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Perioperative outcomes following radical prostatectomy for patients with disseminated cancer: An analysis of the National Surgical Quality Improvement Program database.

ABSTRACT: INTRODUCTION:We sought to determine whether patients undergoing radical prostatectomy (RP) in the context of disseminated cancer have higher 30-day complications. METHODS:We conducted a retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database. Men undergoing RP (from January 1, 2005 to December 31, 2014) for prostate cancer were identified and stratified by presence (n=97) or absence (n=27 868) of disseminated cancer. The primary outcome was major complications (death, re-operation, cardiac or neurologic events) within 30 days of surgery. Secondary outcomes included pulmonary, infectious, venous thromboembolic, and bleeding complications; prolonged length of stay; and concomitant procedures (bowel-related, cystectomy, urinary diversion, and major ureteric reconstruction). Odds ratios (OR) for each complication were calculated using univariable logistic regression. RESULTS:We did not identify a difference in major complication rates (OR 2.26, 95% confidence interval [CI] 0.71-7.16). Patients with disseminated cancer had increased risk of venous thromboembolic events (OR 3.30, 95% CI 1.04-10.48) and transfusion (OR 2.45, 95% CI 1.18-5.05), but similar odds of pulmonary and infectious complications and length of stay. Bowel procedures were rare, however, a significantly higher proportion of patients with disseminated cancer required bowel procedures (2.1% vs. 0.3%; p=0.03). Patients with disseminated cancer undergoing RP had greater comorbidities and higher predicted probability of morbidity and mortality. This study is limited by its retrospective design, lack of cancer-specific variables, and prostatectomy-specific complications. CONCLUSIONS:RP in the context of disseminated cancer may be associated with increased perioperative complications. Caution should be exercised in embarking on this practice outside of clinical trials.

SUBMITTER: Satkunasivam R

PROVIDER: S-EPMC5167600 | biostudies-literature | 2016 Nov-Dec

REPOSITORIES: biostudies-literature

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Perioperative outcomes following radical prostatectomy for patients with disseminated cancer: An analysis of the National Surgical Quality Improvement Program database.

Satkunasivam Raj R Wallis Christopher J D CJ Byrne James J Hoffman Azik A Cheung Douglas C DC Kulkarni Girish S GS Nathens Avery B AB Nam Robert K RK

Canadian Urological Association journal = Journal de l'Association des urologues du Canada 20161101 11-12

<h4>Introduction</h4>We sought to determine whether patients undergoing radical prostatectomy (RP) in the context of disseminated cancer have higher 30-day complications.<h4>Methods</h4>We conducted a retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database. Men undergoing RP (from January 1, 2005 to December 31, 2014) for prostate cancer were identified and stratified by presence (n=97) or absence (n=27 868) of disseminated cancer. The primary outcome was ...[more]

PMID: 28096918

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Project description:BackgroundHyponatremia and hypernatremia, as conventionally defined (<135 mEq/L and >145 mEq/L, respectively), are associated with increased perioperative morbidity and mortality. However, the effects of subtle deviations in serum sodium concentration within the normal range are not well-characterized.ObjectiveThe purpose of this analysis is to determine the association between borderline hyponatremia (135-137 mEq/L) and hypernatremia (143-145 mEq/L) on perioperative morbidity and mortality.MethodsA retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database. This database is a repository of surgical outcome data collected from over 600 hospitals across the United States. The National Surgical Quality Improvement Program database was queried to extract all patients undergoing elective, noncardiac surgery from 2015 to 2019. The primary predictor variable was preoperative serum sodium concentration, measured less than 5 days before the index surgery. The 2 primary outcomes were the odds of morbidity and mortality occurring within 30 days of surgery. The risk of both outcomes in relation to preoperative serum sodium concentration was modeled using weighted generalized additive models to minimize the effect of selection bias while controlling for covariates.ResultsIn the overall cohort, 1,003,956 of 4,551,726 available patients had a serum sodium concentration drawn within 5 days of their index surgery. The odds of morbidity and mortality across sodium levels of 130-150 mEq/L relative to a sodium level of 140 mEq/L followed a nonnormally distributed U-shaped curve. The mean serum sodium concentration in the study population was 139 mEq/L. All continuous covariates were significantly associated with both morbidity and mortality (P<.001). Preoperative serum sodium concentrations of less than 139 mEq/L and those greater than 144 mEq/L were independently associated with increased morbidity probabilities. Serum sodium concentrations of less than 138 mEq/L and those greater than 142 mEq/L were associated with increased mortality probabilities. Hypernatremia was associated with higher odds of both morbidity and mortality than corresponding degrees of hyponatremia.ConclusionsAmong patients undergoing elective, noncardiac surgery, this retrospective analysis found that preoperative serum sodium levels less than 138 mEq/L and those greater than 142 mEq/L are associated with increased morbidity and mortality, even within currently accepted "normal" ranges. The retrospective nature of this investigation limits the ability to make causal determinations for these findings. Given the U-shaped distribution of risk, past investigations that assume a linear relationship between serum sodium concentration and surgical outcomes may need to be revisited. Likewise, these results question the current definition of perioperative eunatremia, which may require future prospective investigations.

