Articles: postoperative-complications.
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To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy. ⋯ This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-BW ratio is higher in children compared with adults, and the FLR is sufficient even in extreme resections with <20% of the liver remnant. These findings strongly question the use of asociating liver partition and portal vein ligation for staged hepatectomy, portal vein embolization, or transplantation based on suspected insufficient liver remnants in children.
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Multicenter Study
Covert perioperative strokes in older patients having non-cardiac surgery (PRECISION): a prospective cohort analysis.
Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery. ⋯ Among patients aged 60 yr and older who had major noncardiac surgery, mainly intracranial, one in nine patients experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.
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With estimated global postoperative mortality rates at 1% to 4% leading to approximately 3 million to 12 million deaths per year, an urgent need exists for reliable measures of perioperative risk. Existing approaches suffer from poor performance, place a high burden on clinicians to gather data, or do not incorporate intraoperative data. Previous work demonstrated that intraoperative anesthetics induce prefrontal electroencephalogram (EEG) oscillations in the alpha band (8 to 12 Hz) that correlate with postoperative cognitive outcomes. ⋯ Intraoperative EEG alpha power is independently associated with postoperative mortality and adverse outcomes, suggesting it could represent a broad measure of postoperative physical resilience and provide clinicians with a low-burden, personalized measure of postoperative risk.
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Observational Study
A Pilot Study Using Machine Learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery.
To evaluate whether a machine-learning algorithm (ie, the "NightSignal" algorithm) can be used for the detection of postoperative complications before symptom onset after cardiothoracic surgery. ⋯ Machine-learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications-before symptom onset-after cardiothoracic surgery.
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Retrospective cohort study. ⋯ Level IV.