Incidence and Risk Factors for Hospital-acquired Pneumonia After Surgery for Gastric Cancer: Results of Prospective Surveillance
ABSTRACT Postoperative hospital-acquired pneumonia (HAP) is recognized as a major risk associated with surgery. Although upper abdominal surgery is known to have the highest incidence of postoperative HAP, little is known about the risk factors that contribute to HAP after gastric cancer surgery. The aim of this study was to determine the incidence and risk factors for HAP after elective surgery for gastric cancer.
We conducted prospective surveillance of all elective gastric resections by surgeons in ten affiliated hospitals, including ours, from May 2001 to May 2005. The outcome of interest was postoperative HAP. Univariate and multivariate analyses were performed to determine the predictive significance of variables in gastric cancer surgery.
A total of 529 patients undergoing elective operations for gastric cancer were admitted to the program. Postoperative HAP was identified in 20 patients (3.6%). Univariate and multivariate analyses showed that male gender and intra- and/or postoperative blood transfusion were independently predictive of postoperative HAP.
Male gender and intra- and/or postoperative blood transfusion were independent risk factors for the development of HAP after elective resection of gastric cancer. Surgeons should keep these risk factors in mind when managing postoperative patients.
- SourceAvailable from: Marzena Lenart
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- "Direct comparison of different studies was not always possible because complication types and data collection were not uniform [18–20]. The main risk factors reported in the literature are: the extent of lymphadenectomy, splenectomy, tumor size, age, comorbidities, American Society of Anesthesiologists (ASA) score, malnutrition, and preoperative blood loss [1, 12, 13, 16, 17, 21–23]. "
ABSTRACT: Despite progress in surgical techniques and perioperative care, gastrectomy remains a procedure of significant morbidity. Several scoring systems and clinical measures have been adopted to predict postoperative complications in gastric cancer patients. The aim of this study was to investigate whether high serum levels of interleukin 6 (IL-6) in the early postoperative period may be a prognostic factor of postoperative morbidity. A group of 99 consecutive patients with resectable gastric cancer were enrolled. The mean age was 62.9 years and the male/female ratio was 72:27. Subtotal gastric resection was performed in 22 patients and total gastric resection in 77. The IL-6 serum level was measured on the 1st postoperative day (POD). Complications were recorded in 28 patients (28.3%). The observed case-fatality rate was 3.03%. An IL-6 serum level of >288.7 pg/ml on the 1st POD in univariate and multivariate Cox proportional hazard models was an independent prognostic factor for overall complications and infective complications. Our study showed an association between perioperative IL-6 serum levels and postoperative morbidity in gastric cancer patients. The IL-6 serum level on the 1st POD was shown to be an independent prognostic factor for both overall complications and infective complications.Gastric Cancer 04/2011; 14(3):266-73. DOI:10.1007/s10120-011-0039-z · 4.83 Impact Factor
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ABSTRACT: Predicting models of operative morbidity and mortality in the geriatric population are important in the prevention of adverse surgical outcomes. A retrospective review of medical records was performed for patients over 80 years of age who underwent gastrointestinal surgery from 1998 to 2008. 215 patients were identified with a mean age of 83.7 years. Overall morbidity and mortality rates were 48.8 and 14.4%, respectively. Multivariate logistic regression analysis revealed that serum albumin levels [odds ratio (OR) = 0.367, p = 0.0267], postoperative pneumonia (OR = 3.471, p = 0.0101), hollow organ perforation or anastomosis combined with leakage (OR = 7.600, p = 0.0126), and preoperative systemic inflammatory response syndrome (OR = 3.186, p = 0.0323) were significant predictors of hospital mortality. Moreover, albumin (OR = 0.270, p = 0.0002) and physical disability (OR = 3.802, p = 0.0009) were significant predictors of postoperative pneumonia, and albumin (OR = 0.491, p = 0.0212) and enterotomy (OR = 3.335, p = 0.0208) were significant predictors of surgical site infections. This study provides novel predicting models to identify the elderly surgical patients at high risk, who should receive more intensive preventive and perioperative care.Digestive surgery 08/2010; 27(3):224-31. DOI:10.1159/000274485 · 1.74 Impact Factor
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ABSTRACT: The profile of lipoprotein expression in plasma is altered by surgical stress. The role of total cholesterol in postsurgical patients with nosocomial infection remains unknown. We validated the data from 1,031 patients undergoing open gastrointestinal surgery between December 2006 and November 2008 using a clinical database available from Iizuka Hospital. Biochemical parameters related to plasma total cholesterol were measured. Various parameters predictive of the conditions--e.g., surgical incisional infection, organ space infection, pneumonia within 30 days after surgery--were assessed by multiple logistic regression analyses. The most frequent infection was surgical incisional infection. Serum total cholesterol levels-(1) lowest quartile (<159 mg/dl) vs. reference (200-239 mg/dl): adjusted odds ratio (OR) 5.39, 95% confidence interval (CI) 2.28-12.76; (2) second lowest quartile (160-199 mg/dl) vs. reference: OR 2.76, 95% CI 1.01-7.53-showed a significant inverse relation with surgical incisional infection. Both lowest and highest total cholesterol levels were associated with a higher risk of surgical incisional infection and organ space infection. None of the patients with high (> or =200 mg/dl) total cholesterol levels suffered from pneumonia. Total cholesterol levels appeared to be one of the risk factors for surgical incisional infection and pneumonia. Patients with borderline blood cholesterol levels (200-239 mg/dl) seemed to be the best candidates for operation.World Journal of Surgery 09/2010; 34(9):2051-6. DOI:10.1007/s00268-010-0652-8 · 2.35 Impact Factor