Project description:BACKGROUND:A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. METHODS:We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. RESULTS:Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score?7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). CONCLUSIONS:Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist.

Project description:Retrospective review of a prospective cohort.The aim of the study was to determine the patient characteristics and surgical procedure factors related to increased rates of 30-day unplanned readmission and major perioperative complications after spinal fusion surgery, and the association between unplanned readmission and major complications.Reducing unplanned readmissions can reduce the cost of healthcare. Payers are implementing penalties for 30-day readmissions after discharge. There is limited data regarding the current rates and risk factors for unplanned readmission and major complications related to spinal fusion surgery.Spine fusion patients were identified using the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Participant User File. Rates of readmissions within 30 days after spine fusion surgery were calculated using the person-years method. Cox proportional hazards models were used to assess the independent associations of spine surgical procedure types, diagnoses, patient profiles, and major perioperative complications with unplanned related readmissions. Independent risk factors for major complications were assessed by multivariable logistic regression.Of the 18,602 identified patients, there was a 5.2% overall major perioperative complication rate. There was a rate of 4.4% per 30 person-days for unplanned readmissions related to index surgery. Independent risk factors for both readmissions and major perioperative complications included combined anterior and posterior surgery, diagnosis of solitary tumor, older age, and higher American Society of Anesthesiologists class. Patients with deep/organ surgical site infection carried higher risk of having unplanned readmission, followed by pulmonary embolism, acute renal failure, and stroke/cerebral vascular accident with neurological deficit.This study provides benchmark rates of 30-day readmission based on diagnosis and procedure codes from a high-quality database for adult spinal fusion patients and showed increased rates of 30-day unplanned readmission and major perioperative complications for patients with specific risk factors. Targeted preoperative planning on modifiable risk factors with proportional reimbursement may promote higher-quality healthcare.3.

Project description:Background The occurrence of postoperative complications was associated with poor outcomes for patients undergoing robotic-assisted radical prostatectomy. A prediction model with easily accessible indices could provide valuable information for surgeons. This study aims to identify novel predictive circulating biomarkers significantly associated with surgical complications. Methods We consecutively assessed all multiport robotic-assisted radical prostatectomies performed between 2021 and 2022. The clinicopathological factors and perioperative levels of multiple circulating markers were retrospectively obtained from the included patients. The associations of these indices with Clavien-Dindo grade II or greater complications, and surgical site infection were assessed using univariable and multivariable logistic regression models. Further, the models were validated for the overall performance, discrimination, and calibration. Results In total, 229 patients with prostate cancer were enrolled in this study. Prolonged operative time could independently predict surgical site infection (OR, 3.39; 95% CI, 1.09–10.54). Higher RBC (day 1-pre) implied lower risks of grade II or greater complications (OR, 0.24; 95% CI, 0.07–0.76) and surgical site infection (OR, 0.23; 95% CI, 0.07–0.78). Additionally, RBC (day 1-pre) independently predicted grade II or greater complications of obese patients (P value = 0.005) as well as those in higher NCCN risk groups (P value = 0.012). Regarding the inflammatory markers, NLR (day 1-pre) (OR, 3.56; 95% CI, 1.37–9.21) and CRP (day 1-pre) (OR, 4.16; 95% CI, 1.69–10.23) were significantly associated with the risk of grade II or greater complications, and both the indices were independent predictors in those with higher Gleason score, or in higher NCCN risk groups (P value < 0.05). The NLR (day 0-pre) could also predict the occurrence of surgical site infection (OR, 5.04; 95% CI, 1.07–23.74). Conclusions The study successfully identified novel circulating markers to assess the risk of surgical complications. Postoperative increase of NLR and CRP were independent predictors for grade II or greater complications, especially in those with higher Gleason score, or in higher NCCN risk groups. Additionally, a marked decrease of RBC after the surgery also indicated a higher possibility of surgical complications, especially for the relatively difficult procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-023-03049-y.

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Perioperative outcomes following radical prostatectomy for patients with disseminated cancer: An analysis of the National Surgical Quality Improvement Program database.

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Perioperative outcomes following radical prostatectomy for patients with disseminated cancer: An analysis of the National Surgical Quality Improvement Program database.

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