Objective To analyze the impact of body mass index (BMI) on surgical difficulty and surgical reaction of patients with colorectal cancer served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA were updated on September 22, 2021. All data items included BMI, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, surgery reaction, and perioperative complications of colorectal cancer module including temperature, flatus, pain, and mental status. The patients were divided into lean (BMI <18.5 kg/m2), normal (BMI 18.5–23.9 kg/m2), overweight (BMI 24.0–27.9 kg/m2), and obesity (BMI ≥28.0 kg/m2) by Chinese four classification method. ResultsAfter scanning, 6 311 data rows were analyzed. ① The effect of BMI on surgical difficulty: BMI was weakly positively correlated with operative duration (rs=0.096, P<0.001). The overweight and obesity patients were more likely to have anatomical abnormalities (rs=0.385, P<0.001 ), pelvic stenosis (rs=0.386, P<0.001), abdominal obesity (rs=0.567, P<0.001), and adhesion in surgical area (rs=0.043, P=0.004). There was difference in tissue or organ hypertrophy among patients with different BMI (χ2=39.988, P<0.001). It was also found that the lean patients were prone to develop ‘very heavy adhesions’ when adhesions occurred in surgical area, and to ‘mesangial contracture, short, fixed’ of abnormal mesenteric status, while the obesity patients were prone to ‘mesangial thickening’ of abnormal mesenteric status. There was no difference in intestinal quality among patients with different BMI (P>0.05). ② The effect of BMI on surgical reaction: BMI was weakly positively correlated with the overall assessment of surgical reaction (rs=0.049, P=0.001), and obesity patients were more likely to have severe surgical reaction. BMI was weakly negatively correlated with pain (rs=–0.058, P<0.001）and the lean patients were more likely to have pain that needed drug control. However, there were no differences in temperature, flatus, and mental status among patients with different BMI (P>0.05). ConclusionsHigh BMI of patients will affect several indicators including operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, resulting in increased difficulty of surgery. Although high BMI might affect overall response state after surgery, it will not affect temperature, flatus, and mental status, reflecting a relatively weak impact on surgical reaction.
ObjectiveTo compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations. MethodsAccording to the inclusion and exclusion criteria, the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014 to March 2021 were collected. The enrolled patients were assigned into low, medium, and high difficulties by the Hasegawa liver resection surgical difficulty score model, then the patients were matched by propensity score matching. The liver function and inflammatory indexes, intraoperative bleeding, operative time, total hospital stay, postoperative complications, and hospitalization expenses of patients with benign liver tumors after laparoscopic (laparoscope group) or open (open group) hepatectomy were compared. ResultsA total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study. According to the Hasegawa criteria, there were 59, 89, and 61 patients with low, medium, and high difficulties respectively. After 1∶1 propensity score matching, 18, 34, and 14 patients in the laparoscope group and open group were matched respectively. There were no statistic differences in the baseline data between the laparoscope group and open group (P>0.05). ① For the patients with low and medium difficulties, compared with the open group, the different values of alanine aminotransferase, aspartate aminotransferase, white blood cell count, and neutrophil percentage were lower (P<0.05), the intraoperative bleeding and total hospital stay were less or shorter (P<0.05), and the albumin were higher (P<0.05) in the laparoscope group. There were no statistic differences in these indexes among the patients with high difficulty (P>0.05). ② Compared with the open group, the operative time of the laparoscope group was shorter in the patients with low difficulty (P<0.05) and longer in the patients with high difficulty (P<0.05), and there was no statistic difference in patients with medium difficulty (P>0.05). ③ The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties (P>0.05), while which in the laparoscope group were lower than in the open group for the patients with medium difficulty (P<0.05). ④ The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty (P<0.05), while which had no statistic differences between the two groups for the patients with low and medium difficulties (P>0.05). ⑤ The total hospital stay of the laparoscope group was shorter than the open group (P<0.05) no matter which difficult operation.ConclusionsAccording to results of this study, laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty, which could greatly shorten hospital stay and accelerate rehabilitation of patients. Even for patients with high difficulty, laparoscopic hepatectomy still shows an advantage of shortening hospital stay.
ObjectiveTo analyze the current version of the West China Database from Colorectal Cancer (DACCA) and explore how the occupational background of colorectal cancer patients affects the complexity of surgical difficulty and postoperative complications. MethodsWhen using the updated version of DACCA data on May 28, 2023 for analysis, the data items concerned covered occupation, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, postoperative complications in hospital, short-term postoperative complications and long-term postoperative complications. According to the “Occupational Classification Code of the People’s Republic of China”, the occupations of patients were divided into professional and technical personnel, staff, service personal, production personnel, manufacturing personnel and retirees according to different occupations. The operative difficulty and postoperative complications of 6 groups were analyzed. ResultsAccording to the screening conditions, 5 734 valid data rows were obtained from DACCA. The results of occupation analysis showed that there were significant difference in operative duration (H=11.609, P=0.041), anatomical difficulty (H=29.166, P<0.001), pelvic stenosis (H=16.412, P=0.006), abdominal obesity (H=44.622, P<0.001), adhesion in surgical area (H=23.695, P<0.001), abnormal mesenteric status (χ2=39.252, P=0.035), tissue or organ hypertrophy (χ2=58.284, P<0.001) and intestinal quality in surgical area (H=21.041, P=0.001) between different groups. There were no significant differences in the occurrence of complications in hospital, near and short-term and long-term after operation among different occupations (P>0.05). Further subgroup analysis showed that only the difference of fever (χ2=10.969, P=0.041) and intestinal obstruction (χ2=12.025, P=0.021) were statistically significant among different occupations. ConclusionThe occupation of patients may affect the difficulty of colon cancer surgery, and the occurrence of postoperative complications is nothing to do with the occupation of patients, but the occurrence of postoperative fever and postoperative intestinal obstruction is related to occupations, and the possible causes need to be further explored.
Objective To investigate and analyze the difficulties of nosocomial infection management in different-level medical institutions in Shanghai, and to provide scientific basis for improving the level of nosocomial infection management. Methods A questionnaire was designed to include 10 difficulties in nosocomial infection management such as professional title promotion, salary, and personnel allocation. In October 2023, the Shanghai Nosocomial Infection Quality Control Center, in collaboration with the Shanghai Hospital Association, conducted a questionnaire survey among the heads of nosocomial infection management departments in medical institutions in Shanghai. The scores of difficulties were analyzed by stratification according to hospital level, allocation and changes of full-time personnel. Results A total of 548 questionnaires were distributed, and 530 valid questionnaires were retrieved, with a recovery rate of 96.72%. There were 55 public tertiary, 93 public secondary, 169 public primary and 213 social medical institutions. The rates of full-time personnel allocation meeting standards were 76.36% (42/55), 72.04% (67/93), 31.95% (54/169), and 21.60% (46/213), respectively. There was a statistically significant difference in the rates of full-time personnel allocation meeting standards among different levels of medical institutions (χ2=105.149, P<0.001). There was no statistical difference in the total scores of nosocomial infection management difficulties among different-level medical institutions (F=1.657, P=0.176). There were statistically significant differences in the scores of difficulties in professional title promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel, and high personnel turnover (P<0.05). Conclusions The main difficulties in nosocomial management of medical institutions at all levels in Shanghai include the difficulty in career promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel and lack of experience. In the future, medical institutions should strengthen the allocation of full-time personnel and enhance their capabilities, provide smooth promotion channels, to promote the high-quality development of nosocomial infection management ultimately.