Search

Anastomotic leakage reflects a major problem in visceral surgery, leading to increased morbidity, mortality, and costs. This review is aimed at evaluating and summarizing risk factors for colorectal anastomotic leakage. A generalized discussion first introduces risk factors beginning with nonalterable factors. Focus is then brought to alterable impact factors on colorectal anastomoses, utilizing Cochrane systematic reviews assessed via systemic literature search of the Cochrane Central Register of Controlled Trials and Medline until May 2019. Seventeen meta-anaylses covering 20 factors were identified. Thereof, 7 factors were preoperative, 10 intraoperative, and 3 postoperative. Three factors significantly reduced the incidence of anastomotic leaks: high (versus low) surgeon’s operative volume (RR=0.68), stapled (versus handsewn) ileocolic anastomosis (RR=0.41), and a diverting ostomy in anterior resection for rectal carcinoma (RR=0.32). Discussion of all alterable factors is made in the setting of the pre-, intra-, and postoperative influencers, with the only significant preoperative risk modifier being a high colorectal volume surgeon and the only significant intraoperative factors being utilizing staples in ileocolic anastomoses and a diverting ostomy in rectal anastomoses. There were no measured postoperative alterable factors affecting anastomotic integrity.

Introduction The prognostic value of pharmacologic stress echocardiography has been extensively demonstrated in patients undergoing noncardiac surgery since 42% of the perioperative complications are cardiac. Coronary artery stenoses can became flow-limiting due to hemodynamic fluctuations in this period leading to myocardial ischemia. Purpose Evaluation of prognostic value of pharmacologic stress echocardiography in preoperative risk stratification. Methods Single center retrospective analysis of patients’ data referred to perform a preoperative risk stratification through pharmacological stress echocardiography between January 2014- December 2018. Data was collected regarding clinical and echocardiographic parameters to predict perioperative cardiac complications (myocardial infarction and development of arrythmias) and evaluate the impact of the result of DSE in patients´ clinical management. Results Of 910 pharmacological stress echocardiograms, 106 were performed to evaluate preoperative risk. Patients´ mean age was 66 ± 11 years, 85% males. 64% had hypertension, 45% dyslipidaemia, 38% current smokers and 18% diabetes. 189% had previously myocardial infarction and 9% stroke. All patients were proposed to intermediate-high risk surgeries: 73% to vascular surgery, 14% to kidney transplant and 13% to other type of surgery (especially abdominal surgery). Most of the stress tests (64%) were performed with dobutamine and the others 34% with dipyridamole. 91% of stress echocardiography were negative, 6% positive and 4% inconclusive. The patients with a positive stress test was submitted to coronary angiography to treat relevant lesions and cardiovascular risk factors were optimized. 72% of the patients has already been submitted to the proposed surgery; in this population, there was a 5% rate of cardiac complications following the surgery, all in patients with previous negative stress echocardiography. Complications were non-ST elevation myocardial infarction in 1% and de novo atrial fibrillation in 4%. Half of the patients with a positive stress echocardiography were operated with no cardiac perioperative complications, possibly related to patient´s optimization before the surgery; in the other half it was decided not to perform the surgery due to the potential cardiac risk. Predictor factors for perioperative cardiac complications, evaluated through univariate and multivariate analysis, were age (odds ratios (OR) 1.232, confidence interval (CI) 1.043-1.456, p 0.007) and stroke (OR 0.057, CI 0.947-44.592, p 0.033). Conclusion In our study, patients with a positive stress echocardiography were optimized before the surgery leading to none cardiac perioperative complications, emphasizing the importance of this test in preoperative patients´ management.

OBJECTIVE(S): The technical complexity of laparoscopic liver resection (LLR) poses unique challenges distinct from open surgery. An objective scoring system was developed that preoperatively quantifies the difficulty of LRR to help guide surgeon decision-making regarding the feasibility and safety of minimally-invasive approaches. The aim of this multi-institutional study was to externally validate this scoring system. METHODS: Patients who underwent LLR at 2 institutions were reviewed. LLR difficulty score (LDS) was calculated based on patient, tumor, and anatomic characteristics by 2 independent, blinded hepatobiliary surgeons. Surrogates of case complexity (e.g. conversion rate, operative time) were used for validation of this index. RESULTS: From 2006-2016, 444 LLR were scored as low (n=94), intermediate (n=98), and high difficulty (n=152) with respective conversion rates of 5.3%, 15.7%, and 25%. Cases of higher LDS correlated with larger mean blood loss (203 ml vs. 331 ml vs. 635 ml). Mean operative and Pringle maneuver used were associated with increasing LDS (155 min vs. 202 min vs. 315 min and 14.4% vs. 29.7% vs. 45.1% respectively). These operative surrogates of difficulty correlated significantly with the LDS. (all p

A subset of patients who undergo colon cancer surgery may be at a high risk of multiple subsequent admissions. We developed a simplified model to predict the preoperative risk of multiple postoperative admissions (MuAdm) among patients undergoing colon resection to aid in preoperative planning.Patients aged ≥18 y with colon cancer who underwent elective surgical resection identified in discharge claims from California and New York (2008-2011) were included. The primary outcome, MuAdm, was defined as 2 or more admissions in the year following resection. Logistic regression models were developed to identify factors predictive of MuAdm. A weighted point system was developed using beta-coefficients (P 0.05). A random sample of 75% of the data was used for model development, which was validated in the remaining 25% sample.A total of 14,780 patients underwent colon resection for cancer. Almost 30% had an admission in the year after index surgery and 9.8% had MuAdm. The significant predictors of MuAdm were higher Elixhauser comorbidity index score, metastatic disease, payer system, and the number of admissions in the year before surgery. Scores ranged from 0 to 8. Scores ≤1 had a 7% risk of MuAdm, and scores ≥6 had a30% risk of MuAdm.In the year following discharge after resection of colon cancer, nearly 10% of patients are admitted 2 or more times. A simple, preoperative clinical model can prospectively predict the likelihood of multiple admissions in patients anticipating resection. This model can be used for preoperative planning and setting postoperative expectations more accurately.

