Retrospective impact evaluation of frailty as measured by the Memorial Sloan Kettering Frailty Index (MSK-FI) on outcomes in older women surgically treated for advanced epithelial ovarian cancer ...(EOC). Women ≥ 60 years with stage IIIC/IV EOC who underwent primary debulking surgery (PDS) or interval debulking surgery (IDS) were included. Medical records were reviewed for patients’ characteristics and outcomes. We retrospectively applied the MSK-FI which included 10 comorbidities and functional assessment that were extracted from medical records. The MSK-FI ranges from 0 to 11; a score of ≥ 3 was considered frail. Associations were assessed using logistic regression and Cox proportional hazards regression. We identified 79 patients treated with PDS (
n
= 36, 45.5%) or IDS (
n
= 43, 54.4%) with complete data. The prevalence of frailty based on MSK-FI was 25%. Almost half of the frail patients (47.3%) were admitted to the ICU compared to 16% of non-frail patients (
p
= 0.006). In univariable analysis, the MSK-FI was associated with postoperative complications OR 1.57 (95% CI 1.04–2.37),
p
= 0.03 and ICU admission OR 2.05 (95% CI 1.30–3.23),
p
= 0.002, but not with readmission rate OR 1.29 (95% CI 0.65–2.59),
p
= 0.5, postoperative mortality OR 1.02 (95% CI 0.51–2.00),
p
= 0.9, and hospital stay β 0.60 (95% CI − 1.19–2.41). In multivariable analysis, the frailty index was independently associated with postoperative complications OR 1.54 (95% CI 1.02–2.34),
p
= 0.04 and ICU admissions OR 1.97 (95% CI 1.23–3.16),
p
= 0.004. Frailty, based on the Memorial Sloan Kettering Frailty Index, is associated with adverse postoperative outcomes in older women with advanced ovarian cancer, suggesting that MSK-FI can improve the predictive ability of current surgical assessment tools.
Phlegmonous Colitis: Infectious Entity in Cirrhosis Moctezuma-Velázquez, Paulina; Pastor-Sifuentes, Francisco Ulises; Aguilar-Frasco, Jorge L.
Indian journal of surgery,
02/2020, Volume:
82, Issue:
1
Journal Article
Peer reviewed
Phlegmonous colitis is a rare source of infection; the main predisposing factor identified is cirrhosis. Herein, we describe a case of a 36-year-old female with abdominal pain and septic shock, with ...a thickened ascending colon by tomography; a fulminant pseudomembranous colitis vs. intestinal vasculitis was suspected. A right hemi colectomy was performed; the patient died hours after surgery. Pathology analysis diagnosed phlegmonous colitis, which is the gold standard for the diagnosis. A computed tomography is an important tool in the diagnostic approach to rule out other infectious sources. In most cases, phlegmonous colitis is a fulminant infection.
Colonic lipomas are infrequent, benign, non-epithelial, fatty neoplasms. Most of the colonic lipomas are asymptomatic, but around 25% of patients may develop symptoms. Nowadays, surgical resection of ...the involved segment is the treatment of choice. We report three cases of colonic intussusceptions caused by colonic lipomas in adult patients. The patients underwent surgical resection, and the diagnosis was confirmed by histopathological examination of the specimens.
Introduction and aims
Sodium can be measured with direct or indirect methods; abnormal plasma total protein concentration can impact on sodium measured by indirect ion-selective electrodes (ISE). ...Serum sodium is an important item to determine the Model for End Stage Liver Disease Sodium (MELD-Na) score, commonly used for liver graft allocation. Patients with cirrhosis usually have hypoproteinemia. The aim of this study was to determine if there was a significant difference between the MELD-Na scores calculated based on the results of two different serum sodium ISE: indirect and direct.
Methods
This was a retrospective study; we included 166 patients that underwent liver transplant assessment, and that had paired (i.e. same date and time) direct and indirect sodium determinations. We calculated the MELD-Na scores with both sodium determinations, and we compared them.
Results
There was a significant difference between MELD-Na scores; the mean difference was 0.4±1.3. If MELD-Na score had been determined by the sodium measured by the direct ISE, 69 patients (42%) would have stayed in the same place on the waiting list, 67 patients (40%) would have moved up, and 30 patients (18%) would have moved down.
Conclusions
There was a statistically significant difference between the MELD-Na scores calculated based on the two different sodium concentrations, which would theoretically result in changes in the order of the waiting list. This finding should prompt studies to assess if MELD-Na calculated based on direct methods has a better performance to predict clinically relevant outcomes.
Purpose
The geriatric population has increased considerably in the last decades. Such increases come along with new challenges for surgical practitioners, who now face a risen number of frail ...patients in need of major operations. The value of frailty indexes in this setting has been discussed recently. This study assessed the modified Rockwood frailty index (mRFI) as a predictive tool for postoperative complications in older adults subjected to major abdominal operations and correlated it with other scores widely utilized for this purpose.
Methods
We performed a prospective study utilizing the mRFI including all patients older than 65 years subjected to major abdominal surgery between May 2017 and May 2019 in a third-level academic center. A comparison between frail (mRFI
>
0.25) and non-frail patients (mRFI <0.25) was performed. We performed logistic regression to identify predictors of postoperative complications and 30-day mortality. We analyzed the correlation between mRFI and ACS-NSQIP, P-POSSUM, PMP, and Charlson score risk calculators.
Results
One hundred forty patients were included in our study, of whom 49 (35%) were identified as frail. Frail patients demonstrated significantly prolonged hospital stay (
p
<.0001), ICU admission rates (
p
=0.004), hospital readmissions (
p
=0.007), and higher mortality rates (
p
=0.02). Our univariate analysis associated frailty (mRFI
>
0.25), ASA
>
III, increased age, and BMI with postoperative complications. In our multivariate analysis, frailty remained an independent predictor for postoperative complications (OR 6.38, 95% CI 2.45–16.58,
p
<0.001). Frailty was also associated with length of stay (LOS) regardless of the type of surgery (OR 3.35, 95% CI 0.37–6.33,
p
= 0.03). mRFI
>
0.25 demonstrated a sensitivity (Se) of 70% and specificity (Sp) 67% with area under the curve (AUC) 0.75 for perioperative complications, Se 69% and Sp 70% with AUC 0.74 for ICU admissions, and Se 83% and Sp 68% with AUC 0.83 for mortality.
Conclusion
Frail patients demonstrated significantly prolonged hospital stay, ICU admission rates, hospital readmissions, and higher mortality rates. mRFI is an independent predictor for perioperative complications with a Se of 70% and Sp 67% and AUC 0.75.
In this study we assessed the neutrophil-lymphocyte ratio (NLR) as a predictor of steroid non-response (SNR) in patients with acute severe ulcerative colitis and found a NLR on day 3 (NLR-3) >6.1 as ...a suitable cutoff point to identify SNR (OR 3.44, 95%CI 1.22-9.66) with sensitivity, specificity, positive predictive value, negative predictive value, and AUROC of 66.75, 63.2%, 35.9%, 86%, and 0.650, respectively. A model including bowel movements, albumin levels, and a NLR-3>6.1 had an AUC of 0.812 to predict SNR, with acceptable calibration.
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