Association Between Pre-operative BUN and Post-operative 30-Day Mortality in Patients Undergoing Craniotomy for Tumors: Data From the ACS NSQIP Database

Liu, Yufei; Hu, Haofei; Li, Zongyang; Han, Yong; Chen, Fanfan; Zhang, Mali; Li, Weiping; Huang, Guodong; Zhang, Liwei

doi:10.3389/fneur.2022.926320

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…BUN is a low-molecular-weight nitrogen product derived from protein catabolism and excreted by the kidney [ 24 ]. Therefore, BUN reflects protein intake, endogenous protein catabolism, fluid balance, hepatic urea synthesis, and fluid/renal status in critically ill patients and have been widely used as a prognostic marker in patients with various surgical diseases [ 5 , 7 , 25 ]. Similarly, albumin also has various biological effects, including maintenance of osmotic pressure, binding and transport of various drugs, and neutralization of free radicals, and hypoalbuminemia has been identified as a poor prognostic factor in critically ill surgical patients [ 9 , 11 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

et al. 2023

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Background Blood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored. Methods We enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan’s National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables. Results A total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127–1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247–1.811). Conclusions BAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.

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Section: Discussionmentioning

confidence: 99%

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

et al. 2023

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“…17 day mortality in patients who underwent craniotomy for tumors. 18 The proper preoperative management of BUN and the maintenance of BUN near the inflection point (9.804 mg/dL) could reduce the risk of postoperative 30day mortality.…”

Section: Unplanned 30-day Readmissionmentioning

confidence: 99%

Using machine learning to predict 30-day readmission and reoperation following resection of supratentorial high-grade gliomas: an ACS NSQIP study involving 9418 patients

Ghaith

Ghanem

Zamanian

et al. 2023

Neurosurgical Focus

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OBJECTIVE High-grade gliomas (HGGs) are among the rarest yet most aggressive tumor types in neurosurgical practice. In the current literature, few studies have assessed the drivers of early outcomes following resection of these tumors and investigated their association with quality of care. The authors aimed to identify the clinical predictors for 30-day readmission and reoperation following HGG surgery using the American College of Surgeons (ACS) National Surgical Quality Improvement Project (NSQIP) database and sought to create web-based applications predicting each outcome. METHODS Using the ACS NSQIP database, the authors conducted a retrospective, multicenter cohort analysis of patients who underwent resection of supratentorial HGGs between January 1, 2016, and December 31, 2020. Demographics and comorbidities were extracted. The primary outcomes were 30-day unplanned readmission and reoperation. A stratified 80:20 split of the available data was carried out. Supervised machine learning algorithms were trained to predict 30-day outcomes. RESULTS A total of 9418 patients were included in our cohort. The observed rate of unplanned readmission within 30 days of surgery was 13.0% (n = 1221). In terms of predictors, weight, chronic steroid use, preoperative blood urea nitrogen level, and white blood cell count were associated with a higher risk of readmission. The observed rate of unplanned reoperation within 30 days of surgery was 5.2% (n = 489). In terms of predictors, increased weight, longer operative time, and more days between hospital admission and operation were associated with an increased risk of early reoperation. The random forest algorithm showed the highest predictive performance for early readmission (area under the curve [AUC] = 0.967), while the XGBoost algorithm showed the highest predictive performance for early reoperation (AUC = 0.985). Web-based tools for both outcomes were deployed (https://glioma-readmission.herokuapp.com/ and https://glioma-reoperation.herokuapp.com/). CONCLUSIONS In this study, the authors provide the first nationwide analysis for short-term outcomes in patients undergoing resection of supratentorial HGGs. Multiple patient, hospital, and admission factors were associated with readmission and reoperation, confirmed by machine learning predicting patients’ prognosis, leading to better planning preoperatively and subsequently improved personalized patient care.

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“…Elevated BUN levels reflect the function of many body systems and are associated with poor kidney function, dehydration, acute hemodynamic alterations, and acute neurohumoral alterations [7,18]. Therefore, high BUN has been correlated with increased mortality in many patient populations, including those with heart failure, acute myocardial infarction, pneumonia, exacerbation of chronic obstructive pulmonary disease, and after cranial tumor resection and surgical resection for pancreatic adenocarcinoma [19][20][21][22][23]. Often, elevated BUN is associated with elevations in creatinine, but Beier et al reported that high BUN levels were correlated with increased short-term and long-term mortality after ICU admission, independent of creatinine levels [24].…”

Section: Introductionmentioning

confidence: 99%

A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer

Dumitriu Carcoana,

Labib,

Fiedler

et al. 2023

Cureus

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Background: The blood urea nitrogen to serum albumin ratio (BAR) is an emerging prognostic parameter of interest. The utility of BAR as a prognostic factor has not been analyzed in lung cancer patients undergoing pulmonary lobectomy. We evaluated the ability of High BAR to predict worse outcomes after roboticassisted pulmonary lobectomy (RAPL) for lung cancer.Methods: We retrospectively analyzed 400 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. Patients were stratified by Low BAR (<6.25 mg/g) and High BAR (≥6.25 mg/g). Patients' demographics, tumor characteristics, comorbidities, surgical complications, outcomes, and survival were collected and compared by High and Low BAR groups. The primary outcome of interest was 30-day mortality.Results: Receiver operator curves (ROC) confirmed that 6.25 was an optimal threshold for estimating mortality based on Low and High BAR. There were no differences in surgical complications or outcomes between the Low and High BAR groups. The ability of BAR to predict 30-day mortality was evaluated with the area under the curve (AUC) analysis, which showed that higher BAR could not predict mortality (AUC=0.655; 95% CI, 0.435-0.875; p=0.166). Similarly, survival analysis revealed no difference in five-year overall survival between the Low and High BAR groups (p=0.079).Conclusion: High BAR did not predict worse outcomes after RAPL for lung cancer in our study. Further studies are needed to better determine the prognostic ability of BAR in lower-risk populations.

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Association Between Pre-operative BUN and Post-operative 30-Day Mortality in Patients Undergoing Craniotomy for Tumors: Data From the ACS NSQIP Database

Cited by 4 publications

References 37 publications

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

Using machine learning to predict 30-day readmission and reoperation following resection of supratentorial high-grade gliomas: an ACS NSQIP study involving 9418 patients

A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer

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