Objective Self-extubation of tubes and catheters causes various adverse events in postoperative patients. We investigated preoperative risk factors associated with self-extubation. Design A matched case-control study. Setting Teikyo University Hospital. Participants Postoperative patients over 50 years old. Methods Sixty-five patients with a comment in the incident report about self-extubation within 7 postoperative days were recruited for the case group. One hundred ninety-five matched patients in the control group were randomly recruited from an electronic medical record. This group was three times larger than the case group. The matching factors were age, sex, type of tube, duration of tube insertion, and year of the incident. Conditional multiple logistic regression analysis was performed. Results Sixty-five self-extubation events occurred, and constituted 6.5% of 996 postoperative incident reports. Three significant preoperative risk factors were abdominal operation (odds ratio [OR], 3.21; 95% confidence interval [95% CI], 1.05-10.83), history of dementia (OR, 10.71; 95% CI, 1.45-132.55), and preoperative hemoglobin level (OR, 0.77 per 1.0 g/dL increase; 95% CI, 0.62-0.96). Conclusions Elderly patients with a history of dementia and low preoperative hemoglobin are at a risk of postoperative self-extubation, especially after an abdominal operation. These predictors can contribute to the more effective prevention of perioperative self-extubation.

ZusammenfassungDieses Dokument der DGP ersetzt die Empfehlungen von 1998 und 2013. Anhand der aktuellen Datenlage und einer Konsensuskonferenz wurden Empfehlungen zu Indikationen, zur Auswahl und Durchführung der geeigneten Belastungsuntersuchungen sowie zu den technischen und personellen Voraussetzungen formuliert. Detaillierte Angaben werden zur Blutgasanalyse unter Belastung, zu Gehtests und Rechtsherzkatheter unter Belastung sowie zur Spiroergometrie und Stressechokardiografie gemacht. Der korrekte Einsatz von Belastungsuntersuchungen bei anstrengungsinduziertem Asthma, bei sport-, arbeits- bzw. rehabilitationsmedizinischen Fragestellungen, bei Adipositas, bei der präoperativen Risikostratifizierung und beim Therapiemonitoring pneumologischer Erkrankungen wird dargestellt.

Background Recently published reports have shown that the American Society of Anesthesiology (ASA) classification system has limited applicability in vascular surgery patients. Most patients undergoing vascular procedures are designated as ASA class III, limiting discrimination in preoperative risk assessment. The 2006 National Surgical Quality Improvement Project (NSQIP), containing over 170,000 surgical cases, demonstrated that functional status is an important predictor of mortality. We propose that dividing ASA class III into 2 subgroups, based on NSQIP-defined functional status, improves the predictive value of the ASA scheme. Methods The 2006 NSQIP database was queried for ASA class III patients undergoing vascular surgery procedures. Patients were divided into groups IIIA and IIIB based on independent or dependent (partial or complete) functional status, respectively. Difference in 30-day survival between subgroups was evaluated using Kaplan–Meier and logistic regression analyses. Differences in postoperative morbidity and length of stay were compared using the unpaired t-test. Results ASA class III patients having undergone vascular surgery procedures numbered 11,555 (68%). Of those 9,913 (85.7%) patients were independent (IIIA), and 1,642 (14.3%) were dependent (IIIB). Mean 30-day mortality was 1.3% in subgroup IIIA, and 6.5% in IIIB (logrank P Conclusions A 5-fold difference in mortality was observed between patients who were functionally independent and dependent. A significant increase in length of stay and incidence of postoperative complications was also observed in subgroup IIIB. Subdividing ASA class III vascular surgery patients markedly improves the value of the ASA classification system. Given the “high-risk” nature of patients with vascular disease, the addition of functional status to the preoperative assessment will assist in predicting outcomes in this patient population.

The preoperative assessment of the patient's health status is an indispensable part of planning any procedure where the patient is undergoing anesthesia. The American Society of Anesthesiologists' Physical Status classification – known as ASA PS classification - is routinely used today to assess the risks of anesthesia and perioperative mortality of patients undergoing surgery. Given the imperfections of ASA status as a predictor of perioperative risk in children, there are attempts to develop new risk assessment systems and guidelines specific to children. Two novel tools for assessing the preanesthetic risk in children are briefly presented: Pediatric Risk Assessment (PRAm) score and ''NARCO-SS'' (neurological, airway, respiratory, cardiovascular, other – surgical severity) score. Already in the first evaluations, the "NARCO-SS" system has proven to be a more precise measure of perioperative risk in children compared to the ASA status. Finally, the aim of this paper was to establish the value of the current guidelines in assessing the preoperative risk in children. The algorithm and the specificity of the preanesthesia evaluation process in children with an emphasis on identifying risk factors that could affect complications during and immediately after anesthesia are presented. Careful risk assessment is the basis for designing a plan for intraoperative child care, recovery after anesthesia, and perioperative pain management. Safety and success of the anesthetic procedure depends on valid preoperative risk assessment.

Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients&rsquo, cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.

The Quality In-Training Initiative (QITI) provides hands-on quality improvement education for residents. As our institution has ranked in the bottom quartile for prolonged mechanical ventilation (PMV) according to the National Surgical Quality Improvement Program (NSQIP), we sought to illustrate how our resident-led QITI could be used to determine perioperative contributors to PMV.The Model for Improvement framework (developed by Associates in Process Improvement) was used to target postoperative ventilator management. However, baseline findings from our 2016 NSQIP data suggested that preoperative patient factors were more likely contributing to PMV. Subsequently, a retrospective one-to-one case-control study was developed, comparing preoperative NSQIP risk calculator profiles for PMV patients to case-matched patients for age, sex, procedure, and emergent case status. Chart review determined ventilator time, 30-d outcomes, and all-cause mortality.Forty-five patients with PMV (69% elective) had a median ventilator time of 134 h (interquartile range 87-254). The NSQIP calculator demonstrated increased preoperative risk percentages in PMV patients when compared to case-matched patients for any complication (includes PMV), predicted length of stay, and death (all P 0.05). Thirty-day outcomes were worse for the PMV group in categories for sepsis, pneumonia, unplanned reoperation, 30-d mortality, rehab facility discharge, and length of stay (all P 0.05). All-cause mortality was also significantly higher for PMV patients (P 0.05).Resident-led QITI projects enhance resident education while exposing opportunities for improving care. Preoperative patient factors play a larger-than-anticipated role in PMV at our institution. Ongoing efforts are aimed toward preoperative identification and optimization of high-risk patients.

