin, China
| | - Hong Wang
- Department of General Surgery, Liuyang People’s Hospital, Liuyang, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People’s Hospital, Ziyang, China
| | - Yao-Ming Zhang
- The Second Department of Hepatobiliary Surgery, Meizhou People’s Hospital, Meizhou, China
| | - Xiao Xu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wan-Guang Zhang
- Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Xin-Fei Xu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Timothy M Pawlik
- Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Tian Yang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China
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Oh EJ, Kim J, Kim BG, Han S, Ko JS, Gwak MS, Kim GS, Choi EA, Kang J, Park HY. Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation. Transplantation 2023; 107:1748-1755. [PMID: 36959123 DOI: 10.1097/tp.0000000000004544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND The relationship between intraoperative anesthetic management and postoperative pulmonary complications (PPCs) after liver transplantation is not fully understood. We aimed to determine the intraoperative contributors to PPC. METHODS The retrospectively collected cohort included 605 patients who underwent living donor liver transplantation. PPCs comprised respiratory failure, respiratory infection, pulmonary edema, atelectasis (at least moderate degree), pneumothorax, and pleural effusion (at least moderate degree). The presence and type of PPC were evaluated by 2 pulmonary physicians. Logistic regression analysis was performed to determine the association between perioperative variables and PPC risk. RESULTS Of the 605 patients, 318 patients (52.6%) developed 486 PPCs. Multivariable analysis demonstrated that PPC risk decreased with low tidal volume ventilation (odds ratio [OR] 0.62 [0.41-0.94], P = 0.023) and increased with greater driving pressure at the end of surgery (OR 1.08 [1.01-1.14], P = 0.018), prolonged hypotension (OR 1.85 [1.27-2.70], P = 0.001), and blood albumin level ≤3.0 g/dL at the end of surgery (OR 2.43 [1.51-3.92], P < 0.001). Survival probability at 3, 6, and 12 mo after transplantation was 91.2%, 89.6%, and 86.5%, respectively, in patients with PPCs and 98.3%, 96.5%, and 93.4%, respectively, in patients without PPCs (hazard ratio 2.2 [1.3-3.6], P = 0.004). Graft survival probability at 3, 6, and 12 mo after transplantation was 89.3%, 87.1%, and 84.3%, respectively, in patients with PPCs and 97.6%, 95.8%, and 92.7%, respectively, in patients without PPCs (hazard ratio 2.3 [1.4-3.7], P = 0.001). CONCLUSIONS We found that tidal volume, driving pressure, hypotension, and albumin level during living donor liver transplantation were significantly associated with PPC risk. These data may help determine patients at risk of PPC or develop an intraoperative lung-protective strategy for liver transplant recipients.
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Affiliation(s)
- Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bo-Guen Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ah Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wang B, Liang H, Zhao H, Shen J, An Y, Feng Y. Risk factors and predictive model for pulmonary complications in patients transferred to ICU after hepatectomy. BMC Surg 2023; 23:150. [PMID: 37270566 DOI: 10.1186/s12893-023-02019-1] [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: 06/16/2022] [Accepted: 04/26/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE Postoperative pulmonary complications (PPCs) seriously harm the recovery and prognosis of patients undergoing surgery. However, its related risk factors in critical patients after hepatectomy have been rarely reported. This study aimed at analyzing the factors related to PPCs in critical adult patients after hepatectomy and create a nomogram for prediction of the PPCs. METHODS 503 patients' data were collected form the Peking University People's Hospital. Multivariate logistic regression analysis was used to identify independent risk factors to derive the nomogram. Nomogram's discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curve. RESULTS The independent risk factor for PPCs are advanced age (odds ratio [OR] = 1.026; P = 0.008), higher body mass index (OR = 1.139; P < 0.001), lower preoperative serum albumin level (OR = 0.961; P = 0.037), and intensive care unit first day infusion volume (OR = 1.152; P = 0.040). And based on this, we created a nomogram to predict the occurrence of PPCs. Upon assessing the nomogram's predictive ability, the AUC for the model was 0.713( 95% CI: 0.668-0.758, P<0.001). The Hosmer-Lemeshow test (P = 0.590) and calibration curve showed good calibration for the prediction of PPCs. CONCLUSIONS The prevalence and mortality of postoperative pulmonary complications in critical adult patients after hepatectomy are high. Advanced age, higher body mass index, lower preoperative serum albumin and intensive care unit first day infusion volume were found to be significantly associated with PPCs. And we created a nomogram model which can be used to predict the occurrence of PPCs.
