ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.
ObjectiveTo investigate the predictive value of preoperative red blood cell distribution width to platelet count ratio (RPR) and platelet-albumin-bilirubin (PALBI) scoring for postoperative complications after radical resection of hepatic alveolar echinococcosis (HAE). MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients diagnosed with HAE and underwent radical hepatectomy in the Affiliated Hospital of Qinghai University from January 2018 to October 2022 were retrospectively collected. The risk factors affecting postoperative complications after radical hepatectomy for HAE were analyzed by univariate and multivariate unconditional logistic regression analysis, which were used to construct the nomogram. The receiver operating characteristic curve was used to evaluate the value in predicting postoperative complications by nomogram model. The discrimination of the nomogram was evaluated using Bootstrap internal 1 000 resampling and evaluated using a consistency index. The predicted postoperative complications probability by nomogram and actual postoperative complications probability were calculated by Kaplan-Meier method, and the calibration curve was drawn. The calibration ability of the nomogram model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The decision curve analysis was used to evaluate clinical benefit of the nomogram model. ResultsA total of 160 patients with HAE radical hepatectomy were included, of which 105 had no postoperative complications and 55 had postoperative complications. The multivariate unconditional logistic regression analysis showed that the operation time ≥207 min, intraoperative bleeding ≥650 mL, and albumin ＜38 g/L, RPR ≥0.054, and higher PALBI grading (3 levels) were the risk factors affecting postoperative complications after HAE radical hepatectomy (OR＞1, P<0.05). Based on the risk factors, the nomogram was constructed. The area under the receiver operating characteristic curve (95%CI) predicted by the nomogram for the postoperative complications was 0.873 (0.808, 0.937), with an optimal cutoff value of 0.499. The consistency index was 0.855 for discriminating postoperative complications after HAE radical hepatectomy. The calibration curve was tested by Hosmer-Limeshow and showed a good fit between the predicted curve by the nomogram and actual curve (χ2=3.193, P=0.367), indicating that the nomogram had a good calibration ability. The decision curve analysis showed that there was a good clinical applicability within the range of 11% to 93% of the threshold probability. ConclusionsThe preoperative RPR and PALBI scoring are risk factors affecting postoperative complications after radical hepatectomy for HAE. The nomogram constructed with risk factors including RPR and PALBI has a good predictive value for postoperative complications after radical hepatectomy for HAE.
ObjectiveTo investigate the predictive value of prognostic nutritional index (PNI) in complications after thoracoscopy-assisted radical resection of esophageal cancer.MethodsWe collected the clinical data of patients who underwent thoracoscopy-assisted esophagectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2020. The predictive value of PNI for postoperative complications was evaluated by establishing receiver operating characteristic (ROC) curve and the optimal cut-off point was determined. The patients were divided into a high PNI group and a low PNI group according to the cut-off point. The differences of baseline data and perioperative complications-related indicators between the two groups were compared and analyzed. Univariate and multivariate analyses were used to investigate the influence of PNI and other related indexes on postoperative complications.ResultsA total of 116 patients were enrolled in this study, including 75 males and 41 females, aged 65 (58-69) years. The area under ROC curve was 0.647, and the optimal cut-off point was 51.9. According to the cut-off point, there were 45 patients in the high PNI group and 71 patients in the low PNI group. The overall complication rate (χ2=10.437, P=0.001) and the incidence of postoperative pulmonary infection (χ2=10.811, P=0.001) were statistically different between the two groups. The results of univariate analysis showed that the duration of ventilator use (Z=–3.136, P=0.002), serum albumin value (t=2.961, P=0.004), and PNI value (χ2=10.437, P=0.001) were the possible risk factors for postoperative complications after thoracoscopy-assisted esophagectomy. The results of multivariate analysis suggested that the duration of ventilator use (OR=1.015, P=0.002) and the history of drinking (OR=5.231, P=0.013) were independent risk factors for postoperative complications, and high PNI was the protective factor for postoperative complications (OR=0.243, P=0.047).ConclusionPNI index has a certain value in predicting postoperative complications, which can quantify the preoperative nutritional and immune status of patients. Drinking history and duration of ventilator use are independent risk factors for postoperative complications of thoracoscopy-assisted esophagectomy, and high PNI is a protective factor for postoperative complications.
ObjectiveTo explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic.MethodsThe clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors.ResultsThe overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%) vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications.ConclusionIn low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.
Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.
Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.
ObjectiveTo discuss the clinical characteristics and the management of major complications after thoracic surgery.MethodsRetrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized.ResultsThe age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%).ConclusionThoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
Objective To analyze the influence of the ABO blood types of colorectal cancer patients served by West China Hospital as a regional center on surgical characteristics and postoperative complications in the current version of Database from Colorectal Cancer (DACCA). Methods The DACCA version was updated on January 5, 2022. The data items included ABO blood type, sex, type of operation, nature of operation and postoperative complications. The operative characteristics and complications at different stages after operation (in hospital, short-term and long-term after operation) of colorectal cancer patients with different blood types (A, B, AB, O) were analyzed. Results According to the DACCA database, we obtained 5 010 analysable data rows, covering 2005–2022. The results of blood types analysis showed that there was no significant difference among different blood types in the overall postoperative complications and the occurrence of complications in hospital, short-term and long-term after operation (P>0.05). Further subgroup analysis showed that only the difference of anastomotic leakage among different blood types was statistically significant (χ2=9.588, P=0.022). There was no significant difference among different blood types in whether the primary focus of colon cancer surgery was removed or not, the degree of radical resection of the primary focus, and whether the anus was preserved or not in rectal cancer surgery (P>0.05), and there was significant difference among different blood types with different degrees of radical resection of primary rectal cancer (χ2=15.773, P=0.001). Conclusions The ABO blood types of patients with colorectal cancer has nothing to do with the occurrence of overall complications in the short and long term after operation, and has no impact on the implementation of different surgical methods. However, the occurrence of a single postoperative anastomotic leakage is related to blood type, and its possible causes need to be further explored.