Background/aim The aim of this study was to analyze the influence of preoperative status on the risk of developing further postoperative complications after debulking surgery for advanced-stage ovarian cancer. Patients and methods A total of 80 consecutive patients submitted to surgery between 2014 and 2019 for advanced-stage ovarian cancer were retrospectively reviewed. Results Among the 80 cases there were seven patients who developed serious postoperative complications requiring reintervention. Among these cases it seems that association of obesity, poor nutritional status (defined as a lower than 3.5 g/dl serum albumin level) and elderly age were significantly associated with the risk of developing further complications. Conclusion When selecting the candidates for debulking surgery for advanced-stage ovarian cancer attention should be focused on excluding cases presenting such preoperative risk factors in order to decrease the postoperative morbidity.

Background Patients with normal pressure hydrocephalus (NPH) are often elderly, frail and affected by multimorbidity. Treatment is surgical with cerebrospinal diversion shunts. The selection of patients that are of an acceptable level of risk to be treated surgically has been a matter of debate for years and has deprived some patients of life-changing surgery. The aim of this service evaluation was to investigate the preoperative risk factors and early postoperative morbidity of patients with NPH using a standardized postoperative survey. Materials and methods Consecutive NPH patients admitted for neurosurgical management of NPH between May 2017 and May 2018 were included in this prospective service evaluation. In addition to the collection of traditional outcome measures, the cardiac version of the Postoperative Morbidity Survey (C-POMS) was conducted on postoperative days 4, 7, and 10 to identify postoperative morbidity. Results Eighty-eight patients (63 males, age mean±SD, 75±7 y) underwent 106 surgical procedures (61 lumbar drains, 45 ventriculoperitoneal shunts). There was no 30-day mortality and no unexpected return to the operating room or admission to intensive care unit. There was 1 conservatively managed surgical complication. On postoperative day 4, the C-POMS identified no postoperative morbidity in 72% of the patients, and mild morbidity (postoperative nausea and mobility issues) in 28%. There was a delay in discharge in 50% of the patients with no postoperative morbidity on day 4, highlighting areas of our service requiring improvement. Conclusions Early postoperative outcomes of NPH patients are good after both ventriculoperitoneal shunt insertion and lumbar drainage. This evaluation provides initial evidence on the utility of the C-POMS as a service evaluation tool in the standardized assessment postoperative outcomes in neurosurgery patients.

Background Thoracic corpectomies are performed for various reasons, including spinal deformity, trauma, neoplasms, and infection. Regardless of indication, both anterior and posterior approaches are surgical options, selected based on pathology, anatomy, patient characteristics, and surgical experience. Risk profiles and outcomes for these procedures are poorly characterized, however, and the choice between the 2 approaches remains inconclusive. Objective To compare risk factors and complications for adult patients undergoing anterior and posterior thoracic corpectomies. Methods A review of the American College of Surgeons National Quality Improvement Program database was performed, with 30-day patient outcomes after anterior or posterior thoracic corpectomy queried from 2005 to 2016. Preoperative risk factors and postoperative outcomes (e.g., deaths, reoperations, readmissions) were identified and compared. Results In total, 1327 corpectomies were studied, 861 (64.9%) by an anterior approach and 465 (35.1%) by a posterior approach. Patients undergoing a posterior approach were generally male, older, and had a greater American Association of Anesthesiologists class, whereas those subject to anterior approaches had a greater average body mass index. After we controlled for these baseline characteristics, no significant difference in postoperative events was observed, with 9.3% of anterior approach patients and 7.1% of posterior approach patients returning to the operating room within 30 days. Conclusions No significant difference in rates of reoperation, readmission, death, average length of stay, or medical complications exists between anterior and posterior thoracic corpectomy approaches. Both have relatively low-risk profiles and, in situations in which either strategy is reasonable, each can be selected at the surgeon's discretion with comparable risk.

Background Obesity has been associated with complications after a total knee arthroplasty (TKA). Surgical site infection (SSI) after TKA is one of the feared complications as it increases revision rates, costs, and stress to the patient. There is conflicting evidence in the literature regarding body mass index (BMI) and risk of infection after TKA, and some studies have suggested that site-specific fat distribution may be a better metric for determining risk of postoperative infections. Here, we investigate the correlation of soft tissue distribution about the knee to SSI after TKA. Methods We retrospectively review 572 patients who underwent primary TKA at a single institution from 2006 to 2010. We introduce the prepatellar fat thickness ratio (PFTR) as a radiographic means to quantitatively assess fat distribution about the knee and evaluate this measurement’s ability to assess the risk of developing an SSI after TKA. Results The PFTR was shown to be a better predictor of SSI than BMI in both the univariate (P = .05) and multivariate (P = .01) analyses. Conclusion Although BMI cannot fully account for variations in adipose distribution, the PFTR may account for this variability and may be a helpful tool for assessing a patient’s preoperative risk of SSI after TKA.

