Is body mass index and obesity surgery mortality score important in perioperative complications of laparoscopic sleeve gastrectomy before discharge? / Os índices de mortalidade, de massa corporal e da cirurgia da obesidade são importantes nas complicações perioperatórias de gastrectomia vertical laparoscópica antes da alta?

ABSTRACT Background: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn't seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.

RESUMO Racional: A cirurgia da obesidade mórbida e complicações relacionadas aumentaram com o tempo. Objetivo: Avaliar a relação entre as complicações perioperatórias antes da alta e o índice de massa corporal pré-operatório e o escore de mortalidade da cirurgia de obesidade na gastrectomia vertical laparoscópica. Método: 1.617 pacientes que atenderam aos critérios de inclusão foram avaliados retrospectivamente. Os pacientes foram examinados quanto aos dados demográficos, presença de comorbidades, ocorrência ou não de complicações, tipo de complicações e escore de mortalidade cirúrgico da obesidade. Resultados: Complicações foram observadas em 40 pacientes (2,5%) e mortalidade não foi observada no período pós-operatório imediato antes da alta. A média de idade dos pacientes com complicações foi de 36,3±10,02 anos (19-57) e sem complicações de 34,12±9,54 (15-64) anos. Os valores médios de IMC pré-operatórios dos pacientes com e sem complicações foram 45,05±3,93 (40-57) kg/m2 e 44,8±3,49 (35-67) kg/m2, respectivamente. De acordo com os grupos de IMC 40-45 kg/m2, 45-50 kg/m2 e 50 e mais, não houve qualquer significância estatística observada em três grupos em termos de positividade de complicações e taxas de complicações maiores-menores. Não houve significância estatística entre os pacientes com e sem complicações maiores e menores e o escore de mortalidade da cirurgia de obesidade. Conclusão: Não houve qualquer relação entre as taxas de complicações da gastrectomia vertical laparoscópica perioperatória antes da alta e os escores de mortalidade da cirurgia de obesidade e IMC.

Safety evaluation of patients with heart valve replacement undergoing general surgery / 中国实用外科杂志

OBJECTIVE: To evaluate the safety in patients with heart valves replacement undergoing general surgery.METHODS: From 2010 to 2016,the clinical data of demographic characteristics,comorbidities,preoperative laboratory tests,and surgical operation related information of 164 cases with heart valves replacement after general surgery in Department of General Surgery,Zhongshan Hospital,Fudan University,were collected retrospectively.Univariate and multivariate analysis were applied to identify the risk factors associated with major bleeding events and non-hemorrhagic complications.RESULTS: Among 164 cases,12 patients(7.3%) presented major bleeding events,and 27 patients(16.5%)presented non-hemorrhagic complications.Seven patients(4.3%) suffered grade Ⅲ perioperative complications and one patient(0.6%) died(grade V).The incidence of major bleeding events was significantly higher in emergent patients than in elective surgery(25.0% vs.4.9%,P=0.007),and there was no significant difference in the incidence of nonhemorrhagic complications(15.0% vs.16.7%,P=1.000).Significant risk factors for major bleeding events included emergency surgery [odds ratio(OR) 6.455,95% confidence interval(CI) 1.672-24.472,P=0.008],operative time≥60 minutes(OR=14.989,95%CI 1.683-2015.140,P=0.009),as well as aortic valve replacement(OR=3.408,95%CI 1.001-12.191,P=0.050).Significant risk factors for non-hemorrhagic complications were gastrointestinal surgery(OR=4.323,95% CI 1.740-11.629,P=0.002) and atrial fibrillation(OR=2.717,95% CI 1.053-7.022,P=0.037).CONCLUSION: Patients with heart valve replacement can undergo elective general surgery safely.The risk of hemorrhagic complications in emergency surgery is acceptable,as long as the standardized perioperative anticoagulation and antithrombotic management is carried out.

A Case of Takotsubo Cardiomyopathy Following Endovascular Abdominal Aortic Repair / 日本心臓血管外科学会雑誌

We describe a case of Takotsubo cardiomyopathy in an 88-year-old woman who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm. The patient developed cardiac arrest shortly after the surgery. Following immediate resuscitation, her electrocardiogram showed extensive ST segment elevation in leads V2-V6, and echocardiography revealed apical akinesis with basal hyperkinesis. Emergency coronary angiography confirmed the absence of coronary lesions, and she was diagnosed with Takotsubo cardiomyopathy. Her cardiac function improved within a few days following the administration of catecholamines. Although EVAR is a less invasive surgical procedure, it may trigger Takotsubo cardiomyopathy. Prompt diagnosis and appropriate management of Takotsubo cardiomyopathy are essential to treat critical conditions in the acute phase.

Impact of different surgical methods of radical cystectomy on the perioperative com-plications in patients over 75 years / 北京大学学报(医学版)

Objective:To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age.Methods:A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015.A total of 239 pa-tients were ≥75 years (median age:78 years),of whom,74 patients (31.0%)suffered one or more perioperative complications.According to the different operation methods,patients could be divided into ileal conduit group and cutaneous ureterostomy group.The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit.The cutaneous ureterostomy group included transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy. Results:Perioperative complications were significantly associated with the patient’s age (P =0.012), American Society of Anesthesiologists (ASA)score (P =0.001),node staging (P =0.043),and dif-ferent surgical methods.Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs.21 d,P =0.002).For different surgical methods,the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P =0.013).However,there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P =0.836).The perioperative complication rate was statistically signifi-cant among transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P =0.022).On multivariate analysis,age (hazard ratio =4.856,95% CI:1.465 -16.103,P =0.010),ASA score (P =0.008),and different surgical methods (P =0.016) were significantly associated with the perioperative complication rate.Conclusion:The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients’age,ASA score,and different surgical methods.Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications,which was an appropriate choice for elderly patients.

Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

Recent Surgical Treatment of Moyamoya Disease

The authors reviewed the recent trend of surgical treatment for pediatric as well as adult onset moyamoya disease(MMD). Combined direct and indirect arterial anastomosis or multiple indirect arterial bypasss has been increasing for pediatric MMD and direct arterial bypass is recommended for adult MMD, especially in patients with hemorrhagic MMD. Besides perioperative complications related to the management of MMD and 1999 annual report by the Research Committee on Spontaneous Occlusion of the Circle of Willis(Moyamoya Disease) of the Ministry of Health and Welfare, Japan will be summarizd.