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      Call for Papers: Artificial Intelligence in Gastroenterology

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      About Digestion: 3.2 Impact Factor I 6.4 CiteScore I 0.914 Scimago Journal & Country Rank (SJR)

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      Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

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          Abstract

          Background: Older patients are increasingly faced with pancreatic surgery because of shifting demographics. The differential effects of aging on surgical outcomes remain vague, while the elderly patient is often neglected in clinical trials. Methods: Medical records of 370 patients who underwent pancreaticoduodenectomy were analyzed. Patients were then subdivided into 3 groups according to age and comorbidities. Results: Overall mortality was 5% and did not significantly differ between age-matched groups. Increasing age was linked to a higher prevalence of diabetes mellitus (p < 0.001) and preoperative cardiovascular comorbidities (p < 0.001). Independent risk factors for major complications were age over 70 years (p = 0.018; OR 2.3), elevated body mass index (p = 0.004; OR 0.2) and cardiovascular comorbidities (p = 0.022; OR = 2.6). Patients who were older (>70 years), obese and had cardiovascular disease had an increased risk of major complications when compared with the younger study population (p = 0.010). Conclusions: Pancreatic surgery in elderly patients showed similar mortality rates as in younger patients. Nevertheless, a careful risk assessment is particularly important because older patients who are considered to be high risk suffer more frequently from major surgical complications compared with young patients that have similar risk profiles.

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          Obesity in general elective surgery.

          Daniel Dindo, Markus Muller, Markus Weber … (2003)
          Obese patients are generally believed to be at a higher risk for surgery than those who are not obese, although convincing data are lacking. We prospectively investigated a cohort of 6336 patients undergoing general elective surgery at our institution to assess whether obesity affects the outcome of surgery. Exclusion criteria were emergency, vascular, thoracic, and bariatric operations; transplantation procedures; patients under immunosuppression; and operations done under local anaesthesia. Postoperative morbidity was analysed for non-obese and obese patients (body-mass index or=30 kg/m(2)). Obesity was further stratified into mild obesity (30.0-34.9 kg/m(2)) and severe obesity (>or=35 kg/m(2)). Risk factors were analysed with univariate and multivariate models. The cohort consisted of 6336 patients, of whom 808 (13%) were obese, 569 (9%) were mildly obese, and 239 (4%) had severe obesity. The morbidity rates in patients who were obese compared with those who were not were much the same (122 [15.1%] of 808 vs 901 [16.3%] of 5528; p=0.26), with the exception of an increased incidence of wound infections after open surgery in patients who were obese (17 [4%] of 431 vs 92 [3%] of 3555, p=0.03). Incidence of complications did not differ between patients who were mildly obese (91 [16.0%] of 569), severely obese (36 [15.1%] of 239), and non-obese (901 [16.3%] of 5528; p=0.19). In multivariate regression analyses, obesity was not a risk factor for development of postoperative complications. Of note, the additional medical resource use as estimated by a new classification of complications showed no differences between patients who were and were not obese. Obesity alone is not a risk factor for postoperative complications. The regressive attitude towards general surgery in obese patients is no longer justified.
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            Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery.

            John Mullen, Daniel L. Davenport, Matthew M Hutter … (2008)
            Obesity is an increasingly common serious chronic health condition. We sought to determine the impact of body mass index (BMI) on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. A prospective, multi-institutional, risk-adjusted cohort study of patients undergoing major intra-abdominal cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program (NSQIP). Demographic, clinical, and intraoperative variables and 30-day morbidity and mortality were prospectively collected in standardized fashion. Analysis of variance, Bonferroni multiple comparisons of means tests, and multivariable logistic regression analysis were performed. We identified 2258 patients who underwent esophagectomy (n = 29), gastrectomy (n = 223), hepatectomy (n = 554), pancreatectomy (n = 699), or low anterior resection/proctectomy (n = 753). Patients were stratified by National Institutes of Health (NIH)-defined BMI obesity class, with 573 (25.4%) patients classified as obese (BMI > 30 kg/m(2)). There were no differences in mean work relative value units, total time of operation, or length of stay amongst the BMI classes. After adjusting for other risk factors, obesity was not a risk factor for death or major complications but was a risk factor for wound complications. The risk of postoperative death was greatest in underweight patients (odds ratio [OR] 5.24; 95% confidence interval [CI] 1.7-16.2). In patients undergoing major intra-abdominal cancer surgery, obesity is not a risk factor for postoperative mortality or major complications. Importantly, underweight patients have a fivefold increased risk of postoperative mortality, perhaps a consequence of their underlying nutritional status.
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              Postoperative complications in obese and nonobese patients.

              P Dorje, T Rutter, Olubukola O Nafiu … (2007)
              Postoperative complications are undesirable and potentially common in the increasing obese population of surgical patients. There is a scarcity of recent and reliable studies comparing postoperative morbidity and mortality in obese and nonobese patients. The aim of this study was to evaluate the prevalence, pattern, and severity of postoperative complications in obese and nonobese surgical patients. A retrospective review and analysis of adult postoperative complications recorded on an electronic database was conducted. The database covered a period of 4 years and consisted of 7,271 cases of postoperative complications that occurred within 30 days of noncardiac moderate or major surgery. Appropriate data and variables were compared between obese and nonobese patients using the SPSS program. The rate of postoperative complications was 7.7%. Obese patients had a higher prevalence of myocardial infarction (P = 0.001), peripheral nerve injury (P = 0.039), wound infection (P = 0.001), and urinary tract infection (P = 0.004). ). Morbidly obese patients had a higher mortality rate of 2.2% compared with 1.2%; for all other patients (P = 0.034) and a higher prevalence of tracheal reintubation (P = 0.009) and cardiac arrest (P = 0.015). Obese patients had higher American Society of Anesthesiologists (ASA) physical status scores than other patients (P = 0.001). Obese patients have a significantly higher risk of postoperative myocardial infarction, wound infection, nerve injury, and urinary infection. Obesity is an independent risk factor for perioperative morbidity, and morbid obesity is a risk factor for mortality.
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                Author and article information

                Journal
                Journal ID (publisher-id): DSU
                Journal ID (nlm-ta): Dig Surg
                Journal ID (doi): 10.1159/issn.0253-4886
                Title: Digestive Surgery
                Abbreviated Title: Dig Surg
                Publisher: S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )
                ISSN (Print): 0253-4886
                ISSN (Electronic): 1421-9883
                Publication date (Print): November 2016
                Publication date (Electronic): 20 July 2016
                Volume: 34
                Issue: 1
                Pages: 43-51
                Affiliations
                aDepartment of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, and bDepartment of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
                Article
                Publisher ID: DSU2017034001043 Other ID: Dig Surg 2017;34:43-51
                DOI: 10.1159/000448059
                PubMed ID: 27434057
                SO-VID: 97fb1284-414e-464e-a81f-840bffa9df03
                Copyright © © 2016 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 19 May 2016
                Date accepted : 27 June 2016
                Page count
                Figures: 1, Tables: 5, References: 26, Pages: 9
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Medicine,General social science
                Keywords: Elderly,Major complications,Pancreaticoduodenectomy
                Data availability:
                ScienceOpen disciplines: Medicine, General social science
                Keywords: Elderly, Major complications, Pancreaticoduodenectomy

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