OBJECTIVES Persistent postoperative pain is reported by 30% to 50% of patients following breast cancer surgery. Studies testing preventive measures, however, have so far failed to produce consistent positive results. If preventive measures could be targeted to a subgroup of patients at high risk of persistent pain, positive results would be more likely. Our aim was to develop a simple risk score predicting persistent pain after breast cancer surgery. MATERIALS AND METHODS In a prospective observational cohort study, we tested the predictive ability of a 4 simple items score for persistent pain in 200 patients scheduled for breast cancer surgery. A multivariable logistic regression model was created for the outcome of clinically important pain at 4 months. RESULTS On the basis of literature review and univariable analysis of our data, 4 parameters were selected: preoperative pain at the surgical site, history of depression, age below 50 years and expected pain of high intensity (>6/10). Points for the score are based on the coefficients of the logistic regression model. A total score ≥2 points/5 predicts a risk of developing clinically important pain at 4 months >30%, with an area under the curve-receiver operating characteristic of 0.81. DISCUSSION We studied known risk factors for persistent pain in patients scheduled for breast cancer surgery and constructed a preoperative risk score simple enough to select high-risk patients in future prevention studies.

Zunehmend werden hochaltrige Patienten auch in Krankenhausern ohne geriatrische Fachabteilung operativ versorgt. Es gilt, moglichst fruh Patienten zu identifizieren, die ein hohes Risikopotenzial fur perioperative Komplikationen mitbringen, und ihre Versorgung anzupassen. Der Einsatz des „Identification of Seniors at Risk“ (ISAR) zur Identifikation von Risikopatienten, die eine spezialisierte perioperative Betreuung erhalten, soll sowohl in der Notaufnahme als auch zwecks Validierungsversuch in der Elektivchirurgie hinterfragt werden. Die vorgestellte Studie hinterfragt den Einsatz des ISAR zum einen, wie langjahrig empfohlen, in der Notaufnahme und zum anderen, als neue Option, zwecks Validierung in der Elektivchirurgie. Retrospektiv wurden Daten von 389 Patienten ausgewertet, die routinemasig im Rahmen der stationaren Aufnahme erfasst worden waren. Bei den Patienten wurden praoperativ der ISAR und ggf. als kognitives Screening der Mini-Mental-Status-Test (MMST) durchgefuhrt, sofern nicht bereits eine vordiagnostizierte Demenz vorlag. Das Delir wurde mithilfe der „Confusion Assessment Method“ (CAM) erfasst. Es dienen 88 Patienten der Unfallchirurgie (Notfall UCH) als Beispiel fur den Einsatz in der Notfallchirurgie und 93 Patienten der Orthopadie fur die Elektivchirurgie (Elektiv ORTHO). Alle Patienten erhielten eine Betreuung durch die Abteilung fur perioperative Altersmedizin. Mit ≥2 Punkten laut ISAR gelten 85,2 % der Behandelten der Gruppe Notfall UCH und 48,4 % der Behandelten der Gruppe Elektiv ORTHO als geriatrische Risikopatienten. Unter den ISAR-negativen Patienten fanden sich besonders in der Gruppe Elektiv ORTHO viele Patienten mit praoperativen kognitiven Auffalligkeiten (positiver MMST-Befund oder vordiagnostizierte Demenz). Die Delirraten betrugen 5,7 % in der Gruppe Notfall UCH und 4,3 % in der Gruppe Elektiv ORTHO. Der ISAR als Screeningtool erwies sich bei einem „Cut-off“-Wert von 2 als nur bedingt geeignet. Insbesondere wurde die erhoffte Filterfunktion in beiden Gruppen nicht erfullt.

Objective Nationwide databases are expected to provide critical data to improve medical practice. The present study used such data to develop risk models for clinically important outcomes after right hemicolectomy based on preoperative risk factors. Methods Japan's National Clinical Database (NCD) identified 38 030 cases of right hemicolectomy in the years 2011 and 2012. These were used to analyze correlations between mortality and eight selected clinical outcomes of interest by Pearson's correlation coefficient (r). To construct risk models for the eight selected clinical outcomes, 80% of all the examined cases were extracted randomly as a development cohort, and preoperative risk factors for each clinical outcome were identified using a forward stepwise selection method. Morbidities predicted from the risk models were used to find areas under the receiver operator curves among the remaining 20% of the testing cohort. Results The following clinical outcomes were identified as highly associated with operative mortality: systemic sepsis (r = .360), renal failure (r = .341), unplanned intubation (r = .316) and central nervous system (CNS) occurrences (r = .301). Risk models containing up to 21 preoperative variables were constructed for these eight postoperative clinical outcomes. Predictive values of the eight models were as follows: surgical site infections (0.634), anastomotic leakage (0.656), systemic sepsis (0.816), pneumonia (0.846), unplanned intubation (0.838), renal failure (0.883), CNS occurrences (0.833) and transfusion >5 units (0.846). Conclusions This study indicated that the NCD‐generated risk models for six of the eight selected critical postoperative outcomes had high discrimination among right hemicolectomy patients. These risk models can accurately identify high‐risk patients prior to surgery., This article is the first study that shows risk models for eight clinically important factors for morbidity after right hemicolectomy, based on preoperative risk factors. Our models and their evaluations are based on data from the NCD in Japan for the years 2011 and 2012.

Wound healing complications in the early postoperative period can be severely detrimental to clinical outcomes after total knee arthroplasty. Thorough knowledge of preoperative risk factors, meticulous surgical technique and wound closure, along with careful postoperative wound monitoring can prevent wound complications or lead to their resolution without subsequent morbidity. If complications arise in the postoperative period, the wound must be evaluated and treated promptly to avoid periprosthetic infection.

We sought is to determine the mechanism of failure among primary total knee arthroplasties (TKAs) performed at a single high-volume institution by asking the following research questions: (1) What are the most common failure modes for modern TKA designs? and (2) What are the preoperative risk factors for failure following primary TKA?From May 2007 to December 2012, 18,065 primary TKAs performed on 16,083 patients at a single institution were recorded in a prospective total joint arthroplasty registry with a minimum of 5-year follow-up. We retrospectively reviewed patient charts to determine a cause of failure for primary TKAs. A cox proportional hazard model was used to determine the risk of revision surgery following primary TKA.The most common reasons for failure within 2 years after TKA were infection and stiffness. The multivariable regression identified the following preoperative risk factors for TKA failure: history of drug abuse (hazard ratio [HR] 4.68; P = 0.03), deformity/mechanical preoperative diagnosis (HR 3.52; P.01), having a constrained condylar knee implant over posterior-stabilized implant (HR 1.99; P.01), post-traumatic/trauma preoperative diagnosis (HR 1.78; P = .03), and younger age (HR 0.61; P.01) CONCLUSION: These findings add to the growing data that primary TKAs are no longer failing from polyethylene wear-related issues. This study identified preoperative risk factors for failure of primary TKAs, which may be useful information for developing strategies to improve outcomes following TKA.