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Affiliation(s)
- Bin Wang
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HanSheng Liang
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HuiYing Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - JiaWei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - YouZhong An
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
| | - Yi Feng
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
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Eyraud D, Creux M, Lastennet D, Lemoine L, Vaillant JC, Savier E, Vézinet C, Scatton O, Granger B, Puybasset L, Loncar Y. Restrictive intraoperative fluid intake in liver surgery and postoperative renal function: A propensity score matched study. Clin Res Hepatol Gastroenterol 2022; 46:101899. [PMID: 35257960 DOI: 10.1016/j.clinre.2022.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a common complication in hepatic surgery. In hepatic surgery, relative hypovolemia may help to limit blood loss, but the consequences of restrictive fluid intake are unknown. The goal of this study was to determine the influence of intraoperative fluid intake on the incidence of AKI and its consequences. METHODS Data from 397 consecutive patients who underwent liver resection were prospectively recorded and retrospectively analyszed. We compared the incidence of postoperative acute kidney failure in patients given restrictive (≤ 5 mL/kg/h) versus liberal (> 5 mL/kg/h) fluid therapy. We calculated a 1:1 match propensity score using logistic regression to estimate the likelihood of patients receiving restrictive or liberal intraoperative fluid intakes. The association between the intraoperative fluid intake strategy and occurrence of postoperative AKI were tested using a Cox frailty model on the database of matched patients. RESULTS Postoperative AKI was diagnosed in 133 of the 397 patients. Fluid intake strategy was restrictive for 121 patients and liberal for 276 patients. After propensity score matching to balance confounding factors, the liberal strategy was associated with a significantly lower risk for postoperative AKI compared to the restrictive strategy (Hazard Ratio 0.40 [0.29; 0.56], P<0.001). Patients with postoperative AKI had longer hospital stays and higher mortality. There were no cases of further blood loss in the liberal fluid intake group. CONCLUSIONS A restrictive fluid intake strategy is a risk factor for developing postoperative AKI, with serious consequences, without reducing blood loss in liver surgery.
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Affiliation(s)
- Daniel Eyraud
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France.
| | - Marine Creux
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Diane Lastennet
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Lemoine
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Jean Christophe Vaillant
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Eric Savier
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Corinne Vézinet
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Olivier Scatton
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Benjamin Granger
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Puybasset
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Yann Loncar
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
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Pulmonary infection after hepatic resection: Associated factors and impact on outcomes. Clin Res Hepatol Gastroenterol 2022; 46:101733. [PMID: 34146724 DOI: 10.1016/j.clinre.2021.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Postoperative pulmonary complications are frequent after hepatectomy. The aim of this retrospective study was to use preoperative and intraoperative data to establish specific factors associated with post-hepatectomy pneumonia (PHPN). METHODS Patients underwent minor or major hepatectomy for cancer or non-cancer treatment. Surgical procedure was performed by laparoscopy or laparotomy. PHPN was defined as a new radiologic finding associated with fever, leucocytosis and purulent bronchial secretions. The incidence, associated factors and prognosis of PHPN were investigated. RESULTS In 399 patients undergoing planned hepatectomy, 49 (12.3%) developed pneumonia. Of 81 patients (20.3%) with cirrhosis, 77 were Child-Pugh A and 4 were Child-Pugh B. Hepatectomy indication was cancer in 331 patients (of which metastasis in 213). Laparoscopy rate was 31.3%. In multivariate analysis, the main factors statistically associated with PHPN were: chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 4.17; 95% confidence interval [CI], 1.60-10.84; P = 0.003), intraoperative blood transfusion (OR = 2.46; 95% CI 1.01-5.70; P = 0.001), laparotomy (OR = 3.01; 95% CI 1.09-8.27; P = 0.03), and nasogastric tube maintained at day 1 (OR = 2.09; 95% CI 1.03-4.22; P = 0.04). Length of stay was significantly different between groups without PHPN (10.2 days) versus with PHPN (26.4 days; P < 0.001). Intra-hospital and one-year mortality were greater in the PHPN group than the pneumonia-free group (8.16 vs 0% and 18.4 vs 3.4%, respectively; P < 0.001). CONCLUSIONS COPD, transfusion and laparotomy (versus laparoscopy) are factors associated with PHPN and impaired survival.