Objective Prolonged hypocalcemia but normal intact parathyroid hormone (iPTH) levels after surgery for primary hyperparathyroidism (PHPT) are referred to as ‘hungry bone syndrome’ (HBS). The aim was to evaluate preoperative risk factors for HBS with a focus on the impact of 25-hydroxyvitamin D (25(OH)D) deficiency. Design Patients having undergone initial successful surgery for sporadic PHPT within 6 years were considered for retrospective analysis. Methods A total of 385 patients were evaluated, of whom 33 (8.6%) developed HBS influencing negatively the postoperative bone metabolism. All patients underwent biochemical evaluations two days before parathyroid surgery and were followed biochemically on a daily basis in the first postoperative week and thereafter at 8 weeks and 6 months. Conclusions No relationship was established between preoperative 25(OH)D deficiency and HBS. The only significant risk factor for HBS in multivariable analysis was high levels of preoperative iPTH. As HBS therefore cannot be predicted preoperatively, we recommend a consistent postoperative calcium and vitamin D supplementation to improve the bone metabolism.

Background The role of preoperative clinics in improving surgical outcomes, reducing rate of surgical delays and case cancellations for patients undergoing outpatient elective surgery is well established. However, the impact of preoperative evaluation and risk assessment of inpatients undergoing surgery is less clear. We hypothesized that utilizing a standardized risk stratification method could reduce the rate of Same-Day Inpatient Cancellations (SDICs) in patients undergoing inpatient surgery. Methods This was a single center study conducted at an academic tertiary care hospital. An inpatient surgery form (ISF) that included a “risk stratification matrix” was completed for all inpatients undergoing non-emergent surgery. ISF was implemented at our institution over a three-year period (July 2014- March 2017). ISF stratified patients into “low,” “intermediate,” and “high” risk groups, which prompted hospitalist and anesthesia consultations based on the patient's risk category. We evaluated the difference in median SDIC rates during the four phases and differences in median proportions of SDICs attributable to Medical Related cancellations (MRCs) and Process-related cancellations (PRCs). Results Of 17,177 inpatient cases included for analysis, the average SDIC rate over the study was 9.5%. The Post-ISF SDIC rate was significantly less than the Pre-ISF SDIC rate (8.0% vs. 9.7%, p = 0.004). The proportion of MRCs during Post-ISF was also less than the Pre-ISF proportion of MRCs (47.1% vs. 60%, p = 0.02). Conclusion Standardized approach to preoperative risk stratification combined with timely pre-operative assessment and medical optimization of inpatients requiring surgery reduces the overall rate of inpatient surgical case cancellations.

Many methods for preoperative risk stratifications used in everyday practice do not take into account all of the comorbidities and complex physiological status of older patients. Therefore, anaesthesiologists and surgeons must consider multiple ways of preoperative diagnostics. Determining which of the preoperative clinical risk scores [Revised Lee score, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator and Surgical Outcome Risk Tool (SORT)] best improves routinely used American Society of Anaesthesiologists (ASA) physical status classification. The prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Preoperatively, anaesthesiologist determined ASA score according to guidelines. Then, the data of patients have been processed on the interactive calculators of Revised Lee score, ACS NSQIP and SORT. Mean age of included patients was 71.4 ± 6.9 years. When it comes to postoperative mortality prediction, three risk scores (ASA, ACS NSQIP and SORT) have been statistically significant, respectively, P = 0.016, P

Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal tract to resection cavity distance (TRD) and outcome is needed to further evaluate the validity of the model. Aim of the study: To use the postop MRI-derived resection cavity to measure how closely the resection cavity approximated the preoperatively calculated corticospinal tract (CST) and how this correlates with the risk model and the outcome. Methods: We included 183 patients who underwent nTMS-based DTI and surgical resection for presumed motor-eloquent gliomas. TTD, TRD, and motor outcome were recorded and tested for correlations. The intraoperative monitoring documentation was available for a subgroup of 48 patients, whose responses were correlated to TTD and TRD. Results: As expected, TTD and TRD showed a good correlation (Spearman’s ρ = 0.67, p &lt, 0.001). Both the TTD and the TRD correlated significantly with the motor outcome at three months (Kendall’s Tau-b 0.24 for TTD, 0.31 for TRD, p &lt, 0.001). Interestingly, the TTD and TRD correlated only slightly with residual tumor volume, and only after correction for outliers related to termination of resection due to intraoperative monitoring events or the proximity of other eloquent structures (TTD ρ = 0.32, p &lt, 0.001, TRD ρ = 0.19, p = 0.01). This reflects the fact that intraoperative monitoring (IOM) phenomena do not always correlate with preoperative structural analysis, and that additional factors influence the intraoperative decision to abort resection, such as the adjacency of other vulnerable structures. The TTD was also significantly correlated with variations in motor evoked potential (MEP) responses (no/reversible decrease vs. irreversible decrease, p = 0.03). Conclusions: The TTD approximates the TRD well, confirming the best predictive parameter and giving strength to the nTMS-based risk stratification model. Our analysis of TRD supports the use of the nTMS-based TTD measurement to estimate the resection preoperatively, also confirming the 8 mm cutoff. Nevertheless, the TRD proved to have a slightly stronger correlation with the outcome as the surgeon’s experience, anatomofunctional knowledge, and MEP observations influence the expected EOR.

Profiling recovery following knee replacement (KR) is a focus of substantial research interest because KR surgery has become one of the most common major surgical procedures. In the United States, for example, approximately one million KRs are performed annually. Additionally, there is substantial clinical practice and research interest in the study of poor pain outcome and predictors of poor pain outcome following KR.