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Soufi M, Flick KF, Ceppa DP, Blackwell MM, Mararu R, Nguyen TK, Schmidt CM, Nakeeb A, Zyromski N, House MG, Moszczynski Z, Ceppa EP. Investigating the incidence, impact, and severity of pulmonary complications after hepatectomy: A single institution experience. Surgery 2022; 171:643-649. [PMID: 35074169 DOI: 10.1016/j.surg.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative pulmonary complications are a common cause of postoperative morbidity in patients undergoing hepatectomy. This study aimed to identify risk factors, define severity, and evaluate the impact of postoperative pulmonary complications on postoperative morbidity after hepatectomy. METHOD We used a prospective database in identifying all hepatectomies from 2013 to 2018. The database was then augmented using extensive review of medical records. The Strasburg system was used in categorizing resections per complexity: major hepatic resection and minor hepatic resection, whereas the Clavien-Dindo system was used in defining postoperative pulmonary complications per severity. Potential confounders were controlled for on multiple regression models. RESULTS A total of 702 cases were identified: major hepatic resection 413 (60%) and minor hepatic resection 289 (40%). Patients demonstrated comparable characteristics, but the postoperative pulmonary complications group was more likely to have chronic obstructive pulmonary disease (10% vs 5%; P = .02). Severe postoperative pulmonary complications among major hepatectomy was observed in 38 patients (13%). Predictors for severe postoperative pulmonary complications requiring intervention included postoperative liver failure (odds ratio = 2.8; P = .002) and biliary fistula (odds ratio = 3.5; P = .001). In addition, the occurrence of severe postoperative pulmonary complications markedly hindered recovery, increasing length of stay by 4.4-fold and readmission rates by 3-fold (P < .001). On multivariable analysis, postoperative pulmonary complications significantly increase postoperative length of stay (8 vs 5 days; P < .001) and readmission (odds ratio = 3.2; P = .001). Mortality was similar (1% vs 4%; P = .066). CONCLUSION Postoperative pulmonary complications are a major cause of delayed recovery and worse outcomes after hepatectomy. Further, postoperative liver failure and biliary fistula can predict the occurrence of severe postoperative pulmonary complications among major hepatic resection and the associated need for readmission with these complications.
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Affiliation(s)
- Mazhar Soufi
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Katelyn F Flick
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Duykhanh P Ceppa
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Madeline M Blackwell
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Rodica Mararu
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Trang K Nguyen
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - C Max Schmidt
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Attila Nakeeb
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas Zyromski
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael G House
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - Eugene P Ceppa
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Zhang Z, Yao W, Yuan D, Huang F, Liu Y, Luo G, Hei Z. Effects of Connexin 32-Mediated Lung Inflammation Resolution During Liver Ischemia Reperfusion. Dig Dis Sci 2020; 65:2914-2924. [PMID: 31900713 DOI: 10.1007/s10620-019-06020-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic ischemia reperfusion (HIR) leads to a lung inflammatory response and subsequent pulmonary barrier dysfunction. The gap junction communication protein connexin 32 (Cx32), which is widely expressed in the lungs, participates in intercellular signaling. This study determined whether the communication protein Cx32 could affect pulmonary inflammation caused by HIR. METHODS Mice were randomly allocated into four groups (n = 8/group): (i) Cx32+/+ sham group; (ii) Cx32+/+ HIR model group; (iii) Cx32-/- sham group; and (iv) Cx32-/- HIR model group. Twenty-four hours after surgery, lung tissues were collected for bright field microscopy, western blot (Cx32, JAK2, p-JAK2, STAT3, p-STAT3), and immunofluorescence (ZO-1, 8-OHDG) analyses. The collected bronchoalveolar fluid was tested for levels of interleukin-6 (IL-6), matrix metalloproteinase 12 (MMP-12), and antitrypsin (α1-AT). Lung mmu-miR-26a/b expression was detected using a PCR assay. RESULTS Increased expression of Cx32 mRNA and protein was noted in the lungs after HIR. Cx32 deletion significantly aggravated pulmonary function from acute lung injury induced by HIR. In addition, Cx32 deletion decreased the protein level of ZO-1 (pulmonary function) and increased the level of the oxidative stress marker 8-OHDG in the lungs. Moreover, in the Cx32-/- HIR model group, the levels of IL-6 and MMP-12 in bronchoalveolar lavage fluid were significantly increased leading to activation of the JAK2/STAT3 pathway, and decreased α1-AT levels. Furthermore, we found mmu-miR-26a/b was significantly downregulated in the Cx32-/- HIR model group. CONCLUSION HIR leads to acute lung inflammatory injury. Cx32 deletion aggravates hepatic-derived lung inflammation, partly through blocking the transferring of mmu-miR-26a/b and leading to IL-6-related JAK2/STAT3 pathway activation.
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Affiliation(s)
- Zheng Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Dongdong Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Fei Huang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yue Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Gangjian Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Surgical resection for liver cancer during the COVID-19 outbreak. Updates Surg 2020; 72:305-307. [PMID: 32436017 PMCID: PMC7239351 DOI: 10.1007/s13304-020-00799-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
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