Bariatric surgery is frequently recommended prior to total joint arthroplasty (TJA) for morbidly obese patients with end-stage arthropathy. Current published data on the efficacy of bariatric surgery for preoperative medical optimization has yielded mixed results, and the effect of time from bariatric surgery to TJA on the preoperative risk profile is not well defined. Our study evaluated the effect of time from bariatric surgery to TJA on 90-day complication and readmission rates. We utilized the Healthcare Cost and Utilization Project (HCUP) California State Inpatient Database (SID) to identify patients who underwent TJA following bariatric surgery between 2007 and 2011. Primary endpoints were 90-day complication rates and all-cause 90-day readmission rates following TJA. We identified 330 cases of bariatric surgery followed by total hip arthroplasty (THA) and 1017 cases followed by total knee arthroplasty (TKA). There were no significant demographic differences among patients who underwent TJA greater than or less than 6 months after bariatric surgery. Patients undergoing THA more than 6 months after bariatric surgery were significantly less likely to be readmitted within 90 days for any cause. There was no association between time from bariatric surgery to THA or TKA and 90-day complications. Delaying THA at least 6 months after bariatric surgery may help reduce the rate of 90-day readmissions in this high-risk patient population. Arthroplasty surgeons recommending bariatric surgery as preoperative risk modification should consider the patient’s overall nutritional status, medical comorbidities, and overall response to surgery prior to booking for TJA.

In recent years, risk-adjusted control charts that account for the preoperative risk of patients have been widely used for monitoring of surgical outcomes. Generally, risk-adjusted control ...

Although laparoscopic distal pancreatectomy is considered a standard approach, 10% to 40% of these are converted. The preoperative risk factors for conversion are not well described. The aim of this study was to identify risk factors associated with conversion.Clinicopathological variables of 211 consecutive patients who underwent laparoscopic distal pancreatectomy between January 2007 and December 2015 at Johns Hopkins were analyzed to identify factors associated with conversion. Furthermore, the learning curve for laparoscopic distal pancreatectomy was studied.On univariate analysis of diabetes mellitus, preoperative diagnosis of malignant disease, multiorgan resection, surgeons' years and case experience were significantly associated with conversion (all P .05). Risk factors independently associated with conversion included diagnosis of malignant disease (odds ratio = 5.40; 95% confidence interval, 1.93-15.12, P = .001), multiorgan resection (odds ratio = 7.10; 95% confidence interval, 1.60-31.53, P = .01), and surgeons' case experience (odds ratio = 0.32; 95% confidence interval, 0.12-0.85, P = .023). Intraoperative reasons for conversion included presence of excessive intraabdominal and retroperitoneal fat (N = 10, 32.3%), adhesions (N = 10, 32.3%), extent of tumor invasion (N = 8, 25.8%), anatomy of vessels (N = 6, 19.4%), and intraoperative bleeding (N = 2, 6.5%).Patients undergoing laparoscopic distal pancreatectomy with a preoperative diagnosis of malignant disease or possible multiorgan resection are at a higher risk of conversion. Surgeon experience of performing15 procedures significantly reduces the risk of conversion.

The objective: the purpose of the work was to determine the risk factors for the occurrence of postoperative complications in patients with ureterolithiasis of a single kidney (SK) after minor invasive surgical interventions. Patients and methods. 254 patients with ureterolithiasis participated in the study, of which 141 were cohorts of persons with SK (groups I, II and III), and others – a cohort of persons with two kidneys. According to the gender distribution, the male sex was 152 (59.8%), female – 102 (40.2%) cases, and the average age was 44,7±2,1 years (female – 42,3±1,5 years, male – 39,7±1,4 years). Formation of groups was carried out on the basis of rendering of operational help: I group – treatment of ureterolithiasis SK by the method of TUCL – (n=34); Group II – treatment of Ureterolithiasis in SK by ESWL method (n=76); Group III – treatment of ureterolithiasis in SK by means of ureterolithotomy (n=31); IV group – treatment of ureterolithiasis by the TUCL method (n=42); V group – treatment of ureterolithiasis by ESWL (n=38); VI group – treatment of ureterolithiasis by means of ureterolithotomy (n=33). Results. Preoperative risks of the occurrence of postoperative complications in patients with Ureterolithiasis of the SK are presented: by the fact of the presence of SK; the fact of a high level of cardiovascular pathology and metabolic syndrome, 1,5 times more than in the case of persons with two kidneys; the fact of lowering the average indicators of glomerular filtration rate, which is 1,8 times lower than that of those with dummy kidneys. Levels of risk of development of postoperative complications in the cohorts of persons with two kidneys (23,3%) and SK (33,3%) differ significantly in 1,4 times (p

Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative for patients presenting with severe symptomatic aortic stenosis and considered either at high (1,2) or intermediate preoperative risk (3,4) for surgical aortic valve replacement (SAVR).

We evaluated the relationship between admission serum uric acid (SUA) and in-hospital and one-year mortality after valve replacement surgery (VRS) for patients with rheumatic heart disease (RHD).One-thousand five-hundred thirty-six consecutive patients with RHD undergoing VRS were divided into 4 groups based on the quartiles of SUA on admission. The association between SUA and adverse outcomes was analyzed.The in-hospital mortality (2.1% vs 2.6% vs 5.3% vs 7.7%, p0.001) and postoperative acute kidney injury (AKI) (52.0% vs 52.6% vs 61.6% vs 63.3%, p=0.001) increased from the lowest to the highest SUA quartiles. SUA levels were negatively correlated with eGFR value (r=-0.426, p0.001) and positively correlated with C-reactive protein value (r=0.103, p0.001). ROC analysis showed that SUA had good predictive value for in-hospital death (AUC=0.665, p0.001) and was similar to Euro score (Z=0.966, p=0.334). Multiple logistic regression analysis showed that SUA was independently associated with in-hospital (OR=1.21, 95% CI: 1.06, 1.37, p=0.004) and one-year mortality (HR=1.17, 95% CI: 1.05, 1.29, p=0.003). Kaplan-Meier analysis demonstrated that the cumulative rate of one-year mortality after surgery was higher in patients with SUA7.3mg/dl (Log-rank=21.1, p0.001).Admission SUA could be used as a preoperative risk assessment factor in RHD patients who underwent VRS.

Purpose: To test the impact of surgeon experience on urinary continence (UC) recovery after robot-assisted radical prostatectomy (RARP). Materials and Methods: The study included 1477 consecutive patients treated with RARP by four surgeons between 2006 and 2014. UC recovery was defined as being completely dry over a 24-hour period at follow-up. Surgeon experience was coded as the total number of RARP performed by the surgeon before the patient's operation. Multivariable analysis tested the association between surgeon experience and UC recovery. Covariates consisted of patient age, Charlson comorbidity index, preoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), nerve-sparing surgery (none vs unilateral vs bilateral), and preoperative risk groups (low- vs intermediate- vs high risk). Results: The number of cases performed by each surgeon was 541, 413, 411, and 112, respectively. Median follow-up was 24 months (inter-quartile range: 18, 40). The UC recovery rate at 1 year after surgery was 82%. At multivariable analyses, surgeon experience represented an independent predictor of UC recovery (hazard ratio: 1.02, p < 0.001). The surgical learning curve was similar among surgeons, moving linearly from ∼60% of UC rate at the initial cases to almost 90% after more than 400 procedures. Conclusions: In patients undergoing RARP, surgeon experience is a significant predictor of UC recovery. The surgical learning curve of UC recovery does not reach a plateau even after more than 100 cases, suggesting a continuous improvement of the surgical technique. These findings deserve attention for patient counseling and future comparative studies evaluating functional outcomes after RARP.

OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

This study was conducted to determine whether the duration of mechanical ventilation (DOMV) could be used to benchmark the overall quality of care after neonatal congenital heart operations.Children aged younger than 30 days undergoing cardiac operations were reviewed. Technical adequacy was assessed using the Technical Performance Score (TPS), a previously validated tool for determining the adequacy of a palliative or corrective surgical procedure that uses echocardiography criteria and need for unplanned reintervention to determine technical adequacy. Preoperative risk factors and postoperative complications were determined using The Society of Thoracic Surgeons Congenital Heart Surgery Database definitions. Surgical complexity was assessed using The Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery (STAT) Mortality Categories. We explored associations between preoperative risk factors, STAT category, TPS, and postoperative complications with DOMV.Of 601 patients studied, 49 were not included in the multivariable analysis due to a STAT nonclassifiable operation or unmeasured TPS, or both. Multiple risk factors were associated with longer DOMV, including weight (p = 0.005), The Society of Thoracic Surgeons Congenital Heart Surgery Database preoperative factors (p = 0.005), STAT mortality category (p0.001), TPS (p0.001), and The Society of Thoracic Surgeons Congenital Heart Surgery Database-defined complications (p0.001). Multivariable regression showed that preoperative factors increased DOMV by 1.23 days (p = 0.01), class 3 TPS by 2.16 days (p0.001), and postoperative complications by 2.03 days (p0.001), with adjusted RNeonates with major residual lesions and postoperative complications have prolonged DOMV. DOMV may reflect the quality of care after congenital heart operations.

ZusammenfassungDie präoperative Anamnese und körperliche Untersuchung sind anerkannter Standard bei der Risikoevaluation von Patienten vor elektiven chirurgischen Eingriffen. Ob und unter welchen Umständen technische Voruntersuchungen dazu beitragen können, das perioperative Risiko zu reduzieren, ist bislang nur unzureichend untersucht. Auch besteht unter Anästhesisten, Chirurgen und Internisten vielfach Unsicherheit im perioperativen Umgang mit der Dauermedikation. Die deutschen wissenschaftlichen Fachgesellschaften für Anästhesiologie und Intensivmedizin (DGAI), Chirurgie (DGCH) und Innere Medizin (DGIM) haben daher eine gemeinsame Empfehlung zur präoperativen Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen erarbeitet und erstmals im Jahr 2010 publiziert. Die vorliegende Fassung ist eine Überarbeitung der Stellungnahme von 2010 unter Einbeziehung der seither publizierten Literatur sowie von aktuellen Leitlinien internationaler Fachgesellschaften. Zunächst werden die allgemeinen Prinzipien der präoperativen Evaluation dargestellt (Teil A). Das Vorgehen bei Patienten mit bekannten oder vermuteten kardiovaskulären Vorerkrankungen wird gesondert betrachtet (Teil B: „Erweiterte kardiale Diagnostik“). Abschließend wird der perioperative Umgang mit der Dauermedikation diskutiert (Teil C). Die vorgestellten Konzepte stellen fachübergreifende Empfehlungen dar, die ein strukturiertes und gemeinsames Vorgehen ermöglichen sollen. Ihr Ziel ist es, durch transparente und verbindliche Absprachen eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen zu gewährleisten, präoperative Untersuchungsabläufe zu verkürzen sowie letztlich Kosten zu reduzieren. Die gemeinsamen Empfehlungen von DGAI, DGCH und DGIM spiegeln den gegenwärtigen Kenntnisstand, aber auch die Meinungen von Experten wider, da nicht für jede Fragestellung wissenschaftliche Evidenz besteht. Daher werden eine regelmäßige Überprüfung und Aktualisierung der Empfehlungen erfolgen, sobald gesicherte neue Erkenntnisse vorliegen.

Suicide risk factors were examined in surgical weight loss (SWL) candidates and compared with weight management (WM) patients in an attempt to better understand the increased risk for suicide after bariatric surgery. Participants included 145 SWL and 103 WM patients. Body–mass index, thwarted belongingness, perceived burdensomeness, acquired capability, suicidal ideation, prior suicide attempts, and lifetime history of abuse were assessed. Perceived burdensomeness, thwarted belongingness, prior suicide attempts, lifetime physical abuse, and suicidal ideation were lower in SWL patients. SWL patients may demonstrate lower preoperative risk for suicide due to socially desirable responding or a sense of hope regarding their upcoming surgery. Additionally, the unique physical and psychological aspects of undergoing bariatric surgery may be associated with postoperative increases in suicidality.

OBJECTIVES Valve-sparing operations and root replacement with a biologic composite conduit are viable options in aortic root aneurysm. This study was conceived to compare the early and mid-term results of these 2 procedures. METHODS From September 2002 to November 2015, 749 consecutive patients underwent either a valve-sparing operation or a root replacement with a biologic composite conduit at 2 institutions. Propensity score matching was used to compare similar cohorts of patients in the overall population and in the ≤ 55 and ≥ 65-year age groups. RESULTS Overall operative mortality was 0.4%, mean age 57.4 ± 14.3 years, 84.6% were male. Individuals in the biologic composite conduit group were older and had worse preoperative risk profiles [chronic pulmonary disease (5.5% vs 0.9%; P = 0.001), diabetes (6.4% vs 1.5%; P = 0.001) and NYHA > 2 (25.2% vs 5.2%; P

Introduction: Here we will describe the actual surgical technique to perform the left mammary artery bypass to the left anterior descending artery, and the results of this operation in the Benetti Foundation in the last 20 years. Materials and Methods: The inclusion criteria for this operation were patients with a demonstrated predominant ischemia by functional test. In the patients with double, triple vessels disease or left main, the age was more than 65 years or and Euro score Risk of surgery of more than 4. The exclusion criteria were patients with more areas of ischemia and lesions that involved a considerable territory apart from the Lad and good candidates for surgery are younger than 65 years or the Euro score Risk of surgery were less than 4. Seventy patients were operated in the Foundation through LIMA to LAD Anastomosis with the MINI OPCABG technique. The average Preoperative Risk Euroscore was 3,5. Surgical Technique after open the lower part of the sternum, the left mammary artery is dissected around 8 cm. The pericardium is open and the mammary is connected to the left anterior descending. Results: Operative mortality in this series was 0%. One patient was converted to sternotomy Off Pump (1, 4%). None of the grafts were revised after the measure with the Medistim System. 55 (79%) were extubated in the operating room. The average Hospitalization stay were 60 hours (D +_17 ci 95%), 16 patients with Lima to LAD were restudied in the initially experience with 100% patency, at 144 months, 82% of the patients were alive and 68% asymptomatic. Conclusion: More clinical experience is important to find the definitive indications of this technique; and better technologies are required to be able to standardize this operation in definitive form.

Introduction Patients undergoing isolated coronary artery bypass graft (CABG) at our heart centre require two packed red blood cells (RBC) pre-operatively based on the data from Maximum Surgical Blood Order Schedule (MSBOS). Transfusion-related mortality and morbidity have been shown to be dose dependent, suggesting that the lowest effective number of units should be transfused. Pre-operative identification of patient's characteristic requiring blood transfusion during procedure will allow for better utilization of blood, reduce wastage and increase cost efficiency. We aim to define a set of parameters to indicate necessity for blood transfusion hence, consideration will be given to supply one instead of two packed RBC to patients who do not require transfusion. Methods This cross-sectional study obtained integrated data-set from the hospital information system and clinical database (Cardio thoracic Surgery Registry) from January 2015 to December 2018. A total of 4,646 patients who underwent isolated CABG were included in this study and 28 independent predictors associated with transfusion were identified and analyzed. A predictive model for preoperative requirement of blood transfusion was developed using logistic regression and machine learning approach ie; Decision tree, Logistic Regression, KNN, Naive Bayes, Gradient Boosted Tree, and Random Forest using RapidMiner. Results In 2015-2018, only 25.7% of patients utilized two packed RBC's whereas 20.2% utilized only one for blood transfusion during procedure. The remainder 54.1% of non-utilized blood were returned to the blood bank within 48 hours. Logistic regression and machine learning algorithm unveiled similar significant predictors to predict the requirement of blood transfusion pre-operatively. There are 24 significant predictors identified from the highest accuracy algorithm which is Random Forest (99.78%), as compared to others machine learning approaches particularly the Decision Tree 79.55%, Logistic Regression 85.25, KNN 75.35%, Naive Bayes 79.76%, and Gradient Boosted Tree 83.32%. Discussion A clinical predictive model was developed for preoperative risk stratification of patients requiring blood transfusion and to further assist clinicians for better utilization of blood bank resources. Variables significantly associated with blood transfusion were female gender, EF 40 serum creatinine>100mmol/L, and previous cardiac procedures. This tool may prospectively optimize the ordering of blood with the potential to reduce adverse events and costs related to transfusion in the future. However, for the consideration to supply only one packed RBC in retrospect to patients who do not require transfusion, more data and predictors should be added in this study.

Purpose This study evaluates the prognostic value of preoperative pulmonary function tests (PFTs) on post implant outcomes in LVAD patients. Methods Durable LVAD implants from January 2004 to December 2018 at a single institution were included. The primary outcome was rates of respiratory adverse events (AEs): prolonged intubation >72 hours, pneumonia, reintubation or tracheostomy. Secondary outcome included survival. Criteria for abnormal PFTs was met with an FEV1 Results 333 patients underwent LVAD implant, including 40.8% (n=136) with normal PFTs and 59.2% (n=197) with abnormal PFTs. Patients with abnormal PFTs had higher rates of respiratory AEs overall (26.1% vs 14.6%, p=0.04) (Figure A). Patients with abnormal PFTs had a 2-fold increased risk for respiratory AEs (HR 1.93, 95%CI 1.02, 1.64). After risk-adjustment, the impact of abnormal PFTs was most pronounced when FEV1 was 0.05). Post-implant survival at 1 year follow-up was comparable between the groups (58.1% vs 73.7%, p=0.09) (Figure B), although patients in the lowest strata of FEV1 ( Conclusion PFTs are a useful preoperative risk assessment tool for stratification and patient counseling regarding the likelihood of post-LVAD respiratory AEs. Patients with a FEV1